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-Z- Evergreen Environmental Services <br /> dedicated to the protection of the environment Bill of Lading/ Invoice <br /> To schedule a pickup, call Send payment to: <br /> 400 800-972-5284 Lvergrectt INVOICE 576948 <br /> P.O. Box 45987 <br /> Vernon200 Central Ave.,Newark, CA EPA#aAD98241San 1-ranciu o,CA 9.1145 � 7� Q <br /> 10712 Veon Ave.,Ontario CA EPA# AL000027724 7724 Date !� [ <br /> JOB LOCATION BILLING INFORMATION <br /> N.AAIF NAME CASH ❑ CHECh❑ <br /> C # <br /> ADDRESS V)DRF:SS Cl TS CODE NO. <br /> O <br /> CITY STATE ZIP CO CITY STATE 7IP CO PO it <br /> G¢( C1 Y-7 <br /> PHONE N( . PI IONS NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 421)b ^— ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> tlsed oil.N(n-RCRA I • docs Lubricating ricating CA 221 q, Yeo (hal eo <br /> ` Z i <br /> Waste,Liquid Ind stria) CA 221 Gal <br /> I ised,lutomotive Antifreeze,Non-RCRA Ilazarus CA 134 Gal <br /> Waste,I r uid <br /> RQ Waste Petroleum Oil NOS Combustible Liqu d t iN CA 221 Gal <br /> 1270 111 Oil contaminated with halogens) 1q)tllw- <br /> Oil&Water,Non-RC'RA Ilazardous Waste.Liqt id CA-221 Gal <br /> Waste Solids and Sludge Gal <br /> Wash-out <br /> Each <br /> Drained Used Oil Filters Ilium <br /> :von-RCRA hazardous Waste Solids(oil) debris) Chill Drum <br /> I;nyxy)hunts :=, ' Dnnn <br /> Translx)rtation I In <br /> O thcr: <br /> Other: <br /> van <br /> Other- <br /> Other <br /> Other- <br /> Other: <br /> ther:l thee: <br /> ()(her: <br /> Other: <br /> fF:S'f PA.S ET FAIL❑ PPNt I' . <br /> Collection Station ❑,lgricultural Source <br /> 0 Government Source ❑Industrial Source NET 7 DAY S TOTAL L <br /> ❑hiari�x:Source <br /> CHARGES <br /> Accounting Office 510 795-4400 Please ay From This Invoice <br /> TSDF: Evergreen Oil, Inc. I herebv ce tilt' th all information submitted i this and all attached documents <br /> 6880 Smit Avenuecontains true and a irate descriptions of the waste. All relevant information <br /> regarding known or sus ed hazards asscx is with the waste has been disclosed. <br /> Newark, 9456 This further serves as notdica that the ivc li lid wastes are banned from land <br /> EPA# CA0980887 18 disposal pursuant to Title 22 Section 66268.7(ax I( I also acknowledge that I have <br /> read and at3ee to the terms on the reverse side of d s ort. <br /> IV ROUTE# DRI SIGNATURE GEN T R'S SIGNATURE PRINT NAME <br />