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I A <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services N2- 264636 <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 /> N NAME CASH CHECK F� <br /> ENO. <br /> ADDRESS o- ADDRESS CU <br /> STATE ZIP —Co—. PO# <br /> STATE E ZIP CO. CITY <br /> PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PHONE NO. <br /> ZCDDRESS <br /> IT <br /> � NE N PROFILE N�O- � <br /> 0 <br /> HO <br /> WASTE MANIFEST <br /> UM QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER <br /> C I Gal. <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 <br /> Waste,Liquid Industrial C CA221 I Gal. <br /> pled Automotive Antifreeze,N—RCRA H.—d.., CA134 Gal. <br /> _Waste Liquid Gal. <br /> RQ Waste Combustible Liquid,N.O.S.NA F(CAl/2F2(1'0 2 <br /> 1993 111(oil contaminated with halogens) <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Each <br /> Wash Out <br /> Drum <br /> Drained Used Oil Filters <br /> -N—on-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Drum <br /> Empty Drums <br /> Hrs. <br /> Transportation <br /> Gal. <br /> Non Hazar s Water <br /> Tech <br /> TEST: Clor D Tech 4000 ppm F-1 Clor D Tech 1000 Pass D Fail D Halogen Detector/Flame Test ❑Pa Fail -j.. <br /> —Total Char es <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> Vacuum Se ces Time <br /> Off Load End—Return to and <br /> Out of d—On Site_Off site Off Load Start <br /> TS Consolidated Manifest <br /> TS <br /> .r., ❑ <br /> Evergreen Oil.Inc. Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter <br /> I'It Ave.v <br /> 6880 Smith A e. Road 30B 4139 N.Valentine El 15131 Clark Ave. El <br /> v Industry,CA 91745 <br /> Newark,CA 94560 avis,CA 95926 Fresno,CA 93711 CAD000097432 <br /> CAD980887418 CAD982446874 CAD982446882 <br /> Greenleaf Env.Svc. <br /> Newark, A'416' <br /> 74 1'< <br /> C <br /> ew '6C <br /> CAD' ' <br /> Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR <br /> Pe E 7, <br /> San <br /> Evergreen <br /> 16604 S.San Pe West Betteravia stern 3474 Toyon Circle <br /> 745 A 944 E.Slauson Ave. " 33210 We <br /> A go 6 S <br /> L�13 9 C <br /> C C 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> Carson,CA 90 Santa Maria,CA 93454 Los Angeles.CA <br /> CAD981696 CAD982446858 CAL0001 10621 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station Ll Government quantity&toxicity of the hazardous waste to the degree determined by <br /> L]M generator to be economically practicable. <br /> j Marine Agricultural Industrial I hereby certify that I have read and have the authority to <br /> I Z oo_ bind the above listed generator to the terms on the reverse <br /> Ret * sample # side of this form. <br /> Gen <br /> toes Signature Pr <br /> Signature <br /> Vale Gen tor's Signature Print Name Date <br /> D Signature OHM Name Route# <br />