Laserfiche WebLink
9140 WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Envimmental Services 11W 154162 <br /> dedicated to the protection of the eavrronment <br /> To schedule a pickup, call Send payment tot Sales Order # <br /> 800-972-5284 Evergreen Ga Ino, <br /> 8990 Smith Aver,Newark,CA SPAN CAD992413292 Dept,2457 <br /> 1 B340 s.San Pedro St,Carson,CA EPA#CAD962413262 LOS Angeles• '(.A 900844457 Date; •� <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> N r <br /> NAME CA8B o CHECK❑ <br /> 3t.n C� <br /> D 89 - ADDRESS <br /> CUS CODE N] <br /> Of. <br /> � i <br /> STATE ZIP O• CITY STATE 2:iP CO, PO# <br /> T.O 1PHONE NO. PRONE NO, PROFILE NO. CUSTOMER EFA ID NO. <br /> 9162W.4 P <br /> PRODIUM ar IB MANIFE6T QDANITT1r LtNITs PRICE AMOUNT <br /> CODE NUMBER <br /> used oil.NoaRCRA Hazardous Labrioetiag CA221 LU;,0jZ17 Z40 Gai. Z3 <br /> Warm,Liquid Industrie) CA221 , <br /> M nut ranc asfra nm.a 11. m CA134 Gal. <br /> %m29ambmtiNa LglNA&N,l C,�,• Z . <br /> maul- n parlAlO <br /> 09&Water,Non-RCR4 Hazardous Waste Liquid CA221 Oel. <br /> Waste Solids Sad Sludges GaL <br /> Wuh Out Saab <br /> Drained Used Oil Filters Dram <br /> Non•RCRA Hazardous Waste Solids(oily debris) CA= Dram <br /> Empty Drums Drvm <br /> Tr°aporhab0 Firs. <br /> Non Har!As Water Gal <br /> TEST: Cor D Tech 4000&V�ppm ❑Clor D Tech 1000 pus❑Fait ❑ Haf°gan DetectarTlame Test ❑ '(]Pail �-jj <br /> Fuld Servicc Work Descripdim Total Char es <br /> Critter. <br /> other 14 1 <br /> Victims res Time <br /> out of Do site Off Situ Off Load Start Of Load Sod Ret wn o Y 7, <br /> T8 Consolidated Manifest <br /> Ev <br /> 6gAIS60 SrmthAve° ❑ rpg Hov.Svc. ❑ 4139SN.Valeavyno Svu. ❑ 15131F <br /> tlter Clark Ave. ❑ <br /> Nmvulc,CA 94360 Davis,CA 95926 Fmsnn,CA 93711 Industry CA 91745 <br /> CAD980887411 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ HEnv.s a: ❑ Evergreen Env,Svc. ❑ CPR ❑ <br /> 1666f S.Sae�Pg07im 745 A War aotteravia RURL 5lausen Ave, 33210 Weettm ❑ 34744nT ff Chute' <br /> Carson, <br /> CAe46►4fi sesta Maria,CA 934$4 Loa Mgg�la,CA 90011 Union CRY.CA 94557 VC r ng 1 Cel 95352 <br /> CAD98169 0 a S244685g CAL000110941 1507 44 <br /> Source: Collection Station LI CtWOInII1Cnt Generator°s¢hfies that it has established a program to reduce the volume or <br /> quantity&tmdeity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural cultural ❑Industrial gene utor o be aconem rally Practicable <br /> I harsh card that I have read aad have the authori 10 <br /> R in sample #_�` _ <-� bind the above listed generator to the terms on the reverse <br /> .— side of form. <br /> D er Signature nt Name Route M ate a er tor's Si nater Print Name Date <br /> oNI oo 1N3WdIm]l W t WUBS:01 E002'OT'33O <br />