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WORK ORDER/SERVICE AGREEMENT <br /> ZZO <br /> Evergreen Environmental Services NO- 179641 <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:-3/18 bzi!i <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> NA7& NAME CASH E] CHECK E] <br /> ADDRESSADDRESS CUSTOMER CODE NO. <br /> 4�7i> �j _)9='f Arl C-;O,-. <br /> CITY, ST TE ZIP CO. CITY STATE ZIP Co. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> Z019)(QQ1F- C;P-5/* <br /> PRODUCT WASTE MANIFEST QUANTITY UNITSPRICE AMOUNT <br /> CODE NUMBER T <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 17- <br /> S)C>� Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze.No <br /> ii-RCRA Hurvdoos <br /> Waste <br /> RQ Combustible <br /> CA134 Gal. <br /> Wuste ....Nsfible It, N.O.S. al. <br /> Liquid, �.�,"�A CA221 <br /> 1993 In(Oil contaminated will, FOOIIFO02 <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*ante Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation/ Hrs. <br /> Non Haz-;r7-Water Gal. <br /> TEST:[t Clor D Tech 4000ppmE]Cl or D Tech 1000 F[;6Pass 0 Fail ❑ Halogen Detector/Flame Test ass E] Fail <br /> /P <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Ser/ces Time <br /> Out of Y/—On Site—Off Site Off Load Start Off Load End—1keturn to Test <br /> TSD /I Consolidated Manifest <br /> Evergreen Oil.Inc. Evergreen Env.Svc. Evergreen Env.Svc. AJS Filter <br /> 30B ❑ 4139'N.Valentine 15131 Clark Ave. <br /> 6880 Smith Ave. ❑ Road' 1:1 El <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 F7 CFR ❑ Greenleaf Env.Svc. <br /> ❑ 1:1 stern 1:1 <br /> 16604 S.San P to 745 A West Betteravia 944 E.Slauson Ave. " 33210 We 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 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a pro.-ram to reduce the volume or <br /> Source: C�Collection Station J Government quantity&toxicity of the hazardous waste to the degree determined by <br /> �enerator to be economically practicable. <br /> Ll Marine j Agricultural L] Industrial <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 /> R <br /> to rn sample side of this form. <br /> Dr <br /> Signature Print Name Route# (Date (jenerat-6A Signature Print Name Date <br />