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E 6— <br /> Evergreen Evergreen <br /> Environmental Rill of I, ng / Invoice <br /> Send payment to: <br /> 490 Services , vetFrce,t INVOICE 9431 <br />,990 Smith Ave., Newark CA 94560 P O Box 45997 <br /> 900)972-5294 FPA HO CAT)990695761 San I ancisco,CA 94145 <br /> Date 3i 95— <br /> OB LOCATION BILLING INFORMATION y <br /> NAAIr'" NAME <br /> LADDRIESS <br /> rC'ASIi ❑ CHF,CK❑ADDRESS Cr TS'I.OMTR CODS:NOr pJ <br /> CITY <br /> STATE ZIP COC'I1'\' , CO ,�� <br /> PHONE,NO. I'110NF;NO <br /> --- —-- / i <br /> r <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> -� CODE _NUMBER <br />[lscd oil.Non-R<'1L\ 'azattlous I nhricating (',\221 'J C ��� _ <br /> Waste.Liquid <br /> Industrial CA 221 <br /> (ial <br /> 1'sed Automotive Antifreeze.Non-RCRA Hazardous C•;\ 114 -- <br /> Wastc, Aguid Oral <br /> R(1 Write Petroleum Oil NOS Combustible Liquid UN CA 221 (.�1 <br /> 1270 III Oil contaminated with halo ens IWI 111)2 <br />')il&Water,Nan-RC'RA IT.v_ardous Waste.Liquid C'n221 Gal — <br /> Kaste Solids and Sludges -- - -- --- --- — _--- --- <br /> Gal <br />,Nash-out ----- _ <br /> 1:ach <br /> pained Used Oil Pilfers -- ---- - <br /> D um — <br /> Ori-RCRA I lazardous Waste Solids(oily debris) <br /> C. 2 j - <br /> f hum <br /> — <br /> lhum - <br />'ransportation -.---- <br /> Ilrs. <br />)thcr -rip r7t <br />(till). -- -- ---�-� ' _ ----— - - <br />]Collection Station ❑ icult al Source - - --- <br />]Government Source Industf Source <br /> Marine Source NET 7 DAYS TOTAL <br />] <br />-- CIIARGES <br /> Please P y From This Invoice <br /> 1)1' F,VFR(,RFF.N OTI,. C. (510)795-4400 1 herehv certify that all infortnation s in this and all attached documents <br /> 6990 Smilh Avenn FPA 1D#CAD990997419 contains true and accurate descriptions of the waste. All relevant information <br /> Newark,CA 9456 regarding known or suspeoed hazards associated with the waste bas been disclosed. <br /> This f ter sen es as notification that the above liquid wastes are banned frcmt land <br /> dispo 1 ,rsuant to F,tle 22 1 eL1'at ,(i26R.7(ax 10). 1 also acknowledge that I have <br /> read td. to the.terms o the ev se side of this form. <br /> FR R(lll l F.H 1191 :R CIf;NA'1 nRF ----- . _ .-- ---- <br /> F R fOR'C ST NA t'RF t`trlN t N IMF <br /> rr <br />