Laserfiche WebLink
g <br />WO K' ORDER SERVICE AGREE' NT <br />Evergreen Environmental Services <br />dedicated to the protection of the environment Q <br />116974 <br />To Schedule a_pic,kup, call Send payment to: Sales Order# z- � <br />rg r� <br />$40-972-5284 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. 2457 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90084-2457 Date: <br />NAME <br />DDItESS <br />CITY.._ STATE ZIP <br />PHONE NO. -ry <br />BILLING INFORMATION <br />NAME <br />z, <br />CO. CITY STATE ZIP CO. <br />PHONE NO. _ PROFILE NO, <br />CASH ❑ CHECK ❑ <br />CUSTOMER CODE NO. <br />PO.# y ' <br />CUSTOMER EPA ID No <br />"s d <br />PRODUCT <br />WASTE MANIFEST <br />CODE NUMBER <br />QUANTITY UNITS PRICE <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221, <br />Gal. <br />Fresno, CA 93711 Industry, CA 91745 <br />Waste, Liquid Industrial <br />CA221 <br />Gal <br />❑ CFR CFR ❑ Greenleaf Env. Svc. <br />Used Automotiw Andfreese, Non-RCRA-Hazardous <br />Waste Liquid <br />CA -134' <br />.Gal... <br />CAD981696420 CAD982446858 <br />RQ Wast, Combustible Liquid, N.O.S. NA <br />1993 111(Oil eontaminat,d with halo ens) <br />CA221 <br />F001/F002 <br />Gal. <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 />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />Waste Solids and Sludges <br />Gal. <br />bind the above listed generator to the terms on the reverse <br />Wash Out <br />side of this form. <br />Each <br />Drained Used Oil Filters <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />CA223 <br />x Drum <br />Empty Drums <br />Drum <br />V <br />Transportation <br />Hrs. <br />Non Hazardous Water <br />Gal.,%, <br />TEST: ❑ Clor D Tech 4000 ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail <br />73 <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum Services Time <br />Out of Yard On Site Off Site <br />Off Load Start - Off Load End -Return to Yard <br />TSF <br />U Consolidated Manifest <br />❑Evergreen Oil, Inc. ,❑ Evergreen Env. Svc. <br />❑ Evergreen Env. Svc. ❑AJS Filter <br />6880 Smith Ave. Road 30B <br />4139 N. Valentine 15131 Clark Ave. <br />Newark, CA 94560 Davis, CA 95926 <br />Fresno, CA 93711 Industry, CA 91745 <br />CAD980887418 CAD982446874 <br />CAD982446882 CAD000097432 <br />❑Evergreen Env. Svc. ❑ Evergreen Env. Svc. <br />❑ CFR CFR ❑ Greenleaf Env. Svc. <br />16604 S. San Pedro 745 A West Betteravia <br />944 E. Slauson Ave.33210 Western 3474 Toyon Circle <br />Carson, CA 90746 Santa Maria, CA 93454 Los Angeles, CA 96 Union City, CA 94587 Valley Springs, CA 95352 <br />CAD981696420 CAD982446858 <br />CAL000110021 CAL000091507 CAL000214411 <br />Source: LJ Collection Station Government <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 />Marine Lj Agricultural <br />Industrial <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />bind the above listed generator to the terms on the reverse <br />Retain samplle # <br />side of this form. <br />Driver Signature Print Name Route # Date Generator's Signature Print Name Date <br />