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Evergreen En ntal Servic�- �------ r <br /> dedicated to the protection of the environment Bill of Lading / Invoice <br /> To schedule a pic up, call Semi ]tat r1lent to: <br /> 800-972— 84 Evergreen INVOICE 669945 <br /> 6880 Smith Ave.,Newark, CA EPA#CAD9 2413262 P.O. Box 49065 <br /> 16540 S.San Pedro St.,Carson,CA EPA# AD982413262 San Jose,CA 95161-9065 <br /> Date 7 C� <br /> JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH ❑ C'HEC'h❑ <br /> 1DDRF L <br /> ADDRESS CUSTOMER CODE NO. <br /> SMC N� A _ EGGC�3 <br /> CITY STAtE ZIP CO CITY STATE IIP CO PO ii <br /> 'ESc.AL cA C> --73015 <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> ( )d3 - X04 ( ) 1 Cho 19M <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Iised oil,Non-RCRA Hazardous Lubricating CA 221 Cal <br /> Waste,Liquid Industrial CA 221 Gal <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal <br /> Waste,I�quid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA 221 Gal <br /> 1993 III(Oil contaminated with halogens) IDDI/RAP- <br /> Oil 8c Water.?ion-RCRA Hazardous Waste.Liquid GkMI Gal <br /> Waste Solids and SludgeX22 Gal ZS-. S-- co <br /> Washout J <br /> Each <br /> Drained I'sed Oil Firers Drum <br /> Non-RCRA Ilazardous Waste Solids(oil) debris) CA 223 Drum <br /> Empt) bums <br /> Drum <br /> I'mrupcxtation I Irs. ' <br /> Other: <br /> Other: <br /> Other <br /> t hth-r <br /> Other <br /> Other <br /> Other. <br /> Other <br /> TEST PASS❑ FAIL❑ PPM Test <br /> ❑Collection Station ❑Agricultural Source <br /> ❑Government Source ❑Industrial Source <br /> El Marine sour '� / DAYS <br /> ` . <br /> Accounting Office 510-795-4400 Please i'?y 1-1-0111 1111; <br /> TSDF: Evergreen Oil, Inc. I hereby certiA that all information submitted in this and all attached documents <br /> 6880 Smith Avenue contains true and accurate descriptions of the waste. All relevant information <br /> regarding known or suspected hazards associated with the waste has bean 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 Title 22 Section 66268.7(ax10). 1 also acknowledge that I have <br /> read and agree to the terms on the reverse side of this form. <br /> DRIVER ROUTE# D R 4NATURE GENERATOR'S SIGNATURE PRINT NAME <br /> jk31g8 <br />