Laserfiche WebLink
WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services - ,. 86761 <br /> dedicated to the protection of the environmenr <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#CADDS2413262 Dept.2457 <br /> Date' <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90084-2457 <br /> GENE �R/JOB LOCATION BILLIN NFOR ATION f CASH CHECK <br /> NA ❑ ❑ <br /> ADDRE ,r`n ER CODE N9 <br /> I f. j�l S } XIZ%�/ <br /> CIT / TA'f.6 CO. CITY STA:F CO. PO R <br /> etjON O. CC PHONE NO. L, PROFILE NO. I E EPA Ipiy,O..� <br /> ( l ) ( ) <br /> PRODUCT WASTE 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 /> Ju Awm wI,Arfifi m.No-RCRA Iri da a <br /> W".0 a CA134 Gal. <br /> 0.Q WwcCmmbupiblc LagMd.N D.S.NA C nj Gal. <br /> iw3m ,C=b „,onea, aW MI/Foaz <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA 221 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 /> IEmpty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> TEST:❑Clor D Tech 4000___ppm ❑Clor D Tech 1000❑Pass❑Fail ❑Halogen Delector/Flame Test ❑Pass ❑Fail 'z�"o $19' <br /> Field Servi Work Description: Total Charges <br /> Z- <br /> om i. D G vif.-t I o t <br /> Other:.. <br /> vacuum Services Time <br /> Out of Yard t Site Off Site Off Load Stan Off Load End-Return to Yard <br /> TSDF Consolidated Manifest Lam' II <br /> Evergreen Oil,Inc. Evergreen Env.Svc.. Evergreen Env.Svc. ❑ AIS Filler 1-1�kQA V <br /> 6860 Smith Ave. Road 3081:1 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 /> El16604 <br /> Env.Svc. � Evergreen Env.Svc. ❑ CFR 1:1CFR. 1 I reenleafEnv.Svc: <br /> 16604 S.San Pedro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western LLLJJJ 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 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> e: "0 Collection Station 0 Government quantity&toxicity of are hazardous waste to the degree determined by <br /> Sourc <br /> ❑ Marine 0 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 sapple # side dfthillWr <br /> Driv Signature f4nt Name Route# Date eratoes Signature Print Name Date <br />