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i Evergreen Environmental Services Bi!! of Lading/ invoice <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to 557919 <br /> 800-972-5284 1 %ergreen INVOICE <br /> P t) Bo\44997 C <br /> 7200 Central Ave.Newark. CA EPA#CAD982413262 San>:r uici-eo,CA 94145 Dale <br /> 10712 Vemon Ave.Ontano CA EPA#CAL000027724 ---- - <br /> JOB LOCATION BILLING INFORTVA'TION LASH ❑ C1-lEC1,0 <br /> NAME <br /> DRESS ` CUS 170MER CURE NO <br /> tD <br /> � DRES5 r• 41 L U I D r- �1 <br /> 11 t/ 1 ATI Z!P C() PO 4 <br /> 4 C STATE ZIP <br /> CU CI 1 C <br /> } 11HONE No PROFILE NO CUSTOMER EPA ID NO <br /> P ONE NO <br /> Li �` b - <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> I sed ml hosi-RCR1 Ha7srdouc I.u6nL�atmg C 1221 Gal <br /> 'Aasu Liquid Industrial LA 221 Gai <br /> l-vA Automotive Antt&eeze *Ion-RCRA Hazardous C.\1 i4 Gal <br /> v1 este,Liquid Gal <br /> RQ Waste Petroleum Ord NOS Lcxntntstrble Liquid I1 CA 221 <br /> 1270 III (M eontamtm ued with halogens F�1 1 <br /> (hl Rc Water Non-RCRA Hazardous WaO� Laquid Ca22i Gal <br /> Gal <br /> asu Solids and Sludges t <br /> E.ac-h U <br /> 7'or,RC <br /> ash-out <br /> Drum <br /> ramed l sedO d Filters <br /> RA Ilazardrus Waste Solids(orh d6bris) C 1223 Drum <br /> Drum <br /> Lmpt} Drun>_c <br /> lits <br /> Trwupatrun a <br /> nrt <br /> _UJ <br /> (hher <br /> Oraler <br /> Ubcr- <br /> r-77 7 <br /> Odw <br /> OUxr 1 <br /> I <br /> TEST 1'A.SS F 1l1 ❑ FP\1 7� ^• 3•"" `Y��""<' <br /> ❑Co1lectrQit station ❑ source _ NET 7 DAYS TOTAL. -z <br /> ❑CjpYelnln-1 Son— © Indug—I Source r <br /> ❑ss>mc Source CHARGES �.z <br /> 9 ffice 510-795-4400' r�x'Plc'ase Pay:Fram"Thu Invoice <br /> Accounting 0 - ,y <br /> 1 p , a_ - 5r' <br /> an <br /> I hcr`t" ccruffi that all tnrornruson snba%Mcd m thn AM all sn"awd doomwras <br /> TSDF Evergreen 011, Inc ,��u� <br /> acxwrt< tru, and accurate drx-%TKxwr1 or the write TAIL cele+ <br /> 6880 Smith Avenue retardint km—rt or su-gToctcd►ww&A—Wed with tine K-aue has been&wlm4d_ <br /> Newark, CA 94560 Thr further scr%vs as s+ourmwion that the atu+ve liquid%-a=-arc 1+arQ►cd Krem land <br /> di,pcwal punuarn to Tij1 22 Scman 66268 7(ax 10) I also adcrio%ledgc that I ha%c <br /> EPA CAD980887418 nad and agTec w the terrta 0 tial r side orilts form <br /> s0 .l�u.--�t <br /> Ze�S _ `L .� PRINT NAME <br /> DRIVER R E t! DRIVER SIGN RE GENERATOIZ S SIGMA <br />