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• ,t • <br />WORK ORDER/SERVICE AGREEMENT <br />. 1141 <br />Evergreen Environmental Services NO- 146663 <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 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90084-2457 Date: `� a <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />N E <br />WASTE <br />CODE <br />NAME <br />UNITS <br />CASH ❑ CHECK ❑ <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 <br />Z - j- ��ep <br />Gal. <br /># <br />AD KESS <br />^• <br />' I <br />ADDRESS <br />Gala <br />TOMER CODE NO. <br />Used Automotive Antifreeze, Non-RCRA Hazardous <br />Waste Liquid <br />CA134 <br />(Lal <br />2g:rX=>Z <br />CIT STATE <br />ZIP CO. <br />CITY <br />STATE ZIP CO. <br />PO # <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />fl <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 QUANTITY <br />NUMBER <br />UNITS <br />PRICE AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 <br />Z - j- ��ep <br />Gal. <br />Waste, Liquid Industrial <br />CA221 <br />Gala <br />Used Automotive Antifreeze, Non-RCRA Hazardous <br />Waste Liquid <br />CA134 <br />(Lal <br />RQ Waste Combustible Liquid, N.O.S. NA <br />1993 In (Oil contaminated with halogens) <br />alo ens)FOOIIFO02 <br />CA221 <br />Gal. <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 />-- <br />Drum, <br />Transportatio <br />Hrs. <br />Non Hazar ous Water <br />Gal <br />TEST: V Clor D Tech 40001�SLppm ❑ Clor D Tech I 000EAPassEl <br />Fail ❑ Halogen Detector/Flame Testss <br />❑ Fail <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum S vices Time <br />Out of and On Site _Off Site <br />Off Load Start Off Load End <br />turn <br />to Yard GG <br />TS Evergreen Oil, Inc. <br />6880 Smith Ave. <br />Newark, CA 94560 <br />CAD980887418 <br />Consolidated Manifest <br />❑Evergreen Env. Svc. ❑ Evergreen Env. Svc. 11AJS Filter <br />Road 30B 4139 N. Valentine 15131 Clark Ave. <br />Davis, CA 95926 Fresno, CA 93711 Industry, CA 91745 <br />CAD982446874 CAD982446882 CAD000097432 <br />❑Evergreen Env. c. ❑ Evergreen Env. Svc. ❑ CFR ❑ <br />16604 S. San P ro 745 A West Betteravia 944 E. Slauson Ave. <br />Carson, CA9 46 Santa Maria, CA 93454 Los Angeles, CA 90011 <br />CAD981696 0 CAD982446858 CAL000110021 <br />Source: ❑ Collection Station ❑ Government <br />❑ Marine ❑ Agricultural ❑ Industrial <br />sample # <br />Signature (/Print Name Route # <br />CFR1:1Greenleaf Env. Svc, <br />33210 Western 3474 Toyon Circle <br />Union City, CA 94587 Vallee Springs, CA 95352 <br />CAL000091507 CAL600214411 <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 />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />bind the above list erator to th s on the reverse <br />side of this for <br />r <br />e ator' ure Print Name Date <br />