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I A DIVISION OF CALIFORNIA OIL RECYCLERS, INC. <br /> EVERGREEN BILL OF LADING/ <br /> ENVIRONMENTAL NVOICE 3 09 [� g r_ <br /> SERVICES <br /> 6880 SMITH AVE.,NEWARK,CA 94560 <br /> (800)972-S284 EPA IDM CAD 980695761 DATE Q <br /> JOB LOCATION BILLING INFORMA f ION t?, ,95 <br /> NAME NAME CASH CHECK It <br /> U PQ M <br /> T ADDRESS ADDRESS CUSTOMER NO. <br /> pa <br /> ECEN STATE ZIP CO CITY STATE ZIP CO PHONE NO. <br /> R (Z1� ) <br /> PLEASE PAY FROM TH%c-1 1 4• iCE <br /> PRODUCT MANIFEST# GALLONS PRICE AMOUNT <br /> USED OIL,NON-RCRA HAZAR US WASTE, LUBRICATING Z,Tj � J�(�, <br /> COMBUSTIBLE LIQUID,NA1270 INDUSTRIAL <br /> NON-RCRA HAZARDOUS UNI 142(AUTOMOTIVE ANTIFREEZE) <br /> WASTE LIQUID UN9189(OIL 8 WATER) <br /> WASTE PETROLEUM OIL NOS COMBUSTIBLE LIQUID NA1270 <br /> (GREATER THAN 1000 ppm OGENS) <br /> TEST PAUM5 rAk❑ PPM <br /> OTHER: '} - <br /> CRUSRED UNCRUSHED EMPTY <br /> DRAINED USED OIL FILTERS <br /> TSDF EVERGREEN OIL,INC. (510)7954400 1 o.61Y that n.mhHhh.b.h.m ammmuhown.eo.e an true em oarna TOTAL <br /> 6880 Smith Avenue EPAIDM CAD 887418 .m"r"I dead oil widedno c.werm. Hearth &Sets,SerN<ea meant CHARGE <br /> dNinhioof wW dl Wnwm to C.Ytoao Readh 6 We Cod.. Sectio <br /> i Newark,Califwnia 94560 25250.1.unMea ahsrwiee word. This further ear»e as nonfoafon that th <br /> east"weM.la berm"Iron land diepneal W,."to Sween 6MS](10)of <br /> Tale 22, 1 Mao acfnowlap.dthat I haw read•m aq, .to the terms and <br /> condition.set forth on the ne sid <br /> veree d tms form <br /> � <br /> RIVER ROUTE N AVER SIGNATURE GENERATOR'S SIGNATURE <br />