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WORK ORDER/SERVICE AGREEMENT <br /> Awl' Evergreen Environmental Services No- 247353 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252 Date; <br /> GENERATOR(JOB LOCATION BILLING INFORMATION <br /> Z <br /> N E NAME CASH❑CHECK❑ <br /> AM <br /> ADDRESS" ADDRESS CUSTOMER CODFNd.[' <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> A4 <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Use,Automotive Antifreeze,Non-RCRA Hazardous Gal. <br /> CA134 <br /> Waste Li uid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 <br /> 1993 In(oil contaminated with halogens) F001/1'002 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water <br /> TEST:F1 Clor D Tech 4000ppmClot D Tech 1000 E]Pass 0 Fail E] Halogen Detector/Flame Test E]Pass E]Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Start-Off Load End Return to Yard <br /> TSDF El Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. Evergreen Env.Svc. F7 AJS Filter <br /> 6880 Smith Ave. ❑ Road 30B El 4139 N.Valentine ❑ 15131 Clark Ave.,/-'.r2' r, <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. <br /> F7 Evergreen Env.Svc. CFR CFR ❑ Greenleaf Env.Svc. <br /> E] 16604 S.San Pedro 745 A West Betteravia El 944 E. <br /> Slauson Ave,4033210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA,90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAI,00011002P� CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: LJ Collection Station CJ Government quantity&toxicity of the hazardous waste to the degree determined by <br /> Lj Marine j Agricultural Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Retain Sample # side of this form. <br /> Driver Signature Print Name- Route# Date Generator's Signature Print Name Date <br />