Laserfiche WebLink
4 WORK ORDER/SERVICE AGREEMENT <br /> Evergreen�Environmentalto the,protection of the n Servicesdedicatement o <br /> N_ 19-7290��jj <br /> / To schedule a pickup, call Send payment to: Sales Order o%& <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6860 Smith Ave.,Newark,CA EPA#CA0982413262 P.O. BOX 678252 <br /> 16540 S. Pedro St.,Carson,OA EPA#CAD982413262 Dallas,TX 75267-8252 Date <br /> GENEWORIJOB LOCATIO-N BILLING INFO TION <br /> N NAME CASA❑CHECK❑ <br /> l <br /> ADDRESS � <br /> CITY S A47I CO. C T T h I ZIP O / <br /> PROME N / P ONE N PROFILE NO. A NO. <br /> ( ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gai. <br /> Waste,Liquid Industrial CA22I Gal. <br /> "id A,no .t-nnunxze.�-RCRA a.>.,mm CAI34 Gal. <br /> w rove <br /> RM IRIS li.onumxol[dam�FnN.0.5.NA �CA22I Z Gad. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> V <br /> and Sludges Gal. <br /> Each <br /> Oil Filters Drum <br /> azardous Waste Solids(oily debris) CA223 Drum <br /> sn Ham' <br /> Non Hazardous Water Oral. <br /> TEST:❑Our D Tech 4000—ppm ❑Clor D Tech 1000❑Pass❑Fail ❑ Halogen Detect it/Flame Test ❑Pass ❑Fail o <br /> Field Service Work Description: OtIII Charges <br /> Other <br /> Vazmum Services Time <br /> Out of Yard_On Site Off Sim—Off Load Stan—_Off Load End Return to Yard <br /> TSDF Consolidated Manifest <br /> ❑ fivergran oil, Inc. Evergreen Env.Svc. I—I Evergreen Env.Svc. ❑ AJS Filter I—1 <br /> 6880 Smith Ave. Rond 30B 0 4139 N.Valentine 15131 Clark Ave. LJ <br /> Newark.CA 94560 Davis,CA 95926 Fresno,CA 93711 htdusm,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446881CADOOW97432 <br /> �! Eve,Teen Env.Svc Evergreen Em.Svc. 0 CFR CFR Greenleaf Env.Svc. <br /> J 166M S.San Pedro 745 A West Betteravia 944 E.Slausontj33210Wtsmm 3474 Toyon Circle <br /> Canon.CA 90746 Swim Marie,CA 93454 Los Angeles,CUnion City.CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 C'AD982446858 CALMM0021 CALfAON1507 CAIJM214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station ❑CrOVei'nMent quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marble Q Agricultural ❑ Industria] venerator to be enmomrca0y practicable. <br /> I hereby certify that [ have read and have the authority to <br /> bind the above listed Generator to the terms on the reverse <br /> Retain Sam # aide of this f -- <br /> _ /�__ <br /> D ver , -nature r t Name Route# Datc Gen tor'S Signature Print Name Date <br />