Laserfiche WebLink
_ M <br /> Evergreen Environmental Services <br /> dedicated to the protection of the environment Bill of Lading/ Invoice <br /> To schedule a pickup, call Scp,t <br /> nd Nmcrtt to: <br /> 800_072_5284 Evergreen INVOICE 702 ") b 9 <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 nate <br /> JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH ❑ CHF,CKEI <br /> ADllSS <br /> ADDRESS CU TC Q OMER CODE NO. <br /> � <br /> C p C/`�'Pr <br /> CITY STATE ZIP CO CITY STATE Z,IP CO PO# <br /> 3 Z-o <br /> PHONE NO. PHONE NO. I PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 Gal <br /> Waste,liquid Industrial CA 221 GtG9rG 0 Gal <br /> Used Automotive Antifreeze,Non-RC RA Hazardous CA 134 Gal <br /> Waste,Liquid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA 221 Gal <br /> 1993 III(Oil contaminated with halogens) RDIIHW. <br /> Oil 8c Water,Non-RCRA Hazardous Waste,Liquid CA221 Gal <br /> Waste Solids and Sludges Gal <br /> Wash-out Each <br /> Drained[rsed Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA 223 Drum <br /> Empty Drums P-nC-753a� •c3 Drum <br /> Transportation t� ~~ Ilrs' <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Other: • <br /> Other: <br /> Other: <br /> TEST PASS FAIL.ElPPM Test <br /> ❑Collection Station ❑Agricultural Source �z �'���' may' <br /> ❑Government Source industrial Source 4i i-• 4 . I �CN <br /> ❑Marine Source ('111 A R L E S <br /> Accounting Office 949-757-7770 Please Pa,, From This 111''oice <br /> TSDF: Evergreen Oil, Inc. J I hereby certify 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 regard- <br /> ing known or suspected hazards associated with the waste has been disclosed. This <br /> Newark, CA 94560 ` further serves as notification that the above liquid wastes are banned from land <br /> EPA#CAD980887418 ► disposal pursuant to Title 22 Section 66268.7(a)(10).1 also acknowledge that I have <br /> read and agree to the terms on the reverse side of this form. Pursuant to Title 22, <br /> i Section 66264.12,Evergreen Oil,Inc.has the appropriate permits for,and will accept <br /> Ithe wastes manifested to Evergreen facilities. <br /> DRIVER R UTE# fDR R SIGNA � GENERATOR'S SIGNATURE PRINT NAME <br /> Z. . ,J . <br />