Laserfiche WebLink
t <br /> WORK ORDERISERVICE AGREEMENT <br /> Evergreen Environmental Services NO- 177867 <br /> dedicated to ria prorecriae of the environneeet <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6660 Smith Ave.,Newark.CA EPA#CAD982413262 P.O. BOX 678252 _ ' <br /> 16540 S. San Pedro St.,Carson, CA EPA#CAD982413262 Dallas, TX 75267-8252 Date. Z/lfJp1! <br /> i:E k ATORIJOB LOCATION BILLING INFORMATION <br /> N E ! ` NAME CASH Q CHECK <br /> C. # <br /> DRESS ADDRESS - CU MER CODEIrO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> W_10142 <br /> PHO E NO. PHONE NO. PROFILE NO. CUSTOMER EPA 11)NO. <br /> ( ) <br /> WASTE MANIFEST --� <br /> PRODUCTWASTE <br /> NUMBER QUANTITY :UNITS PRICE AMOUNT <br /> Used oil,tl tiou-RIXZA Hdzardous Lubricating CA221 Ctrl. 21 <br /> Waste.Liquid Industrial CA221 h Gy, - <br /> Usedpmmu, .rA.uiireere.'v,n-ItCR.a n:ii�iil.ra. - <br /> w:udu�;a° CAI34 Gal. <br /> RQ Wane.Ca Mn.0 Lie Lrywq\riI NA CA221 <br /> tw;tit ma:o.....,,,uvw .,m wL"�, r-0nnh002 Oral. <br /> Oil S %Vater,Non-RCRA Hazardous Waste Liquid CA7?1 GaL <br /> Waste Solids and Sludges Gal. <br /> Wash Out <br /> Each <br /> Drained Uscd Oil Fillet's Dmni <br /> Non-RCP 9 Hazardous Wuat Saud(oily dzbni) CA223 Din <br /> Empty Dtmns <br /> Ikam <br /> Trar1.3x+n:ni)i lies. <br /> Nun Hazar us Water Gal. <br /> TPS'1: Cine DTech 1ir70�_ppn+ Q C2or D Tech 1(X/fl Pass❑Fail Q Nidogen DetectortRante Test ©Pass Fail _ <br /> Field Service Work Deu:rip[ion: Total es <br /> Other. <br /> Other: <br /> Vacnwn S ices Timr <br /> Out of d On Site Off Sire Ott Load Start Off Load End Return to Y <br /> TS Consolidated Manifest <br /> Evergreen Oil,ine. S1 Eveigrezu Env.Sva ❑Evergreen Env.Svc. ❑ AIS Filter ❑ <br /> 6880 Smith.ate. LJ Road 306 4139 N.Valentine 1iJ31 Clark Ave. <br /> New;u}:,CA 945ti0 Davis.CA 95926 Fresno,CA 93711 Industry,CA 91745 j <br /> CAD9SOSK'418 CAD%2446874 CAD982446892 CAD000097432 <br /> ❑ Eeeigveen Em. "c. rl Eceramen Env.Svc. ❑ CFR ❑ CFR O Grergleaf Env.Svc. <br /> 1660:7 S.Sv1 o L 745 A West BettelvYa 944 E.Slausan Ave. 33210 Westent 3474(foyoo Circle <br /> Canon.CA 46 Santa Maria.CA 93454 Los Angeles,CA 90011 Uoion City,CA 94587 Valleyy Springgs,CA 95352 <br /> CAD9816' 2U CAD982446858 CAL000110021 CAL000091507 CAL 2211 <br /> So e: C011eL'tIDI1 StaDDII ❑C70VETIIIIIeIIt Ue°°razor comes that it has established a program m reduce the vuluwe or <br /> quantity&tonicity of the hmitrdous waste to the degree detemwted by <br /> L]hlarille Agricultural 0 Industrial generator to he economically practicable. <br /> I hereby cert4 that I have read and have the authority to <br /> R n SaTTI Ie # G Z bind the above fisted Eene=Name <br /> P side of this form. <br /> 8 <br /> D er Signanure tint Name Route# Dace en ator', ignature <br />