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Evergreen Environmental Services <br />dedicated to the protection of the environment <br />400, <br />To schedule a pickup, call Send pa3ineot to: <br />800-972-5284 Evergreen <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. Box 49065 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 San Jose, CA 95161-9065 <br />.IOR LOCATION BILLING INFORMATION <br />Bill of Lading / Invoice <br />INVOKE 679851 <br />Dole /Y�r, / /y, r <br />NAME <br />I <br />NAME <br />CASH ❑ Cllltt'k❑ <br />CA 221 <br />(int <br /># <br />Y <br />CA 134 <br />fiat <br />ADDRESS <br />CA 221 <br />I1xt1.7ix121 <br />ADDRPISS <br />Oat <br />C17S'I'OMF;R CORP, NO. <br />45- <br />&`t/) -5- <br />Ual <br />V IU <br />CITY <br />1'A7T: /,III CF) <br />CrrN. <br />SI'AI'1: 7.111 CO ]i <br />4111 ^ —^ <br />Wash-out <br />Each <br />PHONE NO, <br />PHONE NO. <br />Dnun <br />PROFILE'NO. <br />CUSTOMER EPA ID NO. <br />C`1223 <br />Unun <br />Pimply Drums <br />' l-CV00 <br />FA <br />PRODUCT_ WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br />CODE NUMBER <br />Used oil, Nott-RCRA IP .rrdous Lubricating <br />Waste, liquid Industrial <br />CA 221 <br />(—al_ <br />CA 221 <br />(int <br />Used Automotive Antifreeze, Nou-RCRA Ila/ udous <br />Waste, Liquid <br />CA 134 <br />fiat <br />RQ Waste Combustible Liquid, N.O.S. NA <br />1993111(Oil contaminated with halogens) <br />CA 221 <br />I1xt1.7ix121 <br />Oat <br />_ <br />Oil 8r Water, Non-RCRA hazardous Waste. Liquid <br />CAMI <br />Ual <br />Waste Solids end Sludges <br />OaI <br />Wash-out <br />Each <br />Drained Used Oil Fillers <br />Dnun <br />Non-RCRA I Iazardmrs Waste Solids(oil),debris) <br />C`1223 <br />Unun <br />Pimply Drums <br />Dorm <br />Transportation L NTr' <br />/l <br />Ilro. <br />Outer: <br />: /q iRiLiC' <br />Other: <br />Other: <br />Other. <br />(filler: <br />Other: <br />Other: <br />Older: <br />I PASSLe FAIL LJ PPM 'feat <br />Collection Station ❑ Agricultural Source <br />❑ Uovernnenl Source ❑ Industrial Source <br />❑ Marine Source <br />r <br />N e r o nA v S 'r o 1 , <br />C 11ARG [E <br />7. �u <br />TSDF: Evergreen Oil, Inc. <br />6880 Smith Avenue <br />Newark, CA 94560 <br />EPA# CAD9808874 <br />Accounting Office 714-757-77 ease Pay From This Invoice <br />I hereby certify that all information submitted in this and all attached documents <br />contains We and accurate descriptions of the waste. All relevant infomtalion <br />regarding (mown or suspected hazards associated with the waste has been disclosed. <br />'Phis further serves as notification that the above liquid wastes are banned from lend <br />disposal pursuant lo' Ale 22 Section 66268.7 (a)(10). I also acknowledge that I have <br />read andtiffeloo thq(tekirs op the reverse side of this limn. <br />VER ROUTE# DRIVMVS-IGNATURE ,- GENI4TOM8-&1GNII.TURE <br />