Laserfiche WebLink
Evergreen Environmental Services l <br /> ' dedicated to the protection of the environment Bill of Lading <br /> To schedule a pickup,call Send pa-,ment to. <br /> 715021 <br /> 800-972-5284 Evergreen <br /> 6880 Smith Ave,!Newark, CA EPA#CAD982413262 P 0 Sox 49065 <br /> 16540 S San Pedro S1,Carson,CA EPA#CAD982413262 San Jose,CA 95161-9065 <br /> JOB LOCATION BILLING INFORMATION <br /> NAME N WE CASH ❑ CHECK[] <br /> G-muNd Z t-a # <br /> ADDRESS 1DDRESS CUS IER CODE N <br /> CIT% STATE ZIP CO CIT% STATE ZIP CO PO <br /> 5, 1--Tom 46-`j-C O <br /> PHOT\E NO PHONE NO PROFILE NO CUSTOMER EPA ID NO <br /> I ' PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For Time Of Service Only) <br /> i ised o l :ton RCR%Hazardous Lubncatmg C At 221 Oral <br /> I <br /> Waste Liquid Industrial CA 221 Gal <br /> Used Automotive Antifreeze 'ion-RC RA Hazardous CA 134 Gal <br /> I ' Waste Liquid <br /> RQ Waste Combustible Liquid N 0 S NA CA 221 Gal <br /> 1993 I1I(Oil contaminated Aith halogens) FW1 PJfz? <br /> Oil&Water Non-RCRA Hazardous Waste Liquid CAM Gal <br /> %jN�aastc Solids and Sludges Gal <br /> Asch-uut Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA hazardous Waste Solids(oil}debns) C' 223 Drum <br /> E npl) Dniins Drum <br /> Transportation lirs <br /> ' 011ier A6 3 3`D <br /> Other <br /> Other <br /> ' ether <br /> Other <br /> Other <br /> ' Other <br /> Other <br /> TEST PASS❑ FAII ❑ PPM Test <br /> ❑Collection Station ❑Agricultural Source TOTAL <br /> ❑Government Source ❑Industrial Source <br /> ❑hlartite Source CHARGES �17(p szs <br /> 1 "THIS IS NOT AN INVOICE,YOU WILL Accounting Office 949-757-7770 <br /> RECEIVE AN INVOICE FROM OUR <br /> ACCOUNTING DEPT. PAYMENT AT TIME OF I hereby certify an that all information descriptions this and all attached documents <br /> ' SERVICE WILL ALSO BE NOTED ON INVOICE". contains true and accurate zardsaof the waste A11 relevant information disclosed regard <br /> mg 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 /> TSOF Evergreen Oil, Inc of this form <br /> 6880 Smith Avenue Pursuant to Title 22 Section 66264 12 Evergreen Oil Inc Evergreen <br /> Environmental Services has the appropriate permits for and will accept <br /> Newark, CA 94560 the wastes manifested to Evergreen facilities so long as it meets the <br /> EPA#CAD980887418 approved acceptance criteria <br /> 1�t �Z74 � h►i�Il�v -rc.w++� �I <br /> ' DRIVER ROUTE# DRIVER SIGNATURE GENERATOR'S SIGN TUBE PRINT NAME <br />