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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services NO- 247205 <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 Date: <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252 <br /> GETOR/JOB LOCATION BILLING INFORMATION <br /> N r NAME CASH❑CHECK❑ <br /> ADDRESS ADDRESS CU E 0 ENO. <br /> -7 <br /> CIT STATE ZIP CO. CITY STATE ZIP Co. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> OU9) t 3 7 4!—6 L <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Z <br /> Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA134 Gal. <br /> waste Liquid <br /> RQ Waste Combustible LiquidJq.6 S.NA 221 Gal. <br /> 1993 In(Oil contaminated with halogens) F001CA[F002 <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 /> Transportatic/ Hrs. <br /> Non Hazar/b.s Water Gal. <br /> Z <br /> TEST-�fCl.,D Tech 4000ppmCl.,D Tech 1000 fa,, Ej Fail ❑ Halogen Detector/Flame Test :]/.,s E]Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> WVacuum ervices Time <br /> Ic <br /> Outof ardE-On Site-off Site-Off Load Start 4==Off Load End-Return to Ya <br /> TjF j Consolidated Manifest <br /> S <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. F7 AJS Filter Ave. ❑ <br /> 6, <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.S ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.SanP to, 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696 0 CAD982446858 CALOOO 110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: li6 Collection Station J Government quantity&toxicity of the hazardous waste to the degree determined by <br /> Marine L] Agricultural j Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed gene ator to the terms on the reverse <br /> Re a n sample # side of this rm <br /> r <br /> V <br /> Dri _ ignature_/rint?tName Route# t tiate vera s Signature Print Name Date <br />