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12/23/98 10:50 FAX. 3861256 _ TEICRERT AND SON 19003 <br /> Bill of L"iag <br /> Evergreen EnvironmentaLServices 735040 <br /> dadLc Md to dre pmlec"on of the a irwmtent <br /> To schedule a pickup,cal Send payment to: Sales Order* 9&-3/731 3 <br /> 800-972-5284 <br /> F-O.Box 49065 <br /> SM Sm11h Ave.,Newark CA EPA#CAD98241SM - S=lose,CA 951(31-4065 ! <br /> ar, <br /> 18640 S,gPedro St.,Carson,CA EPA#CAOM413M ❑OCC <br /> JOB LOCATION BILLING INFORMATION Ea <br /> CTI <br /> EC <br /> NAME <br /> ,r r r <br /> ADDRPSS ADDRb4S - <br /> 5 f 5 EIMBPAMN0. <br /> CITY 3rAM ZIP CO (:fl'Y }' SIATa ZIP co <br /> '��"Iljr c, r pfARYENO. PAOFnBN <br /> CA <br /> PHONE NO. <br /> -$S <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE - AMOUNT.'. <br /> "CODE NUMBER .(Fac TLM Of Smace Only) <br /> Usod ml,Noo-RCnh H4zaazlous " Imimc lms CA221 I <br /> Ial (A221 <br /> L16W Atamelive Arddrawn,N.RCRA HAwtdmo CA 134 www AdCA221 CA2H .-. r .qzWW 3 -Y.wane s4tiaa am sladgm <br /> wadt,aa <br /> Each <br /> D"llow ue4d oil einem n"® <br /> Non-@CRAFIarb'dotnWaft So"(oily dehna) CA223 nr® <br /> Empty Drama Doan <br /> Tm'"'t'daa. <br /> e <br /> 011e <br /> - <br /> Oh <br /> OILcr. <br /> TEST <br /> Qdrr: <br /> Olhc' <br /> Omer. <br /> PASS 171 VAR.❑ - P2M T. Tac <br /> ❑cauectia Sbm. a npaim.bM4 Sao= TOTAL <br /> U aamu ❑Iadrtwvl spwce <br /> CHARGES_ <br /> ^TMS IS NOT AN INvoICE;YOU WELL Accounting Office 949-757.7770 <br /> RECEIVE AN INVOICE FROM OUR I hmvLy certify that.idl iafa tLan is this and all etmcted dneamp,ta <br /> ACCOUNTING DEPG'PAYMENT AT JL OR �wemdarxept,de..WdOw of the waste-An relevant mfn+m.ioa mgad' <br /> SERVICE WILL ALSO BE NOTED ON INVOICE". m6lmown w mapmzed hazaea,amoeiamd w th me w has bean d dwrd- <br /> f alto acknowledge that I haw road sed 419aa101he arms on dm tease Side: <br /> TSDF: Evergreen Oil, Ina- PPmmsm to 22,5ecna.66260 12,El-tor.Oil,lea,avargaan <br /> 6880 Smith Avenue rmvirenmaoral Sery�a.las theapptopm,a peaalits far and win acacm <br /> Newark,CA 94560 dw wmtea mmtfaued'm Evew—fadntiec mlang ea it a teen the <br /> EPA#CAD980887418 <br /> DRIVER ROUTE* DRIVER SIGNATURE. GENSR+TOR'S SIGNATURE PRINT <br />