Laserfiche WebLink
WORK ORDER/SERVICE AGREEMENT <br />Evergreen Environmental Services <br />dedicated to the protection of the environment 215319 <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 />GENERATOR/JOB LOCATION <br />Send payment to: <br />Evergreen Oil, Inc. <br />P.O. BOX 678252 <br />Dallas, TX 75267-8252 <br />BILLING INFORMATION <br />Sales Order # <br />Date <br /> <br />NAME NAME CASH CHECK 6 <br /># <br />ADDRESS ADDRESS CUSTOMER copE NO. <br />.1'.6. <br />CITY STATE <br />-- <br />ZIP CO. CITY STATE ZIP CO. PO # <br />PHONE NO. <br />( ) <br />PHONE NO. <br />( ) <br />PROFILE NO. CUSTOMER EPA ID NO. <br />PRODUCT WASTE <br />CODE <br />MANIFEST <br />NUMBER QUANTITY UNITS PRICE AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating CA221 Gal. <br />Waste, Liquid Industrial CA221 Gal. <br />Used Automotive Antifreeze, Non-RCRA Hazardous <br />Waste Liquid CA134 Gal. <br />RQ Waste Combustible Liquid. N.O.S. NA <br />1993 III (Oil contaminated with halogens) <br />CA221 <br />F001/F002 Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gal. <br />Waste Solids and Sludges Gal. <br />Wash Out . EdcIie i. <br />Drained Used Oil Filters Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum <br />Empty Drums ..9 Drum <br />Transportation Hrs. <br />Non Hazardous Water . <br />- <br />I Gal. <br />TEST: E Clor D Tech 4000 ppm Clor <br />,../V <br />D Tech 1000 Pass iaiifl Halogeil Detector/Flame Test Pass Fail , <br />Field Service Work Description: , Total Charges <br />, <br /> <br />.,./.. ( <br />i ) <br />i.../ - <br />• <br />Other: <br />Other: <br />Vacuum Services Time <br />Out of Yard On Site Off Site Off Load Start Off Load End Return to Yard <br />TSDF <br />Evergreen Oil, Inc. <br />6880 Smith Ave. <br />Newark, CA 94560 <br />CAD980887418 <br />Consolidated Manifest <br />fl Evergreen Env. Svc. I—I Evergreen Env. Svc. r-7 MS Filter <br /> Road 30B I I 4139 N. Valentine I I 15131 Clark Ave. <br />Davis, CA 95926 Fresno, CA 93711 Industry, CA me <br />CAD982446874 CAD982446882 CAD000097432 <br />I 1 <br />Evergreen Env. Svc. I—I CFR 1—I CFR I Greenleaf Env. Svc. <br />745 A West Betteravia I 944 E. Slauson Ave. I---I 33210 Western 1 3474 Toyon Circle <br />Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 <br />CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br />Generator certifies that it has established a program to reduce the volume or <br />quantity & toxicity of the hazardous waste to the degree determined by <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br /> <br />bind the above listed generator to the terms on the reverse <br />Retain sample # side of this form. <br />Evergreen Env. Svc. <br />16604 S. San Pedro <br />Carson, CA 90746 <br />CAD981696420 <br />Source: 0 Collection Station D Government <br />Li Marine Agricultural Cl Industrial <br />Date Generator's Signature ' Print Name Date Driver Signature Print Name Route #