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1 <br /> Evergreen Environmental Services <br /> dedicated to the protection of the environment Bill of Lading / Invoice <br /> To schedule a pickup, call Send pa)'ment to. 624267 <br /> 800-972-5284 1:vergrccn INVOICE <br /> P.O. Box 45987 <br /> 7200 Central Ave.,Newark, CA EPA#C D982413262 San Francisco,CA 94145 <br /> 10712 Vernon Ave.,Ontario CA EPA#CAL000027724 Date IL <br /> JOB LOCATION BILLING INFORMATION <br /> NA E N. MF. CASH ❑ C'HF.C1:0 <br /> .U)I RESS :U)DRESS CUSTOMER CODE NO. <br /> CITY STATE ZIP CO C'F]Y STATE ZIP CO PO r <br /> 7 <br /> HONE NO PIION E NO. PROFILE NO. CUSTOMER EPA ID NO, <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA HazAous Lub'eating CA 221 iy Q Q (jai O <br /> Waste,Liquid Indo trial CA 221 Gal <br /> I ised Automotive Antifreeze,Non-RC'RA Hazardus CA 134 Gal <br /> Waste,Liquid <br /> RQ Waste Petroleum Oil NOS Combustible Liqui UN CA 221 (jai <br /> 1270 111 Oil contaminated with halogens) IUQI1 2 <br /> Oil 8e Water,Non-RCRA Ilazardous Waste.LiquiJ CA221 Gal <br /> Waste Solids and Sludges Gal <br /> Wash-out Fath <br /> Drained t ised Oil Filters [t2mt <br /> Non-RC'RA Hazardous Waste Solids(oil}debris) CA 223 Drunt <br /> Empty Drums - 2 1 loll Drum <br /> Transportation lull 11 11n. <br /> Other: <br /> Other: <br /> (cher: <br /> ()cher <br /> WSMAWAMM <br /> (cher: <br /> Other. <br /> Other' <br /> (cher <br /> TEST PAS 1""\I I.❑ 1'I'\1 lest <br /> Collection Station ❑Agricultural Source NET 7 DAY TOTAL <br /> ❑Govenmtent Source ❑Industrial Source <br /> ❑ Marine Source <br /> CHARGES 7S• �' <br /> Accounting Office 714-7 -7770 PI ay From This Invoice <br /> TSDF: Evergreen Environ ental e vices I hereby certitj that all udinntation submitted in this and all attached documents <br /> 16604 South San edro S . contains true and accurate descriptions of the waste. All relevant information <br /> regarding krtUwn or suspected hazards associated with the waste has been disclosed. <br /> Carson, CA 90746 This further serves as notification that the above liquid wastes are banned from land <br /> EPA# CAD981696 20 disposal pursuant to'fitle 22 Section 66268.7(ax Ill). 1 also acknowledge that I have <br /> read and agree to the tents on the reverse side of this lomt. <br /> i <br /> R TE# DIRIVE NATURE 'S SI—CNrFURE PRINT NAME <br />