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Eve rgen Environmental Services <br />dedicated to the protection of the envimninern <br />To schedule a pickup, call <br />800-972-5284 <br />7200 Central Ave., Newark, CA EPA# CAD982413262 <br />10712 Vernon Ave., Ontario CA EPA# CAL000027724 <br />JOB LOCATION <br />Bill of Lading / Invoice <br />Send paplien1it: 657220 <br />Evergreen INVOICE, <br />P.O. Box 49065 <br />Sin Jose, CA 95161-9065 U;dcJ 7 131 <br />BILLING INFORMATION <br />NAME . <br />Usedoil,Non-RCRA Hazardous Tublicating <br />Waste. Liquid Industrial <br />NAME <br />3Z7 <br />('.-NSI1 ❑ C111;(,A❑ <br />J • <br />go- <br />CA 221 <br />1 <br />(hal <br />EPA# CAD980887418 <br />disposal pursuant to Title 22 Section 66268.7 (a)(10). I also acknowledge that I have <br />:1UUI21!SS <br />CA 134 <br />C'f'S'1'UA1F:12CODE <br />Gal <br />RQ N ante Petroleum Gil NGS Combustible Liquid UN <br />1270111 Oil contaminated with halogens) <br />1 �(L <br />Cll'Y S'I'.Ffli <br />ZIP CO <br />C'1'I'Y <br />STATE /if, CO <br />y <br />ayrl .c.Ca <br />C/5 3]r&,, <br />Cin] <br />2.7/4zz <br />PI [ONE, NO. <br />PHONE NO. <br />Gal <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />ZoR Z3 -GZu3 <br />( I <br />Each <br />s <br />I <br />PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br />CODE NUMBER <br />Usedoil,Non-RCRA Hazardous Tublicating <br />Waste. Liquid Industrial <br />CA 221 <br />3Z7 <br />OO lint <br />J • <br />go- <br />CA 221 <br />1 <br />(hal <br />EPA# CAD980887418 <br />disposal pursuant to Title 22 Section 66268.7 (a)(10). I also acknowledge that I have <br />l'sed ,luh>molive ,lnlideeze, Non-RCRA 11a.ardous <br />Waste. I i uid <br />CA 134 <br />Gal <br />RQ N ante Petroleum Gil NGS Combustible Liquid UN <br />1270111 Oil contaminated with halogens) <br />CA 221 <br />HAI 11M <br />ROUTE # DR <br />tial <br />Oil & Water. Non-RCRA hazardous Waste. Liquid <br />CAMI <br />Cin] <br />Waste Solids mid Sludges <br />Gal <br />Wash-oul <br />Each <br />Drained (!sed Oil Fillers <br />Urunh <br />Non-RCRA Hazardous Waste Solids (oik debris) <br />CA 223 <br />Druni <br />11111Pty Drums <br />Druu <br />I rmslmnaliun <br />Other: <br />Other: <br />L <br />Other: <br />Other: <br />i <br />Other: <br />Other: <br />Other: <br />Otter: <br />'1'P:ST PASS Z FAII, <br />❑ PPM 'fest <br />Coll«lin; Station ❑.lgrieuluhrnl Source <br />Source ❑ Industrial Source <br />NFT �1��, 7 DAYS4�10TA_6ovenncnl <br />h.ARG �, <br />�6 fz. <br />Accounting Office 510-795-4400 ee Pay From This Invoice <br />TSDF: Evergreen Oil, Inc. <br />I hereby certify that all information submitted in this and all attached documents <br />6880 Smith Avenue <br />I relevant ilion <br />contain.; true and accurate descriptions of die waste. Nhd'omm <br />regarding known or suspected hazards associated with the waste has been disclosed. <br />Newark, CA 94560 <br />'This further serves as notification that the above liquid wastes arc bmmcd from land <br />EPA# CAD980887418 <br />disposal pursuant to Title 22 Section 66268.7 (a)(10). I also acknowledge that I have <br />read a�Idfagree to the temps on the reverseside of thisffou-no. <br />ROUTE # DR <br />ER SIGNATUREEN�RATOR'S SIGNATURE PRINT NAME <br />