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Ever greenEnvironmental Setwices <br />0.2, dedicated to the protection of the enviAwywN <br />0'A To schedule a pickup, call SM4 poyamixt to: <br />800-972-5284 I'VOV= <br />7200 Central Ave., Newark, CA EPA# CAD9a2413262 K0, PAw 45987 <br />10712 Vernon Ave.. Ontario CA EPA# C 2772 San Fr=ciwo, CA 94145 <br />0.311 NA WTII = I I <br />Date <br />4� _ - <br />PRODUCT <br />WASTE <br />CODE <br />IFEST QUANTITY <br />NUMBER <br />UNITS PRICE AMOUiT <br />MY4004—wa-PI <br />CA 221 <br />CA 221 <br />I' I'Ty "STXI'P, zip Co <br />Ft STATE ZIP CO <br />-3Z 0 <br />Gal <br />Usod Automofivc Anfikceze, Non-RCRA fla"dous <br />Waste, Liguid <br />PROFILE NO. 1: CUSTOMER EPA W NO. <br />Gal <br />PRODUCT <br />WASTE <br />CODE <br />IFEST QUANTITY <br />NUMBER <br />UNITS PRICE AMOUiT <br />Used oil, Non -12012.1 Hazardous Lubricating <br />Waste, Liquid Industrial <br />CA 221 <br />CA 221 <br />Gal <br />Gal <br />Usod Automofivc Anfikceze, Non-RCRA fla"dous <br />Waste, Liguid <br />CA 134 <br />Gal <br />RQ Wage Poisuleurn Oil NOS Combustible Liquid I iN <br />1270 111 JOJI contammatext with halo `ere <br />CA 221 <br />IWIVW <br />Gal <br />Od & Water, Non-RCRA ID ' Waste. Liquid <br />CAMI <br />Gal <br />Wage Solids and Sludges <br />Gal <br />Wabli-out <br />Foot <br />Drained Used Oil Filters, <br />Drum <br />Non-RCRA Ilauiudous Waste Solids (oily da") <br />CA 223 <br />Drum <br />Limply buns <br />Drum <br />Other: <br />Other: es <br />Other: C-01 <br />Vd, <br />"her: r <br />n Ldaz DIL�Ac2te— <br />-d— <br />Other: <br />(Aher: <br />Other: <br />(Xher: <br />TEST P'%.S>e <br />F 11. <br />)'PAI <br />Agricultural <br />pypll.'ti. Station [3AVicuh— <br />I ,OveSource (I Industrial Source at S <br />o�b larmc Source <br />NET 7 DAVS <br />TOTAL <br />CHARGES <br />Accounting Office 510-795-4400 Plean Pay From This InvoicA-.. <br />TSDF: Evergreen Oil, Inc. <br />6880 Smith Avenue <br />Newark, CA 94560 <br />EPA# CAD980887411 <br />HCER TE DRIV' S G A ' <br />17 <br />I hereby ct:rtity that all information submitted in this and all atuiehed documents <br />contams true and "curate descriptions of the waste. All relevam inl4mation <br />regarding known or suspected hazardb ussociaW with thew his bow disclosed. <br />This Iiin her serves as notili"ion that the above liquid wastes am banned fixim land <br />dislx*al pursuant to Title 22 Section 66268.7 (a)(10). 1 also acknowledge dw I have <br />read and agree to thi terms on the revau side of this Harm. <br />M!72?lyi�le� <br />251 <br />