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A member of the Evergreen Group of companies <br /> 01 f VERGREEN Gated to the protection of the environment. <br /> A VACUUM <br /> -�/ SERVICES <br /> INVOICE V 612 <br /> ' 6880 Smith Ave., Newark, CA 94560 <br /> (800) 972-5284 EPA ID# CAD980695761 <br /> •, ,_ .JOB LOCATION _ _ BILLING INFORMATION DATEW `2() <br /> NAME - - NAME - - P.O.# <br /> C S�f✓'�7 <br /> r Cts <br /> S ADDRESS , ADDRESS - - CUSTOMER NO. <br /> T <br /> O <br /> E" CITY_- -='.STATE. ZIP !'-�- COQ. CITY -_...__--:: STATE --ZIP • CO PHONE NO <br /> . PLEASE PAY FROM THIS INVOICE �r7�UjX>6�� / r-`TERMS: NET 7 DAYS <br /> -RODUCT MANIFEST # GALLONS PRICE AMOUNT <br /> WASTE PETROLEUM OILS COMBUSTIBLE LIQUID NA1270 <br /> '7 5 . <br /> HAZARDOUS WASTE LIQUID FORM E-E UN9189 <br /> WASTE OILWITH >1000 PPMHALOGENS'. <br /> a _ J <br /> OTHER..:, iG/�� <br /> TSDF .'EVERGREEN OIL,-INC:(4i5)�795-4400 _.TOTAL CHGES <br /> •. . :6880 Smith Ave. EPA.Mi# CAD980887418 '. t AR (..,':. <br /> _. ' <br /> •:Newark CA I CERTIFY THAT THE ABOVE AMOUNTS AND INFORMAT10N TO BE CORRI <br /> DRIVER ' ROUTE.# DRIVER SIGNATURE ' _ r GENERATORS SIGNATURE <br /> �, o..Tt '''. n s r{ s..-n'•Y' ; i, �i 4 mr _�.rs...' _ <br /> or <br /> J:x <br /> a pocked,marked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If I am a large quantity generator, I certify that I have a-progrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I hove selacled the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> O' threat to human health and the environment;OR,if I am a small quantity generator,it have made a good faith effort to minimize my waste generation and select the best <br /> N <br /> waste management method that is available to me and that I can afford / <br /> 0 Printed/Typed Name / Signature i o Year <br /> 111510 1 <br /> Z T 17. Tr orter 1 Acknowled ement of Receipt of Materials r <br /> Z RN PriMonth Day Year <br /> nceTd N <br /> y a9�eSigna /�1 <br /> P <br /> We 18. Tomas nee 2 Acknowled ement of Recei 1 0l Materials <br /> T Printed/TypSignature <br /> Name SignaMonth Day Year <br /> LL e Y� <br /> O a <br /> W 19. Discrepancy Indication Space – - <br /> N <br /> _ V A _ s. <br /> Z <br /> L <br /> - <br /> ' 1 20. facilityOwner or Operator Certification of recei t of hazardous materials covered b this_manilest except as noted in Item 19. <br /> T printed/Typed Name Sigrmture Month Day Year <br /> y <br /> DO NOT WRITE BELOW THIS LINE. , <br /> OTSC 8022A (7/92) / ' <br /> EPA 8700-22 �L–� Yellow. GENERATOR RETAINS- <br />