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Bill of LadinWInvoice <br />.,/ <br />Evergreen Environmental Services 772169 <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 />Smith Ave., Newark, CA EPA# CAD982413262 P.O. Box 49065 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 San Jose, CA 95161-9065 Date _ 2.5-029 <br />JOB LOCATION RILIAN[_ INRaRMATInN IJ <br />AME <br />WASTE <br />CODE <br />NAME — - -- <br />----- <br />CASH ❑ <br />CA 221a <br />CA 221 <br />ADDRESS <br />fad , <br />�C7�HEECCK <br />CUSTOMER CODE NO. <br />ADDRESS <br />- <br />q <br />' fi / <br />AQ Waste Capbustible Liquid, N.O.S. NA <br />1993 IA (Oil contaminated with halogens) <br />Od A Wala, Non-RCRA Hazadous Waae, Liquid <br />W shwscs <br />CMZ. <br />CITY <br />TATE ZIP CO <br />CITY <br />SPATE ZIP CO <br />PO q <br />G <br />Drained Used Oil Fib= <br />PHONE NO. <br />Dn nn <br />PHONE NO. <br />Nan-RCRA Hazardous Wase Solids (oily debris) <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />Drum <br />—361Z <br />EmptyDrium <br />Drum <br />PRODUeT <br />WASTE <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTITY UNITS PRICE AMOUNT <br />( For Time Of Service Only) <br />Used oil, Kon-RCR1 azar us lubricating <br />WAbU, Liquid Industrial <br />CA 221a <br />CA 221 <br />Gal <br />Q <br />Gal <br />fad , <br />L;*W Automotive Antiftan. Nan-RCRA Hazardous <br />Waste, <br />CA 134 <br />Gal <br />AQ Waste Capbustible Liquid, N.O.S. NA <br />1993 IA (Oil contaminated with halogens) <br />Od A Wala, Non-RCRA Hazadous Waae, Liquid <br />W shwscs <br />CA 221 <br />HOIM <br />CA221 <br />Gal <br />Gal <br />Gal <br />W <br />Each <br />Drained Used Oil Fib= <br />Dn nn <br />Nan-RCRA Hazardous Wase Solids (oily debris) <br />CA 223 <br />Drum <br />EmptyDrium <br />Drum <br />Trampmation <br />l irs <br />Other: <br />Otho- <br />Otber. , <br />Other- <br />Otho <br />(ither. <br />Other: <br />Other: <br />TEST G" ,. Q -, PASS <br />FAIT. ❑ <br />l CNA,„ PPM <br />f Test ^ 00 <br />--O! <br />&CoLkaivn Station ❑ Agricultural Source: <br />❑ Gov Source ❑ Industrial Source <br />® lam` soum <br />T A i <br />TOTAL <br />i O 1 t''!•L <br />CHARGES <br />r eaa <br />"YOU WILL ALSO RECEIVE A COMPUTER <br />GENERATED INVOICE AND/OR <br />STATEMENT FROM OUR ACCOUNTING OFFICE. <br />PAYMENT AT TIME OF SERVICE WILL <br />ALSO BE NOTED ON INVOICE". <br />T F: Evergreen Oil, Inc. <br />6880 Smith Avenue <br />Newark, CA 94560 <br />EPA# CAD98088741 <br />Accounting Office 949-757-7770 <br />I hereby c4rtify that all information in this and all attached documents <br />contains True and accurate descriptions of the waste. All relevant information regard- <br />ing known or suspected hazards associated with the waste has been disclosed. <br />I also acknowledge that I have read and agree to the terms on the reverse side <br />of this form. <br />Pursuant to Title 22,Section 66264.12, Evergreen Oil, Inc, Evergreen <br />Environmental Services, has the appropriate permits for and will accept <br />the was nifested to Ever gr en facilities so long as it meets the <br />approv d acce once criteria <br />