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WORK QRDER/SERVICE AGREEMENT <br /> - Evergrea ---Env1-li'flnme-int- e--r-Y-IC£S <br /> dedicated to the protection of the environntetu <br /> — <br /> _Tasche&le a.pickup, call Send payment to: Sales Order# %J <br /> -. 0� T _5297 84 Evergreen Oil,Inc. <br /> 6880 Smith Ave., Newark,CA EPA#CAD982413262 P.O. BOX 3071-7 <br /> 18540 S.San Pedro St Carson,CA EPA#CAD9824132-62 Los Angeles. CA 90030-0517 Date: �0 <br /> GER Tf R 9B ,©C I©N - BILLING INF( RMI ATION _ <br /> N * _ _ NAME CASH D CHECK[] <br /> ADDRESS -- - ADDRESS CUS 0 ODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO PO# <br /> 4 , <br /> PHONE NO _ = ROFILP71ti1II CUSTOMER EPA Ill NO: <br /> WASTE NIANIFES-'F _ <br /> PRODUCT QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal, <br /> Waste,Liquid - Industrial - CA221 - Gal. <br /> Used Automotive Antifreeze,Non-RCRA Haznda.s CA 134 '� Gal. <br /> Waste Li uid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 Gal <br /> _ <br /> 1993 UT Oil contaminated with halo ens --- FOOIIFOO2 <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 Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation His. <br /> Non Hazardou Water Gal. <br /> Glycol Bulk 50/50 Gal. <br /> Glycol B-/ Conc. Gal. <br /> TEST:It Clor D Tech 4000 ppm ❑Clor D Tech 1000 Pass❑Fail ❑ Halogen Detector/Flame Test ❑Pass Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum e'vices Time <br /> Out of and On Site Off Site Off Load Start Off Load End Return o Yard <br /> TS Consolidated Manifest <br /> Evergreen Oil, Inc. ❑ Evergreen Env.Svc. ElEvergreen Env.Svc. ❑ AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B 4139N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen E/vS Evergreen Env.Svc. ❑ CFR CFR Greenleaf Env.Svc. <br /> 16604 e. Saro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD982446858 CAL000116021 CAL000091507 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 ® Agricultural ® Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> 2 bind the above listed generator to the terms on the reverse <br /> talri Sari1I?�� # �7 side of.this form. <br /> river Signature Print Name 'Route# Date Gene is Signature tint Name Da <br />