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WORD ORDER/SERVICE AGREEMENT <br />Evergreen Environmental Services <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 Dept. 2457 t <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90084-2457 Date: <br />GENERATOR/.IOB LOCATION BILLING INFORMATION <br />N d <br />lfpc�-14� <br />WASTE <br />CODE <br />MANIFEST <br />_NUMB_ER <br />NAME <br />UNITS PRICE <br />CASH F]CHECK ❑ <br />AI� <br />- CA221 <br />CAD000097432 <br />❑Evergreen Env. Svc. ❑ Evergreen Env. Svc. ❑ CFR <br />Gal. <br /># <br />ADDRESS <br />44 <br />. <br />ADDRESS <br />Gal. <br />CUSTOMER CODE NO. <br />Used Automotive Antifreeze, Non-RCRA Hazardous <br />i id - - <br />Waste Lu <br />(✓'fes. <br />C <br />quantity & toxicity of the hazardous waste to the degree determined by <br />Gal. <br />CITY <br />STATE <br />ZIP CO. <br />CITY <br />STATE ZIP CO. <br />PO # <br />/ <br />dam-, <br />CA221 <br />'•� <br />Gal. <br />PHONE NO. <br />PHONE NO. <br />Gal. <br />PROFILE- NO. <br />CUSTOMER EPA ID NO. <br />( ) <br />Drained Used Oil Filters <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST <br />_NUMB_ER <br />QUANTITY <br />UNITS PRICE <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />- CA221 <br />CAD000097432 <br />❑Evergreen Env. Svc. ❑ Evergreen Env. Svc. ❑ CFR <br />Gal. <br />7r k <br />Waste, Liquid Industrial <br />CA221 <br />CAD9816964 CAD982446858 CAL000110021 <br />CAL000091507 CAL000214411 <br />Gal. <br />Used Automotive Antifreeze, Non-RCRA Hazardous <br />i id - - <br />Waste Lu <br />C'A 134 <br />quantity & toxicity of the hazardous waste to the degree determined by <br />Gal. <br />RQ Wast. CombustibleLiquid, N.O.S. NA <br />1993 In Oil contaminated with halo ens <br />CA221 <br />F0011F002 - <br />I hereby certify that I have read have the authority to <br />Gal. <br />etaample <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <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 Hpzar s Water <br />Gal. <br />TEST: . Clor D Tech 4000z --.->—ppm ❑ Clor D Tech 1000 <br />Pass ❑ Fail ❑ Halogen Detector/Flame Test Pass ❑ If - <br />r <br />Field Service Work Description: <br />ToVI Charges <br />Other: <br />Other: <br />Vacuum Se 76ces Time <br />Out of Yd On Site Off Site <br />Off Load Start Off Load End <br />Re\L- to Yard <br />lL✓i7 ' <br />TSD [L Consolidated. Manifest <br />Evergreen Oil, Inc. ❑ Evergreen Env. Svc. E]EvergreenEnv. Svc. <br />❑ AJS Filter I—1 <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. Svc. ❑ Evergreen Env. Svc. ❑ CFR <br />❑ CFR ❑ Greenleaf Env. Svc. <br />16604 S. San Pedr 745 A West Betteravia 944 E. Slauson Ave. <br />33210 Western 3474 Toyon Circle <br />Carson, CA 907 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 <br />CAD9816964 CAD982446858 CAL000110021 <br />CAL000091507 CAL000214411 <br />01 <br />Source: Collection Station LJGovernment <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 />4 G <br />S <br />I hereby certify that I have read have the authority to <br />bind a above listed generator the terms on the reverse <br />etaample <br />side of s form. <br />Route # <br />Print Name Date <br />