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J � <br /> 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 /> 800-972-5284 Evergreen INVOICE 70445 7 <br /> 6880 Smith Ave.,Newark, CA EPA#CA0982413262 P.O.Box 49065 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 San Jose,CA 95161-9065 <br /> JOB LOCATION <br /> BILLING INFORMATION Date <br /> NAMF. NAM[: CASA ❑ C'HF;CKE] <br /> e / <br /> ADllRI?SS � # <br /> ADDRESS CUSTOMER CODE NO. <br /> 7 LY q Lj �. Gt3Y.G2o 1 I <br /> CITY STA E ZIP CO CITY STATE ZIP CO PO ti <br /> PIiONO 5 PHONE NO. <br /> IPROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> Z G CODE NUMBER <br /> I Ised oil,Non-RCRA Il"jous I,ubricating CA 221 7 �.� Gal <br /> . C. <br /> Waste,liquid Industrial CA 221 .� Sc> <br /> Cial <br /> Used Automotive Antifreeze,Non-RCRA I{ dous CA 134 Tial <br /> Waste,Li uid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA 221 Tial <br /> 1993 111(Oil contaminated with halogens) IWIA�m <br /> Oil&water,Non-RC'RA Hazardous Waste,L uid CA221 Gal <br /> Wase Solids and Sludges Tial <br /> Wash-out <br /> l";uch <br /> Drained 11sed Oil Filters <br /> Drum <br /> Non-RC'RA hazardous Waste Solids(oily deb s) CA 223 Ilium <br /> :nlptti Dnnlu <br /> Drum <br /> 7 ransportation <br /> Ilrs. <br /> ()tiler. <br /> Other: <br /> (cher: <br /> Other <br /> ()tiler: <br /> ()tiler <br /> ()ther <br /> (tiler: J•— _ w_. . <br /> n. <br /> 1'I:S' G -77— /'i"� P SS Ii, f e PPM i fest °`S0 <br /> Collection Station ❑;agricultural Source <br /> ❑Goverrunent Source ❑Industrial Source ;DAYS TOTA <br /> ❑ Marine Source <br /> CHARGES �S- �� <br /> ' j —LOW91 bffiee 949-757- Pay From This Invoice <br /> TSDF: Evergreem Oil, InI hereby certify that all information submitted in this and all attached documents <br /> 6880 Smi h Aven a contains true and accurate descriptions of the waste.All relevant information regard- <br /> Newark, CSA 945 0 ing known or suspected hazards associated with the waste has been disclosed. This <br /> further serves as notification that the above liquid wastes are banned from land <br /> EPA# CA�98088 418 <br /> disposal pursuant to Title 22 Section 66268.7(a)(10). I also acknowledge that I have <br /> read and agree to the terms on the reverse side of this form. Pursuant to Title 22, <br /> Section 66264.12, Evergreen Oil,Inc.has the appropriate permits for,and will accept <br /> the wastes manifested to Evergreen facilities. <br /> Zoe �rzn <br /> VER ROUTE# D SIGNATURE ENE TOR' SIGNATURE PRINT NAME <br />