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O. ;: PRONE NO. PROFILE NO. <br />PA ID: NO r <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE <br />NUMBER <br />AMOUNT <br />Used oil, Non=RCRA Hazardous Lubricating <br />CA221 <br />WORK ORDEWSERVICE <br />AGREEMENT <br />Evergreen viro ental Services <br />CA221 <br />Gal. <br />147205 <br />dedicated to the protection of the environment <br />- -Gal. <br />Toschedulea pickup, call <br />Send Paymenta, v <br />Sales Order <br />800-972-5284 <br />Evergreen Oil, Inc. <br />A221 <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 <br />Dept. 2457 <br />M' <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 <br />Los Angeles, CA, 90084-2457 <br />jute ' . -' <br />fly ERATORUOB LOCATION <br />BILLING INFORMATION <br />Each <br />> , <br />$. <br />N AME <br />- Drum <br />CASH ❑ CHECK ❑ <br />Non-RCRA Hazardous Waste Solids (oily e 's) <br />CA2�& <br />Drum <br />Empty Drums <br /># <br />Drum-' <br />", .,. <br />ADDRESS r ;.> --- <br />� <br />ADDRESS <br />, Hrs. <br />CIISTONIER.UODE N9. <br />Non Hazardous Water <br />Gal. <br />k" <br />TEST:❑ Clor D Tech 4000pp Cl ❑ D Te h 100 ss ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail <br />fl <br />f a <br />Field Service Work Description: <br />Total Charges <br />CITY $T TE ZIP -'CO. <br />CITY STATE ZIP <br />CO. <br />PO # <br />Other: <br />O. ;: PRONE NO. PROFILE NO. <br />PA ID: NO r <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE <br />NUMBER <br />AMOUNT <br />Used oil, Non=RCRA Hazardous Lubricating <br />CA221 <br />Gal. <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />Used Automotive Antifreeze, Nan-RCRA Hazardous <br />Waste Liquid - <br />_CAl 34 <br />- -Gal. <br />RQ Waste Combustible Liquid, N.G.S. NA <br />1993 ❑1 Oil contaminated with halo ens <br />CA221 <br />F001 tF002 <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />A221 <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />`Wash Out <br />i <br />Each <br />Drained Used Oil Filters <br />i <br />- Drum <br />Non-RCRA Hazardous Waste Solids (oily e 's) <br />CA2�& <br />Drum <br />Empty Drums <br />Drum-' <br />", .,. <br />Transportation <br />, Hrs. <br />Non Hazardous Water <br />Gal. <br />k" <br />TEST:❑ Clor D Tech 4000pp Cl ❑ D Te h 100 ss ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail <br />fl <br />f a <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum Services Time <br />Out of Yard On Site Off Site <br />Off Load Start Off Load End Return to Yard <br />TSDF U 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 />Newark, CA 94560 Davis, CA 95926 Fresno, CA 93711 Industry, CA 91745 <br />CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br />❑ Evergreen Env. Svc. ❑ Evergreen Env. Svc.11CFR CFR ❑ Greenleaf Env. Svc. <br />16604 S. San Pedro 745 A West Betteravia 944 E. Slauson AveP'CAL000091507 <br />33210 Western 3474 Toyon Circle <br />Carson, CA 90746 Santa Maria, CA 93454 Los Angeles, CA 90Union City, CA 94587 Valley Springs, CA 95352 <br />CAD981696420 CAD982446858 CAL000110021 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 />Marine Ll Agricultural 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 />Retain Sample # side of this form. <br />Driver Signature Print Name Route # Trate Generator's Signature Print Name Date <br />