Laserfiche WebLink
WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> dedicated to the proteCti0n of the environment N 0- 169791 <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 <br /> Date: A/Vnii <br /> GENERATOR/JOB LOCATION BILLING INFORMATION / I/ <br /> NW &-I NAME CASH[:] CHECK❑ <br /> 6 <br /> 7 <br /> H <br /> /1 <br /> " # <br /> ADDRESS ADDRESS CUST MER CQDE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP Co. PO# <br /> c.4 <br /> 9s-7_157 <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 ZZ4y>' 1c1-Z-'7 3.>0 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Ha—does <br /> Waste Liquid CA134 Gal. <br /> RQ Waste Combustible Liquid.N.O.S.NA CA221 <br /> 1993 IN(Oil contaminated with halogens) F00l/F002 Gal. <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 <br /> / Hrs. <br /> Non Haz_ s Water <br /> TEST:11Clor D Teel)40002ob-ppm Clor D Tech 1000 ElPass E]Fail E] Halogen Detector/Flame Test E/ass [:]Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: L nChaes <br /> Vacuum Services Time <br /> Out oforard—On Site—Off Site—Off Load Start Off Load End Return to <br /> — _ J= <br /> T Z Consolidated Manifest <br /> TS <br /> Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. F7 AJS Filter ❑ <br /> E/ 6880 Smith Ave. Road 3013 4139 N.Valentine " 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env. Svc. F7 CFR F_� F-1 CFR Greenleaf Env.Svc. <br /> 16604 S. San P961,0 745 A West Betteravia 1 944 E.Slauson Ave. 1❑ <br /> 1 33210 Western 3474 Toyon Circle <br /> Carson,CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696;-70 CAD982446858 CAL00051 10021 CAL000091507 CAL000214 I <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station J Government quantity&toxicity of the hazardous waste to the degree determined by <br /> d <br /> l ltI <br /> i <br /> A <br /> L) <br /> Marigenerator to be economically practicable. <br /> Marine L) Agricultural L) Industrial e, <br /> i— I I hereby certify that I have read and have the authority to <br /> R <br /> 4/ bind the above listed generator to the terms on the reverse t n sample # side of this form. <br /> - fir <br /> _Arw <br /> Dri r Signature Print Name Route# Date *e-M&,qto'r's SiVature Print Name Date <br />