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�Z A DIVISION OF CALIFORNIA OIL RECYCLERS, INC. <br /> t ` `I}' <br /> EVERGREEN Z� >� j <br /> F.04. BILL OF LADING/ <br /> ENVIRONMENTAL I NVOICE 27835 -1 <br /> SERVICES <br /> ate 6880 SMITH AVE.,NEWARK,CA 94560 <br /> (800)972-5284 EPA IDN CAD 980695761 DATE <br /> JOB LOCATION BILLING INFORMATION <br /> C NAME NAME CM ❑ CHECKN <br /> U _ _ PO N <br /> S ADDRESS ADDRESS <br /> T CUSTOMER NO. <br /> E C ATE ZI CO CITY STATE ZIP CO PHONE NO. <br /> MY F110M *1111S INVOICE TERrA 5: w- r -T [),'YS <br /> PRODUCT MANIFEST# GALLONS PRICE AMOUNT <br /> USED OIL,NON-RCRA HAZAR OUS WASTE, LUBRICATING Z3:_1C;c <br /> COMBUSTIBLE LIQUID,NA1270 INDUSTRIAL <br /> NON-RCRA HAZARDOUS UNI 142(AUTOMOTIVE ANTIFREEZE) <br /> WASTE LIQUID UN9189(OIL&WATER) <br /> WASTE PETROLEUM OIL NOS COMBUSTIBLE LIQUID NA127 <br /> (GREATER THAN 1000 p HALOGENS) <br /> TEST PASS FAIL❑ PPM ^'CSV �ca0 <br /> OTHER: <br /> CRUSHED UNCRUSHED EMPTY / <br /> DRAINED USED OIL FILTERS /\ <br /> TSDF EVERGREEN OIL,INC. (510)795-4400 I certify that the information and amounts shown above are true and correctTOTAL \ <br /> nd that the used oil provided to Evergreen Environmental S <br /> 6880 Smith Avenue EPA IDN CAD 980887418 aervicee meets IM <br /> definition of used oil pursuant to California Health. S■fety Code, Section HARGE ' <br /> Newark,California 94560 25250 1.unless otherwise noted. This further servee as notification that the <br /> above waste is banned from land disposal pursuant to Section 66268.7(10)of <br /> Title 22. I also acknowledge that I have read and agree to the terms and <br /> conditions set forth on the n ree W is form. <br /> DRIVER ROUTE N NATURE GENERATOR'S SIGNATURE <br />