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WORK ORDER/SERVICE AGREEMENT <br />!V,A Evergreen Environmental Services x 224094 <br />dedicurcd to the protecrion of the envirnatnent i <br />To schedule a pickup, call Send payment to: Sales Order <br />800-972-5254 Everorcen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O BOX 678252 <br />16540 S. San Pedro St., Carson, CA EPA# CAD/82413262 Dallas, TX 7526 -8252 i�atC/ <br />(:�' I!ATQ12f1OB LOCATION [ BILLING IN MATION <br />d <br />1,-,4 —1 NAME -w. w.f.�J C:,1SH F-1 CHECK E] <br />A <br />STATE 'LIP CO. <br />NO. <br />EPA <br />PRODUCT <br />WASTE MANIFEST <br />CGDE NUMBLR <br />7,Q�UAPRICE <br />AOUNT <br />M <br />Used oil. Nan-RCRA Hazardous Lubricating <br />CA221 <br />Gal. <br />Waste. Liquid Industrial <br />' <br />Gal. <br />Iked Ammnntim .oma;—, Non-RCRA rivaidnn» <br />tt'na.• Livid <br />{'A 13 i <br />Gal. <br />RQN':nw ('nuJ.uaiOle t.iqui;I. NJ vs. NA <br />1'W? IU (Ih! �nntan.inatca with h.a,rc, <br />CA _21 <br />1:01r/Hln2 <br />Gal. <br />Oil & Water, Non-RCR.1 Haran/ rs 'asic Liquid <br />CA2V <br />PffEach <br />I Gal. <br />Waste Solids and Sludges <br />gyral <br />Wash Out <br />Drainc,d Used Oil FiltersUA <br />Drum <br />Non-RCRA Hazardous Wasi Solids (oily n:;) <br />CA223 <br />Drum <br />Empty Donis <br />Drum <br />Transportation <br />Hrs. <br />Non Hazardous Water <br />Gal. <br />TEST;❑ Clor D Tech 11(( pin ❑ Clor <br />%Field <br />ech 1000❑Puss ❑ Fail ❑ <br />Halogen Detector/Flante Test ❑ Pass ❑ Fail <br />Service Work Description: <br />otal Char es <br />Other: <br />11� <br />Other: <br />Vacuum Services Time <br />Out of Ywd On Site Off Site <br />Olt Load Start <br />OI'f Load End Return to Yard <br />TSDF ❑ Consolidated Manifest <br />❑ <br />Evergreen Oil, Inc.L1Evergreen Env. Svc. El <br />Env. Svc. j� AJS Filtcr j <br />6990 Smith Ave. Road 306 4139'N. Valentine tL�— 15131 Clark Ave. t7 <br />Newark, CA 94560 Davis, CA 95426 Fresno, CA 93711 Industry, CA 91745 <br />CAD98088731S CAD982446874 CAD982446882 CADOW097432 <br />f—) Evergreen Env. Svc. Evergreen Env. Svc. ❑ CFR CFR Greenleaf Gro. Svc. <br />—J 16604 S. San Pedro 745 A West Betteravia 944 E. Blouson Av' .. 33310 W'es[crn 3471 Tovun Circic <br />Carson, CA 90740 Santa /Maria, CA 93454 Los Angcics• C; H)1 Union City, CA 94587 Valley Sprints, CA 95352 <br />CAD981696420 CAD982446858 CALOOO110021 CALOOOO91507 CAIJXXI214411 <br />Generator certilics that it has established a program to reduce the volume ar <br />SOuree: ❑ Collection Station ❑ Government quantity h tosicily of the hazardous waste to the dcta'ce determine([ by <br />❑ enerator to he economically practicable. <br />Marine ❑ Agricultural ❑Industrial <br />I hereby certify that I have read and have the authori,y to <br />bind the above listed generator to the terms on the rcvcrse <br />Retain Sample side of this form. mm <br />Driver Sign ur i t , a c Route # Date Generator's Signature Print [Mame Date <br />T -d 0992 -99i► -602 SdtTit4dOW aDROr E6S=60 t,0 02 AOW <br />