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Y <br />shk <br />WORK ORUER/SERVICE AGREEMENT <br />Evergreen Environmental Services <br />dedicated to the protection of the environment <br />To -schedule - a -pickup, call- - Send payment to: <br />800-972-5284 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA#-CAD982413262 Dept. 2457 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, 'CA 90084-2457 <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />Sales Order # <br />Date: / , C>'3 <br />NA - ` <br />40L� <br />WASTE MANIFEST QUANTITY <br />CODE NUMBER <br />UNITS PRICE <br />NAME_.. <br />Used oil, Non-RCRA Hazardous Lubricating <br />CASH ❑CHECK ❑ <br />Gal. _Wb <br />CAD980887418 CAD982446874 CAD982446882 <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br /># <br />ADDRESS <br />t4 <br />CA134 <br />Gal <br />ADDRESS <br />RQ Waste Combustible Liquid, N.O.S. NA <br />1993 nI Oil contaminated with halo ens <br />CUSTOMER CODE NO. <br />o q <br />G <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal <br />side of this m. <br />CITY STATE <br />ZIP <br />CO. <br />CITY <br />STATE ZIP , CO. <br />PO # <br />HONE NO. - - <br />Drained Used Oil Filters <br />PHONE NO. <br />Drum <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />—B <br />Drum <br />( ) <br />Drum <br />PRODUCT <br />WASTE MANIFEST QUANTITY <br />CODE NUMBER <br />UNITS PRICE <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 <br />Gal. _Wb <br />CAD980887418 CAD982446874 CAD982446882 <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />16604 S. San Pe o 945 A West Betteravia I—I 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle <br />Carson, CA 90 6 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 <br />CAD9816964,ZO CAD982446858 CAL000110021 CAL000091507 CAL00021441I <br />Used Automotive Antifreeze, Non-RCRA Hazardous - <br />Waste Li uid <br />CA134 <br />Gal <br />®Marine Agricultural ® Industrial <br />RQ Waste Combustible Liquid, N.O.S. NA <br />1993 nI Oil contaminated with halo ens <br />CA221 <br />F001/F002 <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal <br />side of this m. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />CA223 <br />Drum <br />Empty Drums <br />Drum <br />Transportation <br />Hrs. <br />Non Hazardous Water <br />Gal. <br />TEST:[–] Clor D Tech 4000 ppm ❑ Clor D Tech 1000❑Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ ass ❑ Fail• <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum Sey ices Time <br />Out of Y d On Site Off Site <br />Off Load Start Off Load End <br />Return to Yar <br />(,5—, <br />Ts I Consolidated Manifest <br />Evergreen Oil, Inc. Evergreen Env. Svc. ❑ Evergreen Env. Svc. <br />❑ <br />❑ AJS Filter ❑ <br />6880 Smith Ave. 'Road 30B 4139 N. Valentine <br />15131 Clark Ave. <br />Newark, CA 94560 Davis, CA 95926 Fresno, CA 93711 <br />Industry, CA 91745 <br />CAD980887418 CAD982446874 CAD982446882 <br />CAD000097432 <br />❑Evergreen Env. Sv . ElEvergreen Env. Svc. (� CFR <br />1:1CFR ❑ Greenleaf Env. Svc. <br />16604 S. San Pe o 945 A West Betteravia I—I 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle <br />Carson, CA 90 6 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 <br />CAD9816964,ZO CAD982446858 CAL000110021 CAL000091507 CAL00021441I <br />Source: Collection Station ®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 />®Marine Agricultural ® Industrial <br />generator to be economically practicable. <br />I hereby certify that I .have read and have the authority to <br />Retsample # <br />fAor_ <br />bind the above listed generator to the terms on the reverse <br />side of this m. <br />Dri r Signature Print Name Route # Date ener tor' Signature Print Name Date <br />