Laserfiche WebLink
s � Bill of Lading/invoice <br /> Ev&men Environmental Services 773988 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen <br /> 6880 Smith Ave.,Newark, CA EPA#CAD9P2413262 P.O. Box 49065 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 San Jose,CA 95161-9065 Date � r 7 <br /> JOB LOCATION BILLING INFORMATION r <br /> NAME I NAME C'.A.SII ❑ CHECK❑ <br /> ADDRESS Of ADDRESS CUSTOMER CODE.NO. <br /> s C GQo l <br /> CITY STATE ZIP CO CITY STATE. ZIP CO PO# <br /> -t a <br /> PHONE NO. PI[ONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> L <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> (, CODE NUMBER (For Time Of Service Only) <br /> Used oil,Non-RCR1 H dour I, ricating C;1221 -� C'ral — Z'% �� <br /> Waste,Liquid In ustrial CA 221 Gal <br /> Used Automotive Antifreeze,Non-RCRA Hazar ous CA 134 Gal <br /> Waste,Liquid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA 221 Gal <br /> 1993 111(Oil contaminated with halogens) 140014M <br /> Oil k Water,Non-RCRA Hazardous Waste.Liq jid CA221 Gal <br /> Waste Solids and Sludges Gal <br /> Wash-out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Ilazardous Waste Solids(oily debris) CA 223 Drum <br /> Empty Iliums Ilium <br /> Transportation 1 irs. <br /> Other: <br /> Other: <br /> Other: <br /> Other- <br /> Other: <br /> Other: <br /> Other: <br /> Other <br /> I' C- 1: 11,0 PPkTest . S� <br /> Collection Station ❑Agricultural Sourc TOTA L <br /> ❑Government Source El Industrial Source <br /> ❑Marine Source CHARGES /qo , <br /> "YOU WILL ALSO RECEIVE A COMPUTER Accounting Offi949-757-7770 <br /> GENERATED INVOICE AND/OR <br /> STATEMENT FROM OUR ACCOUNTING OFFICE. I hereby certify that all information in this and all attached documents <br /> PAYMENT AT TIME OF SERVICE WIL L contains true and accurate descriptions of the waste.All relevant information regard- <br /> ALSO BE NOTED ON INVOICE"'. ing known or suspected hazards associated with the waste has been disclosed. <br /> I also acknowledge that 1 have read and agree to the terms on the reverse side <br /> JSDF: Evergreen Oil, Inc. of this form. <br /> 6880 Smith Avenue Pursuant to Title 22,Section 66264.12,Evergreen Oil,Inc,Evergreen <br /> Newark, CA 94560 Environmental Services,has the appropriate permits for and will accept <br /> the wastes manifested to Evergreen facilities so long as it meets the <br /> EPA# CAD980887418 approved acceptance criteria. <br /> IVER ROUTE# RIVr SIGNATUREE ATOR'S SIGNATURE PRINT NAME <br />