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Evergreen Environmental Services <br />dedicated to the protection of the environment <br />Our, <br />To schedule a pickup,, call Send payment to: <br />800-.7ul72-5284 Evergreen <br />6880 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 <br />• :j irs:m <br />e <br />Bill of LadinWInvoice <br />774019 <br />ti r <br />Date71 <br />�- <br />AME <br />MANNEST <br />•' 1` t` <br />NAME <br />• <br />Irk,r Time Of Only) <br />MR <br />CASH ❑ CHECK <br /># Z 7 <br />ADDRESS <br />ADDRESS <br />CUSTOMER CODE NO. <br />3ZXI :A2 <br />717 <br />�i.SC,7Z <br />CITY <br />STATE ZIP CO <br />CITY <br />STATE ZIP CO <br />PO # <br />k*(-% <br />.► <br />146NE NO. <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />I Ll / <br />�p <br />ZEa.a <br />.. •WASTE <br />oil, Hazwfious; Lubricating <br />Waste, Liquid Industrial <br />MANNEST <br />•' 1` t` <br />QUANTITY <br />• <br />Irk,r Time Of Only) <br />MR <br />contaminatedUsed <br />RQ Waste Combustible Liquid, N.O.S. NA <br />1993 111 (Oil with halogens) <br />Liquid— <br />Non-RCRA HazardousWaste , ,.. (oily debris) <br />sourceI; FZ;fftion <br />0 Government <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". i <br />DEvergreenO <br />i • f • Smith Avenue <br />Newark, CA • <br />CAD980887418 <br />Accounting Offi a 949-75''7770 <br />I hereby <br />.rt <br />at all information in this and all • documents <br />contains tryre and ac descri tions este. All relevant informa[ion 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,Seetion 66264.12, Evergreen Oil, Inc, Evergreen <br />Environmental Services, has the appropriate pennits for and will kept <br />the wastes man*sted to Evergreen facilities so long as it mats the <br />approved acc ptance criteria. <br />R ROW ITF # DRFVVR SIGNATURF t.FNFRATOR'. S-WNATiFR PRINT Nt NIF <br />