Laserfiche WebLink
Evergreen <br /> Bill of Fading / Invoice <br /> Environmental Send payment to: <br /> Services Evergreett INVOICE <br /> - 437634 - <br /> 6880 Sntitll Ave., Newark CA 94560 P.O. Box 45987 <br /> (800)972-5284 EPA II)#CAI)980695761 San Francisco,CA 94145 Date <br /> Z5�_f <br /> JOB LOCATION BILLING INFORMATION <br /> NAME NAME,. CASH ❑ CHECK[] <br /> AL, l # <br /> ADDRESS ADDRESS CUSTOMER CODE.NO. <br /> S ou <br /> CITY',. n STATE ZIP CO CITY STATE ZIP CO PIT <br /> W M'�", <br /> 1[ONIi N(l. PHONE:NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT / WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Nun-RCRA hazardous Lubricating CA 221 C 3 76 6, — -�) Gal , vTi <br /> Waste,Liquid Industrial CA 221 J Gal <br /> Used Automotive Antifreeze,Non-RC'RA Hazardous CA 134 Gal <br /> Waste,Liquid <br /> RQ Waste Petroleum Oil NOS Combustible Liquid UN CA 221 Gal <br /> 12711 111 Oil conlalnlinlatcd wldl hal,gens HUI 1112 <br /> Oil&Walcr,Nun-RCRA hazardous Waste,Liquid C'Anl (!at JrJ <br /> Waste Solids and Sludges -- — Gal <br /> Wash-out--- <br /> Each <br /> Drained I Ised Oil Filters Drum <br /> Nun-RCRA Ilazardous Waste Solids(oily debris) CA 223 Dm in <br /> Emply DIUIIIS Drum <br /> "Transportation 1 Irs. <br /> Otltu <br /> 011tee <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> (hilar: <br /> TEST PASS FAIT.❑ Test <br /> ❑Collection Slaliuu Eli ultural Source NET 7 DAYS(CHARGES <br /> TOTAL <br /> ❑Guvenuncrtt Sowce Industrial Source <br /> ❑Murute Suurca; <br /> o <br /> Pie ay From This Invoice <br /> TSDF E VI'.I GI0-'FN OII.,INC. (510)795-4400 1 hereby cutily that all ud6nnation subnuned in this and all attached docunwrits <br /> 0880 Sllllill Aveime EIIA ID#CAD980887418 contains true and accurate desuiptiom of the waste. All relevant unfonratiom <br /> NeN,%iuk,CSA 94560 regarding known or suspected hazards associated with the waste has been disclosed. <br /> 'Ibis further sery notification that the above liquid wastes are banned from land <br /> disposal pursu. it 22 c[io 66268.7(aXIO). I also acknowledge that I have <br /> read and agr a nt on he rc erse side oftlus luno. <br /> 70 � <br /> I VER ROUTE# DRIVER G ATURE ENERA 'O S SIGNATOR PRINT NAME <br />