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WORK ORDER/SERVICE AGREEMENT <br /> ffal A Evergreen Environmental Services NO- 224076 <br /> dedicated to the protection of the environment , <br /> To schedule a pickup, call Send payment to: SalesOrder#�% <br /> -.N / <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 /> GXNERATOR/JOB LOCATION BILLING II F O ION <br /> NAME CASH❑ CHECK❑ <br /> ADDREE�� ADDRESS D ll�NO. <br /> CIT S CITY STATE ZIP CO.' 'PO# <br /> P -NE C &-/ PHONE NO. PROFILE 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 /> Used Awora.fivc Antifreeze,Non-RCRA Hazardous <br /> waste Liquid CA134 Gal. <br /> RQ Waste Combustible <br /> Liquid,N <br /> �-sNA CA221 Gal. <br /> 1993 H red_'� <br /> F001fF002 <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 Gal. <br /> TEST:0 Clor D Tech 4000ppmF1 Clor D Tech 1000 0 PassE]Fail 0 Halogen Detector/Flame Test ❑Pass ❑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. ❑ AJS Filter <br /> 6880 Smith Ave. Road 30B 4,39 N.Valentine 1:1 15131 Clark Ave. <br /> Newark,CA 94560 Davis.CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. Evergreen Env. Svc. F7 CFR CFR <br /> ❑ 16604 S.San Pedro ❑ <br /> 745 A West Betteravia 944 E.Slauson Ave. 3 210 Western Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90C I Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> urce: U Collection Station J Government quantity&toxicity of the hazardous waste to the degree determined by <br /> generator to be economically practicable. <br /> j Marine L] Agricultural L) Industrial <br /> I here , ertifv that I have read and have the authority to <br /> bind the Above listed generator.to the terms on the reverse <br /> Retain gnSam # side of thi4 form. <br /> on <br /> Driver a4ture /PvAName- 'R7oute# Date Gen krftcPs Signature Print Name Date <br />