Laserfiche WebLink
WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services 80922 <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order N <br /> 800-972-5284 Evergreen <br /> 6880 Smith Ave.,Newark CA EPAN CADDB2413262 P.O.Bos 49065 <br /> 16540 S.San Pedro St.,Gerson,CA EPA#CAD982413262 San Jose,CA 95161-9065 Date• <br /> GENERpTORMOB LOCATION BILLING INFORMATION <br /> NAME NAME r; - .. CASH❑CHECK❑ <br /> -s % # <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> y <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO N <br /> PHONE NO. PHONE NO. PROFILE NO. Cu TOMR EPA ID NO. . , <br /> PRODUCT HASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE, NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> 11 dAUt vxive Afthf ,Nm-RURA Hmdau <br /> wmie CA134 Gal. <br /> RQWu Cc busfiblc Iigwd NOS.NA CAal1 Gal. <br /> 1voulou conuminelW wiN 64 Feal/Faa2 <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 Danns Drum - <br /> Transportation Hrs. <br /> Non Hazardous Water �=y Gal. <br /> TEST:❑Clor D Tech 4000 'ppm ❑ Clor D Tech 1000 u Pass❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: ... <br /> Vacuum Services Time <br /> I Out of Yard On Site Off Site Off Load Start Off load End Retum to Yard <br /> TSDF H Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc.. F-1Evergreen Env.Svc. ❑ AIS Filter Q <br /> 6880 Smith Ave. Road 30B 4193 N.Valentine 15131 Clark Ave.. <br /> Newark CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. Evergreen Env.Svc ❑ CFR 1:1CFR. Greenleaf Env.Svc. <br /> 16604&San Pedro 745 A West Betteravie 944 E.Slauson Ave. 33210 Westem 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD992446858 CAL000110021 CAL0000915O7 CAL000214411 <br /> Source: 0 Collection Station ❑Government 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 /> 0 Marine ❑Agricultural 0 Industrial generator to be economically practicable. <br /> 1 hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Retain sample # side of this form. <br /> Driver Signature Print Name Route# Date Generator's Signature Print Name Date <br />