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WORK ORDER/SERVICE AGREEMENT <br /> Ad <br /> Evergreen Environmental Services NO- 199843 <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 /> GENERATOR/JOB LOCATION BILLING INFORMATION& CHECK <br /> A NAME CASH ❑ <br /> # <br /> ADDRESS ADDRESS CUSTOMS R—COWE NO. <br /> z-17o 10c; /-0A& '011MAZ Z-:r <br /> CITY STATE ZIP CO. CITY STATE ZIP Co. PO# <br /> Z� Tj—z/S - I <br /> ONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> K <br /> 6056? 1( 1 AIN- <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Z C/Zq$1 7 IDO Gal. <br /> Waste,Liquid Industrial CA221 — Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA134 Gal. <br /> Waste Liquid <br /> RQ waste Combustible Liquid,N.O.S.NA CA221 Gal. <br /> 1993 <br /> ni(Oil contaminated with halogens) 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 um Drum I <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum rum <br /> Empty Drums Drum <br /> Transportatiov 4 14 Hrs. <br /> Non Hazydo-s Water Gal. <br /> TEST:[6 Clor D Tech 4000,9-ppm E]Clo,D Tech 1000 Eass E]Fail El Halogen Detectormame Test F-1 P/s ❑Fail <br /> Field Service Work Description: Total Charges._ <br /> Other: <br /> Other: <br /> Vacuum ervices Time <br /> to YYar� <br /> Out of andOn Site Off Site—Off Load Start Off Load End Return to <br /> Consolidated Manifest <br /> TS Consolidated <br /> Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter ❑ <br /> , <br /> 6 0 SrnH h Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ------------ <br /> ❑ <br /> Evergreen Env. vc. ❑ Evergreen Env.Svc. F7 CFR ❑ CFR ❑ Greenleaf Env. Svc. <br /> S. <br /> . stem F <br /> 16604 S.Evergreen <br /> dro 745 A West Betteravia 944 E.Slauson Ave. 11 33210 We 3474 Toyon Circle <br /> C 95352 <br /> Carson,CA 746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA <br /> CAD98169 20 CAD982446858 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a pro-ram to reduce the volume or <br /> the degree determined by <br /> Collection <br /> Source: Collection Station LJ Government quantity&toxicity of the hazardous waste to <br /> generator to be economically practicable. <br /> M rl <br /> Marine D Agricultural L) Industrial 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 /> Re <br /> a® sample # C, side of this form. <br /> Dri r'Signature VPrint Name Route# /Date Am ator's Signature Print�Name Date <br />