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WORK ORDER/SERVICE AGREEMENr <br />., Evergreen Environmental Services 0 <br />-160879 <br />dedicated to the protection of the environment <br />_ To schedule a,pickup,. call Send payment to: Sales Order # <br />p <br />SOO-972^5284 evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. 2457 e2 / <br />16540 S. San Pedro St., Carson, CA EPA# CA0982413262 Los Angeles, CA 90084-2457 Date: <br />IRIJU13 LUUA"11U1N 131LLILMi INYUKA"TIUN <br />It NAlGtE - CASH [_1 CHECK <br />ADDRESS P ADDRESS GUSTO ER O E NO: <br />CITY STATE ZIP CO. CITY STATE ZIP CO. P # <br />PHONE NO. - PHONE NO PROFILE NO. CUSTOMER EPA ID NO. <br />) C4 -Ca? ( ) <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY <br />NUMBER <br />UNITS PRICE AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating, <br />CA221 <br />6880 Smith Ave. <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />Used Automotive Antifreeze; Non-RCRA Hazardous. <br />Waste Liuid- <br />CA134 <br />..._ <br />Gal. <br />RQ Waste Combustible Liquid; N.O.S. NA _ - - - - <br />1993 nI Oil contaminated with halogens) <br />- CA221 - <br />F001/F0022. <br />-- - _ <br />Gal. _ <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />33210 Western 3474 Toyon Circle <br />Gal. <br />Wash Out <br />CAD98169§!K <br />Each <br />Drained Used Oil Filters <br />Source: CA Collection Station LJ Government <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />CA2123 <br />Drum <br />Empty Drums <br />Re <br />Drum <br />Transportation <br />side of his form. <br />Hrs. ; <br />Non Hazar us Water <br />VN <br />Dri <br />Gal: <br />TEST: F4 Clor D Tech 4000 ppm ❑ Clor D Tech 1000 <br />Pass ❑ Fail ❑ Halogen DetectorlFlame Test Pass ❑Fail ao <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum Se ices Time <br />Out of Yt d On Site off Site <br />Off Load Start Off Load End <br />turn to Yard <br />TS <br />� Consolidated Manifest <br />Evergreen Oil, Inc.F1Evergreen <br />Env. Svc. ❑ Evergreen Env. Svc. <br />❑ AIS Filter ❑ <br />6880 Smith Ave. <br />Road 30B 4139 N. Valentine <br />15131 Clark Ave. <br />Newark, CA 94560 <br />Davis, CA 95926 Fresno, CA93711 <br />Industry; CA 91745 <br />CAD980887418 <br />CAD982446874 CAD982446882 <br />CAD000097432 <br />❑Evergreen <br />Env. Svc.1:1Evergreen <br />Env. Svc. ❑ CFR <br />❑ CFR ❑ Greenleaf Env. Svc. <br />16604 S_ San Pedr <br />745 A West Betteravia 944 E. Slauson Ave. <br />33210 Western 3474 Toyon Circle <br />Carson, CA 907_0 <br />Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 <br />CAD98169§!K <br />CAD982446858 CAL000110021 <br />CAL000091507 CAL000214411 <br />Source: CA Collection Station LJ Government <br />Generator certifies that it has established a program to reduce the volume or <br />quantity & toxicity of the hazardous waste to the degree determined by <br />Ll Marine Lj Agricultural Ll Industrial <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />Re <br />n sH ple # <br />bind the above listed generator to the terms on the reverse <br />side of his form. <br />7. <br />VN <br />Dri <br />Signature <br />Print Name Route # Date Cren rat' is Signature Print Name Date <br />