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aaEvergreen Environmental Services <br /> dedicated to the pr tection of the environment Bill Of Lading / Invoice <br /> -000 To schedule a pic up, call Send payment to: C n 3 2 3 <br /> 800-972-5 84 Evergreen INVOICE U�+ �t <br /> 7200 Central Ave.,Newark, CA EPA# AD982413262 P.O. Box 49065 <br /> 10712 Vemon Ave.,Ontario CA EPA# AL000027724 San Jose,CA 95161-9065 a Date /®� cc' 1 <br /> �Y <br /> JOB LOCATION -- - <br /> �,.�MI; BILLING INFORMATION <br /> NAME CASA ❑ CHECK,] <br /> ADDRESS U)DRESS # <br /> CL'S'fORIF:K CUDF:NO. <br /> CITY STATE ZIP CO CI'fti" ' 57:17'F; !IP C'O PO ii <br /> Cia <br /> PHONE N( PHONE NO. PROFILE NO. CUSTOMER EPA[D NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Nem-RCRA Hazz^us +Liquil <br /> C.11-2 T 7/ !1 3� Cal <br /> Waste,Liquid 7k 221 ! 7 Gal �O <br /> I!sed Autornotive Antifeeze,Non-RCRA HCA 134 Gal <br /> Waste,Liquid <br /> R(2 Waste Petroleum(hl NOS Combustible CA 221 Gal <br /> 1270 111 Oil contaminated with halogens) 1L()1,10)02 <br /> ()it r&Water.Non-RCRA Ilazardous Waste,Liqui I CA221 <br /> Gal <br /> Waste;Solids and Sludges Gal <br /> Wash-out <br /> F;ach <br /> Drained I Ise d(hl Filters <br /> Ilium <br /> Non-RC'RA Ilatardous Waste Solids(oily debris) CA 223 J <br /> Thum <br /> I:urpty Iliums <br /> Drunr <br /> Fransp nation <br /> Ilrs. <br /> Other: <br /> ()the : <br /> Other. <br /> Other. lot <br /> Other <br /> Other: <br /> Other: <br /> (cher: <br /> 1"E ' PASS FAIL.❑ PI'M est <br /> Collection Station ❑Agricultural Source <br /> ❑(ivverrurxn1 Sourex ❑Industrial Source NET 7 DA S T'OTA <br /> ❑Marine Source <br /> CHARG S <br /> Accounting Office 510-7 -4400 Pie se Pay From This Invoice <br /> TSDF: Evergreen Il, Inc. I hereby certify that all irdomtation submitted in this and all attached documents <br /> 6880 Smith venue contains true and accurate descriptions of the waste. All relevant information <br /> Newark, CA 94560 regarding known or suspected hazards associated with the waste has been disclosed. <br /> this further serves as notification that the above liquid wastes are banned from land <br /> EPA#CADS 08874 8 disposal Pursuant to Title 22 Section 66268.7(ax10). 1 also acknowledge that I have <br /> read and agree to the terms on Ore reverse side of this tori. <br /> VER ROUTE# DR R SIGNATURE GENERATOR'S SIGNATURE PRINT NAME <br />