Laserfiche WebLink
2011-Feb-11 02,10 PM DSW AG 09-3�a-8867 27/42 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen E vironmental Services <br /> lrrlir ulrrl!u IY+r!n rnl rrrnrl qJ'du rnl lrnrrmcnr No— 242599 <br /> To schedule pickup, call ;,1,I(l i;nrntrtll lu; <br /> 800-•971-5284 SuJes Order ��7L.�sEf <br /> Evcrgt•een Oil. Inc. <br /> 8880 Smith Ave,, Newark,CA F•PA#C 0982413282 P.O. BOX 678252 <br /> 18540 S.San Pedro St.,Carson,CA qPA#CAD982413282 Dallas,TX 75267.8252 <br /> GF.NERATOR/JOII LOCATION Date: <br /> ,N B BiI.I,iNG INFORMATION <br /> NAMr <br /> cAsII D cI•IEcx 0 <br /> ADDRESS ADDRESS # <br /> STOMM.R ODE.NO. <br /> e <br /> CITY STATE ZIP CO, CITY STATE ZIP CO, Po# <br /> PH F NU. PHON r NO. PROFILE Nn, 1 CU5TONIER EPA 1D NO, <br /> ) � � 1 I Zt <br /> PROI)tICT WASTE MANIFFST <br /> CODE NUINIBER QUAN'YITY UNITS PRICE AMOUNT <br /> Used a.rtl,Non•RCRA Hazardous LU rieating CA221 <br /> Waste, Liquid Ind Ktriul CA221 Gal. <br /> l.d.vu1amniiv,! N111-n('RA Irn the <br /> W,• I.t ul,l CA 114 Gal. <br /> HU Wua,•('SnnF+rtlhlr LIW-gid,s.r+,S,NA <br /> c;nazt <br /> IFII III III I ,Inmini.I lull.+r RCA22lll: <br /> Oil&Water.Non-RCRA Hartar(Inu%Wustc liquid CA221 <br /> wnstc Solids and Sludges Gal. <br /> wwsh out <br /> such <br /> Drained Ilsed(ail Fihcn DIUm <br /> Non•RCRA NIzurloI' wasto Solids Imly d hri..i CA)_3 Drum <br /> Empty Drnns <br /> Drum <br /> TntnsPnrladnn <br /> Nan Hum ,pWut.rHrs•` Gal. <br /> TEST: Clor D Tech dfN)OPPm ('Ittr D Tcch Ifk711 Pnss Fall Flalugen DetectnrlFlame Test Paso [] Fail <br /> 3C <br /> Field 5ervia•Work Description; <br /> Olhcr <br /> Other- <br /> Vacuum <br /> therVucUulll erV iccc Tltlle <br /> Out of and—_On SitC---Off Silt UI'f Utud Stag 01T Lt ad End Rete to Ynrd yj czo <br /> TS �� Consolidated Manifest <br /> F.vcr�fL'cn(ail. Euc•. f•—? f:vcr•Peen <br /> (IV.Svc, I;vrrgreen 671v,SVC. AJS Filter ❑ <br /> (NA911 Smith Ave. L.1 Ru;I 30H 4139 N,Valentine I5I51 Clark Ave. <br /> Newark,CA 945(,4) Davis,CA 59?h Flesnn,CA 93711 Induxtrryy CA 9174,5 <br /> CADY908874Ix C•AUyS2 971 CAD982446982 CA X)97432 <br /> Glivergrcen Env.S- . ❑ E vert��recn nv.Svc. (TR ❑ CFR Greenleaf Env.Svc. <br /> Ih(,111 S.San P + 745,1 Wetit Hegc(ttvia 9a.t 51au nn Ave. 33210 Western 3474 Tuyun Circle <br /> Cdrvem.CA QO G Santa Maria;CA 93454 Loc Anggeles.CA 9(1011 UnionCity,CA 94587 Volleyy Spnnggs,CA 9535: <br /> CAD4111696A 1 (ADyi?44 g5g CAI.,01X)110021 CALOM091507 CALI7(Xl?144II <br /> ❑Guverntnent Genmunr ceriMes that it hos establil,hed a mgrmu tt+reduce the vrNurtip ur <br /> Source: Colicction Station p <br /> quantity k toxicity ul'thu h;vartlnus warm to the dcEruc dctcnnined by <br /> ❑ Marine ❑ A rieu1tural ❑ industrial b'cncrator to be dcnnolnically Practicable, <br /> I hereby certify that I have read and ha��e the authority to <br /> It in Sample #_ - bind the above listed generator tv the terms nn the reverse <br /> ride of this form. <br /> ver Signature rint Name Route# Iate Ge rator's Signature Print a Date <br />