Laserfiche WebLink
WORK ORDER/SERVICE AGREEMENT <br /> I Evergreen Environmental Services N022A25S8 <br /> dedicated to the protection of the environment <br /> r <br /> To schedule a pickup, call Send payment to: Sales Order W, <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 Date:Z <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NA�4 NAME CASHE] CHECKE] <br /> ZZ # <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> -0 <br /> 7 <br /> CITY STATE ZIP CO. CITY STATE ZIP Co. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <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 /> Used Automotive Antifreeze.Non-RCRA Hazardous -7 <br /> W. CA 134 Z �-We Gal. <br /> Waste <br /> Lqud <br /> RQ WC''' eiquidN <br /> .1.1.�A CA.221 <br /> Gal. <br /> 1993 In(Oil contaminated w e F00I/F002 <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 Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> TEST:D Clor D Tech 4000ppm ❑Clor D Tech 1000 0 Pass E Fail E] Halogen Detector/Flame Test ❑Pass ❑Fail <br /> Field Service Work Description: Total Charges <br /> of=m <br /> Other: VAZLJ <br /> Other: +�F <br /> r-uuj <br /> Vacuum Services Time <br /> Out of,-Yard—On Site—Off Site—Off Load Start Off Load End Return to Yard <br /> TSO L-1 Consolidated Manifest <br /> Evergreen Oil,Inc. F7 Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B 4139N.Valentine 1:1 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ reenEnv.Svc. ❑ Evergreen Env.Svc. F—] CFR <br /> Ever,- F—] CFR ❑ Greenleaf Env.Svc. <br /> 16604 S. San Pedro 745 A West Betteravia 944 E.Slauson Ave. " 33210 Western 3474 Toyon Circle <br /> Carson,CA 94 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696P-0 CAD982446858 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a pro-ram to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> L] <br /> jMarine Agricultural L) Industrial generator to be economically practicable. <br /> ource: Ij Collection Station J Government quantity <br /> hereby certify that I.have read and have the authority to <br /> bind the enerator to the terms on the reverse <br /> Retain sample # side of this form. <br /> Driv"-er Signature Print Name Route# Date Generator's Si-nature Print Name Date <br />