Laserfiche WebLink
• • <br />WORK ORDER(SERVICE AGREEMENT <br />Evergreen Environmental Services NO- 345012 <br />dedicated to the protection of the environment <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# CAD982413262 P.O. BOX 30517 <br />16540 S. San Padre SL, Carson. CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Date: <br />GENERATOR/JOB LOCATION BELLING INFORMATION <br />1 PRODUCT <br />v. <br />WASTE <br />CODE <br />MANIFEST QUANTITY <br />NUMBER <br />NAME <br />PRICE <br />CASH ❑ CHECK ❑ <br />A' <br />_ <br />L <br />jfd/sIj <br />Gal, <br />j <br /># <br />'ADDRESS <br />CA221 <br />ADDRESS <br />STM4ER CODE NO. <br />6k <br />CA 134 <br />99 <br />Gal. <br />L-431 <br />C <br />TATE <br />IP CO. <br />CITY <br />STATE ZIP CO. <br />AAAA <br />le17 <br />Gal. <br />PHONE NO. - <br />_ - — <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />Each <br />r 1 <br />Drained Used Oil Filters <br />Z:4— <br />1 PRODUCT <br />v. <br />WASTE <br />CODE <br />MANIFEST QUANTITY <br />NUMBER <br />UNITS <br />PRICE <br />AMOUNT <br />Used oil. Non-RCRA Hazardous Lubricating <br />CA221 <br />jfd/sIj <br />Gal, <br />j <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />uwa Aubna Aoti(¢em NomROtA ii>ama <br />wa <br />CA 134 <br />�'b <br />Gal. <br />RQ Wawa Caobnm L* & N.O.S. NA <br />Iw3 m fol �� wM sauce) <br />CAM <br />ml/ <br />Gal. <br />Oil & Winer. 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 Wage Solids (oily debris) <br />CA223 <br />Drum <br />Empty Drums <br />- <br />Drum <br />Transportation <br />His. <br />Non Hazardous W r <br />Gal. <br />Glycol Bulk 50150 <br />Gad. <br />Glycol Bu Conc. <br />Gal. <br />TEST: Var, D Tech 4000.ppm ❑ Clor D Tech 1000 ZIP= <br />❑ Fail ❑ Halogen DewodFlame Test <br />❑ ❑ Fail <br />Field Service Work Description: <br />Total Charges <br />Other. <br />Other. <br />Vacuum ices Time? <br />Out of and On Site Off Site <br />_Off Load Smn Off Load End <br />Rem <br />to Yard <br />Z `` <br />T F M Consolidated Manifest <br />Evergreen Oil. Inc. ❑Evergreen Env. Svc E]EvergreenEnv. Svc. F-7AISFilter <br />6880 Smith Ave. Road 30B 4139 N. Valentine 15131 Clark Ave. <br />Newark. CA 94560 / Davis, CA 95616 Fiesr , CA 93722 Industry, CA 91745 <br />CAD980887419 CAD982446874 CAD982446982 CAD000097432 <br />❑Evergrecn Env. <br />16604 S. San F <br />Source: W.Collec <br />❑ Matin <br />7(03 <br />Evergreen Env. Svc CFR <br />tersina ❑ 944 E. Slaon Ave. <br />❑ 745 A West Berus <br />CFR Gree f Env. Svc. <br />❑ 33210 Western 3474 Toy <br />Santa Maria CA 93454 ten AAnnggeeles. CA 90011 Union Cim, CA 94587 Valley Springs, CA 95352 <br />CAD982446958 CAL000110021 <br />CAL000091507 CAL000214411 <br />Gerreruar certifies that it has established a program to reduce the volume or <br />quantity & [oziaty, of the hazardous wage to the degree determined by <br />/'a� <br />tion Station ❑ Government <br />e [I A-aTicultural Q Industrial <br />. I geoe+at m be economically pracdr___e <br />-_.. .m_.. - - �_.._ e _..a w . <br />sample # r% L 1 G .3 Ka IT Side of this form. A = J <br />Ll ` <br />onatute Print Name Route # I Date enerator's Signature Print Name Date <br />