Laserfiche WebLink
WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> &,dicated to the protection of the environment NOJ79395 <br /> To schedule a pickup, call Send payment to: Sales Order <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 Dat <br /> G04URATQR/JOB LO-CATION BILLING INFOWATION <br /> �tDNAME CASH❑ CHECK❑ <br /> 'Z <br /> ADD R4& <br /> ��j� 17 ADDRESS <br /> C, <br /> CIT)(7Co. CITY STATE ZIP Co. Po* <br /> PII N PHONE NO. ROFILE NO. PC S MER EPA IDNO. <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 H�­11&­ <br /> w <br /> .,,,a j CA134 Gal. <br /> RQ Waste Combustible Liq.id,N.O.S.NA CA221 <br /> 1993 In(Oil contaminated will,halo ens) F001/F001 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 6a1. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each oe <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:[] Clor D Tech 4000ppm []Clor D Tech 1000 Pass F]Fail D Halogen Detector/Flame Test ❑Pass ❑ Fail 1:3 or <br /> Field Service Work Description: Total Charges <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 17 Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env. Svc. Evergreen Env.Svc. AJS Filter ❑ <br /> 6880 Smith Ave. Road 3013 4139N.Valentine 1:1 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry.CA 91745 <br /> CAD980887418 CAD982446874 CAD42446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. ❑ Evei-reen Env. Svc. CFR F ❑ Greenleaf Env.Svc. <br /> 04 <br /> 166 S. San Pedro 745 A West Betteravia 944 E.Slauson Ave. 3210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 0 A,, Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the Volume Or <br /> SOurce: LJ Collection Station LJ Government <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> Lj ML) qe�arine Agricultural j Industrial gen to be economically practicable.—1 <br /> '� certif <br /> I ereb y that I have read and have the authority to <br /> b1nd Q above listed generator to the terms on the reverse <br /> Retain sampw#- sldTef tAis rfo form. <br /> k <br /> Drive Signature / /lyriot Name Route# j Date G erator's Signature Print Name Date <br />