Laserfiche WebLink
s 0 <br />WORK ORDER/SERVICE AGREEMENT <br />Evergreen Environmental Services o <br />/ dedicated to the protection of the environment N_ 121371 <br />To schedule a pickup, call Send payment to: Sales Order #q(6721 914O <br />800-972-5284 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. 2457 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90084-2457 Date:�'��0 3_ r� <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />NAME`. <br />WASTE <br />CODE <br />NAME <br />QUANTITY <br />CASH F] CHECK ❑ <br />/e+o <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 <br />23--svinrfSro <br /># <br />ADDRESS <br />7. J'O <br />ADDRESS <br />CA221 <br />CUSTOMER CODE NO. <br />2-37 -Ira dlo <br />Gal. <br />G <br />Uud Aummutive A.H., Non-RCRA 14—dwe <br />Wacm Li uid <br />,5'T i <br />CITY TATE ZIP <br />CO. <br />CITY <br />STATE ZIP CO. <br />PO # <br />PHONE NO <br />Print Name Route # Date <br />PHONE NO. <br />Gal, <br />PROFILE NO. <br />CUSTOMER EPA D) NO. <br />an — ss <br />( ) <br />Gal. <br />6_w.zU,0 <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTITY <br />UNITS PRICE <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 <br />23--svinrfSro <br />Source: Collection Station ❑ Government <br />Gal. <br />7. J'O <br />Waste, Liquid Industrial <br />CA221 <br />I hereby certify that I have read and have the authority to <br />Gal. <br />G <br />Uud Aummutive A.H., Non-RCRA 14—dwe <br />Wacm Li uid <br />CA134 <br />� <br />Gal. <br />RQ Wum Combustible Liquid N.O.S. NA <br />,.un,oa.o rrrarov with se.r nc <br />CA221 <br />Ft)01 F 2 <br />Print Name Route # Date <br />enerator's Signatur Print Name Date <br />Gal, <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />CA223 <br />Drum <br />Empty Drums <br />Drum <br />Transportatiov <br />Hrs. <br />Non Haz us Water <br />Gal. <br />TEST: 9 Clor D Tech 4000 ppm ❑ Clor D Tech 1000 <br />Pass ❑ Fail ❑ Halogen Detector/Flame Test [:]/as,, ❑ Fail <br />Zo <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum Services Time <br />Out of Yard On Site Off Site <br />Off Load Start Off Load End <br />etum to Yard <br />Zs7, <br />TS <br />Consolidated <br />Man' <br />Evergreen Oil, Inc. <br />6880 Smith Ave. <br />Newark, CA 94560 <br />CAD980887418 <br />❑ Evergreen Env. Svc. ❑ Evergreen Env. Svc. <br />Road, C Fres o, Valentine <br />Davis, CA 95926 Fresno, CA 93711 <br />CAD982446874 CAD982446882 <br />❑ AIS Filter <br />Indus Clark Ave. <br />Industry, CA 91745 <br />CAD000097432 _ <br />Evergreen Env. Svc. <br />16604 S. San Pedro <br />Carson, CA 90 <br />CAD981696 <br />Evergreen Env. Svc. ❑ CFR <br />745 A West Betteravia 944 E. Slauson Ave. <br />Santa Maria, CA 93454 Los Angeles, CA 90011 <br />CAD982446858 CALOOO110021 <br />J <br />1:1CFR Greenleaf Env. Svc. <br />33210 Western 3474 Toyon Circle <br />Union City, CA 94587 Valley Springs, CA 95352 <br />CAL000091507 CAL000214411 <br />Source: Collection Station ❑ Government <br />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 />❑ Marine ❑ Agricultural ❑ Industrial <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />Re in sample # <br />G <br />bind the above listed enerat • t "the terms on the reverse <br />side of this form. <br />� <br />er Signature <br />Print Name Route # Date <br />enerator's Signatur Print Name Date <br />1 <br />