Laserfiche WebLink
t WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services W 86850 <br /> dedicated to the protection of the environmern <br /> To schedule a pickup,call Send payment to: Sales Order <br /> 500-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark, CA EPA#CAD982413262 Dept.2457 d <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90084-2457 Date' <br /> GEN TOR/JOB LOCATION ILL15MNFORYATION <br /> #CASH L]CHECK❑ <br /> REBS �� ADDRE L `�/ ©aC-•> MF�[t CODE O. <br /> IT / STA I CO. C / ST E CO. POM <br /> �J <br /> - PHO N PHONE NO. PROFILE/NO. AMM-1 <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used ail,Non-RCRA Hazardous Lubricating CA 221 Gal. <br /> Waste.Liquid Industrial CA221 Gal. <br /> Ux Amt.. eAmifreem,Nm-RCRA 14.,d,us CA134 Gal. <br /> WWc Liquid <br /> RR` "u,"Llqui4 N.O S.NA ,A,21 tial <br /> IWllll Oil conummatW with M1a FWW002 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out F ech / <br /> Drained Used Oil Filters Drum (jrs <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 e`' Drum (� <br /> Empty Drums Drum <br /> Transportation Z^2 tlrs- <br /> Non Hazardous Water Gal. <br /> THS(:❑Clor D Tech 4000ppm ❑ Clor D'fech 1000❑Pass❑Fail ❑Halogen Deteetor/Flame Test ❑Pass ❑Fail <br /> r Field Service Work Description: —Total Charges <br /> Other: / <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard On Site Ott Site Off Load Stan Off Load find Return to Yard <br /> TSDF Ll Consolidated Manifest �NAM <br /> „_ pisEvergreen Oil-Inc. ❑ Evergreen F.nv_Svc.. Evergreen Env.Svc. AIS Filter flTf/( <br /> ❑ 6880 Smith Ave. Road 30B ❑ 4193 N.Valentine ❑ 15131 Clark Ave- <br /> Newark. <br /> ve.Newark.CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAIN80887418 CAD982446874 CAD982446882 C'AD000097432 <br /> G n ea F. v, vc. <br /> P:veE <br /> igreen Env.Svc. Evergreen Env.Svc CFR �{CFR <br /> ❑ 16604 S.San Pedro ❑ 745 A West Betteravia ❑ 944 .Slauson Ave.-b 33210 Western 3474 Toyon Circle <br /> Carson.CA 90746 Santa Maria.CA 93454 Los Angeles.CA 90011 Union City,C'A 94587 Valley Springs,CA 95352 <br /> 1 C'AD981696420 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that k has established a program to reduce the volume or <br /> Source: <br /> ❑Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ 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 s ple # side oo m:, <br /> 24 �Y 117 'o <br /> Dri r Siimature Print Name Route AF Date Gen s or's Sienature Print Name Date <br />