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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services No- 241227 <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 /> N7ZZ C.NAME #CASH❑ CHECKE] <br /> ADDRESSADDRESS CU R ODE NO. <br /> — 47�11 e-7' <br /> CITY STATE . ZIP CO. CITY STATE ZIP Co. PO# <br /> C-0-1 9�ez:r'0115� <br /> ONE O. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 6�f <br /> WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER I <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. Z�001__p 6a I W&V <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal. <br /> Waste Liquid <br /> RQ Waste Combustible Liquid N.O.S.NA CA221 Gal. <br /> 'm t.".o... F001/F002 <br /> 199 mated 1� m� <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 oo� <br /> Transportati Hrs. /I <br /> Non Haza/ous Water G/ I <br /> TEST:It Clor D Tech 4000 ppm 0 Clor D Tech 1000 <br /> :�Pass❑Fail ❑ Halogen Detector/Flar/e Test ❑Pass ❑Fail eZ <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuuj Services Time N" <br /> Out 4Yard On Site—Off Site—Off Load Start Off Load End Return and <br /> TS L11 Consolidated Manifest <br /> Evergreen Env.Svc. ❑ AJS Filter <br /> —1Evergreen Env.Svc.Road 30B ❑ 4139 N.Valentine 15131 Clark Ave. <br /> Evergreen Oil,Inc. <br /> 6880 Smith Ave. El <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD98088741 8 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ ce ❑ <br /> EvergrS n Env. Evergm ❑ CFR ❑ CFR Greenleaf Env.Svc. <br /> 16604 S. <br /> San dro 745 A West Betteravia 944 E 33210 Western El 3474 Toyon Circle <br /> en Env.Svc. E. <br /> Slauson Ave. <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 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station LJ Government quantity&toxicity of the hazardous waste to the degree determined by <br /> L)Marine j Agricultural El 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 /> in sample # C side of thisj4prm. <br /> Print Name Date <br /> /6er Signature rint Name Route# bate Venera ora 9i";,nk'r7f- <br />