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Evergreen Environmental Services 3 0 6 <br /> dedicated to the prot ction of the environment Bill of Lading / Invoice <br /> #10" <br /> To schedule a pickp, call Send payment to: 64 <br /> 1 C(� A <br /> -ow800-972-5 84 Evergreen INVOICE 1 V J't <br /> 7200 Central Ave.,Newark, CA EPA#C D982413262 P.O. Box 49065 <br /> San Jose,CA 95161-9065 / <br /> 10712 Vernon Ave.,Ontario CA EPA#CAL000027724 Dale <br /> JOB LOCATION BILLING INFORMATION <br /> NAME N,NbIE (':NSH ❑ cIIEcK0 <br /> <2 7' # <br /> .DDRESS ADDRESS CUSTOMY'R CODE No. <br /> 2 41,7 ca <br /> Q a <br /> CITY STATE IIP CO CITY STATE YIP CO PO i, <br /> J' <br /> 9J3 <br /> PHONE NO- PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> Po ) e31' - a ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubr eating CA 221 Gal <br /> Waste,liquid Indu:trial CA 221 Gal <br /> t`sed Automotive Antifreeze,Non-RCRA Hazardo CA 134 Gal <br /> 'A'aste,Liquid <br /> RQ Waste Petroleum Oil NOS Cornbustible liquil I IN CA 221 Gal <br /> 1270 Ill Oil urotaminated with halogens) R101:t(J02 <br /> (hl&Water.Non-RCRA Ilazardous Waste,LiquidC.N221 Gal <br /> Waste Solids and Sludges Gal <br /> Wash-out <br /> Each <br /> Drained(ised(Irl Filters I)ntm <br /> Non-RCRA Ihazardous Waste Solids(oily debris) CA 223 Drum <br /> Empty Drums Ilium <br /> transportation t Iln. <br /> Other. <br /> Other: <br /> Other. <br /> Other' <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> 'fEST PASS❑ FAII.❑ I'I'ht fest <br /> ❑Collection Station ❑Agricultur Source <br /> ❑Government Source ❑Industrial Source NET 7 DAYS TOTAL <br /> ❑Marine Source <br /> CHARGES h-S� <br /> Accounting Office 510-795-4400 Please Pay From This Invoice <br /> TSDF: Evergreen Oil, Inc. 1 herebv certify that all information submitted in this and all attached documents <br /> 6880 Smith venue contains true and accurate descriptions of the waste. All relevant infonation <br /> regarding known or suspected hazards associated with the waste has been disclosed. <br /> Newark, CA 94560 [his further serves as notification that the above liquid wastes are banned from land <br /> EPA# CAD 808874 8 disposal Pursuant to Title 22 Section 66268.7(ax10). 1 also acknowledge that I have <br /> read and agree to the tens on die reverse side of this form. <br /> Y--)Ls3 <br /> DITTVER ROUTE# VER SIGNATURE GENERATOR'S SIGNATURE PRINT NAME <br />