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9 i
<br />WORK ORDER/SERVICE
<br />Evergreen Environmental Services
<br />,ledirrtlfd to lilt I,rnirrnion of the enriromnent
<br />To schedule a pickup. call
<br />800-972-5284
<br />6880 Smith Ave., Newark, CA EPA# CAD982413262
<br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262
<br />7lvn,17u.A nrnunnu r nc tT1nN
<br />Send payment to:
<br />AGREEMENT
<br />hft20427
<br />Sales Order
<br />Evergreen Oil, Inc.
<br />Dcpt. 2457
<br />Loa .Nnuelcs. CA 90084-2457 Date:
<br />11111 INC 1NFOR\IYTION
<br />\ \ F
<br />\ \>IL
<br />CASH Q CHECK
<br />ADDRESS
<br />AMOUNT
<br />ADDRESS
<br />-
<br />CG$TOM1t[ CODE, NO.
<br />Gal.
<br />Retain sample #
<br />q ustc. Liquid Inrlu'lrial
<br />CA211
<br />_--
<br />C1T1'
<br />-----
<br />Sr::\TIC `71P CO.
<br />CITY
<br />ST,\'fIP CO.
<br />E Z.
<br />#
<br />PHONE NO,
<br />_
<br />PHONE: NO,
<br />r'a'_W2
<br />HFlI%F
<br />PROFILE, NO.
<br />CUSTOMER EPA ID NO.
<br />Ot k Witter. Son-RC'RA Hazardom W,nte Liquid
<br />CA221
<br />Gal.
<br />PRODUCT
<br />B'AST'E
<br />CODE
<br />MANIFEST -
<br />NUMBER "
<br />QUAN'rITY UNITS PRICE
<br />AMOUNT
<br />U,ed oil. Nun-RCRA Hazardous Luhricating
<br />CA22.1
<br />Gal.
<br />Retain sample #
<br />q ustc. Liquid Inrlu'lrial
<br />CA211
<br />Gal.
<br />rya, i ., uiJ
<br />Gal.
<br />Hp unm. Ru„euaiiely l.irfd y n yn
<br />Iv';)III ;Oil cnnumiva¢J u4iF h, l:_,.n
<br />r'a'_W2
<br />HFlI%F
<br />Gal.
<br />Ot k Witter. Son-RC'RA Hazardom W,nte Liquid
<br />CA221
<br />Gal.
<br />Watt, Solids and Sludee,
<br />-
<br />Gal.
<br />%N ash Out
<br />Each j
<br />Drained Used Oil Filters
<br />Drun,
<br />'On-RCRA Ha7ankiu, \\toe Solid, mil)dehri,
<br />CA”;
<br />' Urmn
<br />Empty Drum,
<br />Dtvnl
<br />Trop tjvrtation
<br />_ Hrs.
<br />Nun Hacvdnas Water
<br />TEST:❑ Clor D Tech 4(kHl_ppnr ❑ Chir D Tech IINNIQ Pius ❑Fail r� I{;doges Detecmr/Flanm 'I'e,t ❑ Pas, FailE./�•
<br />Field Service Work Description:
<br />Total Char es
<br />Other:
<br />Other: i
<br />Vacuum Services Time
<br />Out of YarA On site Off Site
<br />—Off Load Stan
<br />Off Load End Return to, Yard
<br />TSDF
<br />U Consolidated Manifest
<br />❑ L,ergrcen Oil. Inc. ❑Evergreen Env. Svc. ❑ Ever^rcen Em. Svc.
<br />Smith Ace. Road 7116 4L',' N. \'alernine
<br />Newark, CA 94564) Davis. CA 95926 Fre,m CA 93711
<br />CAD9Srn87418 CAD9S2446874 CAD982446SS'_
<br />her_ree, I'll, . S,c Evergreen Em Svc. CFR
<br />❑ 166(}{ S San Peds, El745A Wcet Rmtera„a El9441:-Sluuxnt A,e.
<br />C a,,,n. CA 90740 Santa Maria. CA 93454 Lo, Anucl,, CA 9t
<br />CAD9SI69W^_P CAD982446858 C'AU"'ll1H121
<br />F-1AJS Filter El0850
<br />I_ Ii 131 (l;uk Ace.
<br />Indu,ti, C4 91715 _—
<br />C':ADIHtlNhg43'_
<br />C R �I (unleaf Enc S',:.
<br />11) Weston, Ll 1474 Tucnn Cu I
<br />I Union (nN. CA 9 \4587 alk, spring'.C:A 7555'
<br />C'ALaINnp71it17 CAI_[910714411
<br />Generator mite, that it h::, enu,hli,hcd a program n, reduce the w4ume or
<br />qunndn n n,.eiatc of the hnz.vdou, „n„e to a,o de_le determined ny
<br />Source: ❑ Collection Station ❑ Government
<br />❑ Marine ❑ Agricultural Ll Industrial
<br />..---
<br />, he ecu,n,icdh prncac:thk•.
<br />_,nerai„r hm
<br />I herein certifv that 1 have read and have the authorit) to
<br />bind the abnce fisted ¢enerator_to the terms on the reverse
<br />Retain sample #
<br />side of this form.
<br />Driver Signature 'Print Name Route # Date Generator's Sie-nature rint Name Date
<br />
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