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0 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services NO- 212205 <br /> dedicated to the Protection of the environment <br /> To schedule a pickup, call Send p4yinent 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 /> NA;W NAME CASHE] CHECK❑ <br /> # <br /> ADDRESS7 :> C 4� ADDRESS CU D 0 E N <br /> CITY <br /> A-1 t STATE ZIP CO. CITY STATE ZIP Co. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221ZS-C� Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,No n-RCRA Hazardous CA 134 Gal. <br /> Waste Liouid <br /> RQ Waste Combustible Liquid, NA CA221 <br /> Gal. <br /> 1993 1n(oi� inst .it�"aftes' 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 /> Transportation Hrs. <br /> Non Hazard Water Gal. <br /> TEST:Yclor D Tech 40002%-�—ppmE]Clor D Tech 1000 YPassE]Fail E] Halogen Detector/FlameXst 0 Pass E]Fail <br /> Field Service Work Description: Total Charge <br /> Other: <br /> Other: lip <br /> Z <br /> Vacuum S'./ices Time <br /> Out of Y/d—On SiteOff SiteOffLoad Start Off Load End. -turn to Yard <br /> TS " 7 Consolidated Manifest <br /> ;'Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B El 4139 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.Sv ❑c. Evergreen Env.Svc. F7 CFR F---j CFR ❑ Greenleaf Env.Svc. <br /> 16604 S. San -Sdvrc 745 A West Betteravia 944 E.Slauson Ave. " 33210 Western 3474 Toyon Circle <br /> Carson,CA 9/0�7e Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD9816964 CAD982446858 CAL0001 10021 CAL000091507 CAL00022 14411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: L4Collection Station J Government quantity&toxicity of the hazardous waste to the degree determined by <br /> j Marine L) Agricultural j Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> raibind the above listed generator to the terms on the reverse <br /> n sample side of <br /> S' <br /> Dr r Signature Print Name Route# Date denerator's Signature Print Name Date <br />