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0 0 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Services o 2 <br /> dedicated to the protech �g;ff�e,nironment <br /> t t. <br /> To schedule a pickup 64,e Send payment to: Sales Order # <br /> 800 <br /> -972- ". .Evergreen Oil, Inc. <br /> ..iN• <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 +;+,rri'10. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252 Date:// <br /> GENFIUTOPJJOB LOCA'T'ION MILLING INFORMATION <br /> N NAME CASA[:] CHECK❑ <br /> moi` # <br /> ADDRE•S / ADDRESS C <br /> 7v 4/ �� G <br /> CITY STATE ZIP CO. CITY S'L'ATE ZIP Co. PO# <br /> ® E N®, PRONE NO. PROFILE NO. j CUSTOMER EPA ID NO. <br /> �7 <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used Non-RCRA Hazardous Lubricating CA221 Gal. ,7~; <br /> Waste.Liquid Industrial CA221 Gal. <br /> Usej�ALtomotive Antifreeze.Nun-RCRA Hazardous CA134 Gal. <br /> Waste Liquid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 Gal <br /> 1993 111(Oil contaminated with hal-ens) F001/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 /> Transportatio Hrs. <br /> Non Haza pater G <br /> TEST:I Clor D Tech 4000, _vw_ppm ❑Clor D Tech 1000 Pass ❑Fail ❑ Halogen DetectortFla e Test ❑Pass ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuur Services Time <br /> �j <br /> Out o <br /> by On Site Off Site Off Load Start Off Load End Return to Ya <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> El <br /> Newark.CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env. c. ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San P dro 745 A West Betteravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 20 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station Government quantity&toxicity of the hazardous waste to the degree determined by <br /> j Marine ® Agricultural L] 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 /> p et n sample #�, side of this for <br /> D r Signature rant Name Route# Date Genera r' Signature Print Name Date <br /> rd <br />