Laserfiche WebLink
WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services NNS 278755 <br /> dedicated m the protection the environment T <br /> �To schedule a pickup, callll Send payment to: Sales 01/ 7� <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave., Newark,CA EPA#CAD982413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas,TX 75267-8252 Datt(f <br /> GENERATOR(JOB LOCATION BILLING INFO TION <br /> N NAME CASH❑CHECK❑ <br /> # <br /> A n Pj ADDRESS C NO <br /> CIT ,•/ STAT j/Cl Z�P� CO. CITY �A E CO PO# <br /> PHONE NO. PHONE R FII, NO. COSTO R EPA 0. <br /> ( ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Oral Aummalive Mti[w,Nw-RCRA H<uNouc CA134 Gal. <br /> Wanc W yid <br /> RQ Wu¢Comb,ufiblc liqui4 N.O.S.NA CA221 .� <br /> isn m oa amomina<a.;w 11701 F 2 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drams Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> Glycol Bulk 50/50 Gal. <br /> Glycol Bulk Cone. Gal. <br /> TEST:❑ Clor D Tech 4000---ppm p Clot D Tech 1000❑Pass❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑Fail <br /> Field Service Work Description: Total Charge <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard - Ou Site Off Site Off Load Star[ OB Load End-Return to Yard <br /> TSDF ❑ Consolidated Manifest <br /> Evereen Oil,6880 Smith Avec. Road 30B Env.Svc. 4139 Nom.ValentineEvern Env. s 11 15 31 Clark Ave. <br /> El- <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 lndustty,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> CFR <br /> Env.Svc. <br /> 16604 Evergreen San Pedro ❑ 745 Ag West Beuemvia Env.Svc. 11 944 E.Slauson AA 332810 Westem 34 4 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011'\ Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL000110021 CAID00091507 CAIA00214411 <br /> Source: Ll Collection Station Ll Government =Y0 <br /> enerator ce t fies 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 generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> ' d the above listed generator to the terms on the reverse <br /> Retain sarnpl side of this form. <br /> Driver Sig true 4 AYrne Route# Date Generator's Signature Print Name Date <br />