Laserfiche WebLink
Evergreen Environmental Services • <br /> dedicated to the protection of the environment INVOICE Bill Of 1.8(ilittg IttV01CC <br /> To schedule a pickup, call Send payment to: 515923 <br /> 800-972-5284 EverLTeen <br /> P.O. Box 45987 <br /> 7200 Central Ave.,Newark, CA EPA#CAD982413262 San FrmiciscoDale <br /> ,CA 94145 <br /> 10712 Vernon Ave.,Ontario CA EPA#CAL000027724 ---� —-- <br /> JOB LOCATION BILLING INFORMATION CASH ❑ CHECx❑ <br /> NAME N,"IE - <br /> (I .. CUS'fONIER CODE NO.. <br /> ADDRESS <br /> _ ADDRESS <br /> � <br /> 1'fY STATE ZIP' CO CfI'l' S'fA'fF. "LIP CO PO# <br /> G gsu <br /> PHONE O, PHONENO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 4M 0 <br /> PRODUCT - 1VASTE MANIFEST QUANTITY. UNITS PRICE AMOUNT <br /> z� CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 Z Gal <br /> Waste,Liquid Industrial CA 221 Gal <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal <br /> Waste,Li id <br /> RQ Waste Pelrolewn Oil NOS Combustible Liquid UN CA-221 <br /> 1270111 Oil conbuninated with halogens) RAARW <br /> Oil&Water,Non-RCFA Hazardous Waste,Liquid - CA221. <br /> Waste Solids and Sludges Gal <br /> F.ach <br /> Washout <br /> llmm <br /> Drained Used Oil Filters <br /> Non-RCRA hazardous Waste Solids(oily debris) CA 223 Drum <br /> Drum <br /> Empty Drums - - 11rs. <br /> Transportation <br /> Other. <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> 1;;;; <br /> - PAS: FAII,❑ 'fell <br /> ❑Agriculturnl SourceNET 7 DAYS TOTe ❑Industrial Source . <br /> CHARGES <br /> Accounting Office 510-795-4400 Please Pay From This Invoice <br /> I hereby arlify that all information submitted in this and all attached documents <br /> TSDF: Evergreen Oil, Inc. <br /> contains true and accurate descriptions of the waste. All relevant information <br /> 6880 Smith Avenue regarding known or suspected hazards associated with the waste has been disclosed. <br /> Newark, CA 94560 This further serves as notification that the above liquid wastes are banned from land <br /> EPA#CAD980887418 disposal pursuant to nte,22 Section 66268.7(a)(10). I also acknowledge that I have <br /> read and agree to the 1 a. n the reverse side of this fomt. <br /> DR ROUTE# DRIZNIGNATU GENERATO SIGNATOR PRINT NAME <br />