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L` <br />_ WORK ORDER/SERVICE AGREEMENT <br />_74Evergreen Environmental Services ® 224284 <br />dedicated to the rroreezion of the environment <br />To schedule a pickup, call Send payment to: Sales Order #77G <br />800-972-5284 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 678252 j <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Dallas. TX 75267-8252 Date: <br />GENERATOR/.1011 I,OCA'I'ION RIVI.Mr. iNWORM,f`tl'rnNT <br />NAME J <br />NAME <br />U Consolidated Manifest <br />i'A <, ❑ CHECK ❑ <br />ADDRESS <br />ADDRESS <br />- <br />U <br />CUSTOKER CODE, NO. <br />CIT I' STATI? 'LIP CO. <br />CITY <br />STATE 111 <br />€�.� <br />PGB :. <br />+,P-�HONE No <br />L �j� •"'Z <br />PHONE NO. <br />( 1 <br />PROFILE NO. <br />r <br />CUSTOMER EPA tIssD��N�O�. <br />tr..�l4ij1TT.-.i <br />i6':1S'I'Ii <br />PRODUCT CODE <br />NIANIFFs'!' <br />NUI4ffiER <br />QUANTIT�S' ! UNITS <br />PRICE AMOUNT <br />i_I,r(! oil, Nun-RCRA H;vnttous Lubricating CA22115(JPs <br />)z <br />Gal. <br />Waste, Liquid [ndusirial CA221 <br />Gal. <br />li.cd Autmmntiv Antirn.Un•, Nun.R(RA oar ak— CAI 3-1 <br />wa,t,tsw <br />Q ��� <br />J <br />u� Gal. <br />'yam yZ__ C5 D <br />R(J N'a,.• ('ninhU:tihl.+ t.i�vid, K.(1 s. \A ('A22 i <br />rrN nl iUJ :,,n4m:nmlrvl wish hal...... 100 UR02 <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />-- <br />Drained Used Oil Filters <br />Drum <br />Nun-RCRA 1lazerd s Waste Solids (oily debris) CA223 <br />Drum <br />Empty Dtvms <br />Drum <br />Transportatio <br />Hrs. <br />— <br />Non Hazar ous Water <br />Clal. <br />TEST: Clor D Tcch 40OO. ppm ❑ Clur D Tech 1000 <br />Pass ❑ Fail ❑ Halogen Detector/Flame'rest ❑ Pass ❑ Fail <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum irviccs'Fintc <br />Out of and On Site Off Site Off Load Start Off Load End Return to Yard <br />1,�� <br />U Consolidated Manifest <br />7 E\crgrcen Oil. Inc. <br />6890 Smith Ave. <br />Newark, CA 94560 <br />CAD9R0887418 <br />❑Evergreen Env. Svc. ❑ <br />Road 30B <br />Davis, CA 95926 <br />CAD982446574 <br />Tiverereen Env. Svc. <br />4134 N. Valentine <br />Fresno, CA 93711 <br />CAD982446992 <br />❑ :AJS Filter <br />15131 Clark Ave. <br />Industry, CA 91745 <br />CAtXUM1432 <br />U <br />LiT rergreen En Svc. <br />16604 ,l'. a cdro <br />C':usan. CA 8746 <br />C.1IKI8169( 20 <br />❑ Evergreen Lim•. Svc. ❑ CFR ❑ CPR <br />745 A West Bettcravia 944 G Slauson Ave. 33'10 Western <br />Santa Aiaria. CA 93454 Los Angeles, CA 90011 Union City, CA 94587 <br />CAD992446358 CALM'H IW21 CALM0091507 <br />❑ Greenleaf Env. Svc. <br />.1474'I'oyun Circle <br />Valley Spring., CA 95352 <br />CAL(W214411 <br />Gelelalor certifies that It has estahhshcd a program to reduce the voltanc or <br />Source: A Collection Station ❑ Government quantily & toxicity of the hazardous \\as(c to the &Lg,we detennined by <br />U Marine ❑ Agricultural ❑ Industrial generator to he econoillically practicable. <br />oe I hereby certify, that I have read and have the authority to <br />bind the above listed genenitor to the terns an the reverse_ <br />Rke In saH pie # -1 ellside of this form. <br />i <br />ignature 1vv1 1 atnc s:oute # ate Uc»' 5ignaturt Print Name Date <br />I•d <br />0992-99b-602 SJTITiudow aoRoC <br />e9S :60 -1p0 22 AQN <br />