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^, r <br />"fir 1>`IC. <br />BILLING INFORMATION <br />Send Payment to: <br />P.O. Box 1904 <br />Vacaville, CA 95696 <br />(800) 669 - TANK <br />JOB SITE <br />Invoice <br />ic,'s F r:i <br />#„i'r. <br />Date: <br />EPA #: CAD981694722 <br />NAME <br />NAME„ <br />PO# CASH CHECK <br />ADDRESS <br />ADDRESS <br />CUSTOMER EPA ID # <br />f - <br />CITY STATE ZIP <br />CITY STATE ZIP <br />. <br />PROFILE # <br />r <br />PHONE # <br />PHONE # <br />CUSTOMER ID # <br />PRODUCT PROPER <br />WASTE <br />MANIFEST NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />SHIPPING DESCRIPTION <br />CODE <br />Non-RCRA Hazardous Waste, Liquid <br />221 <br />GAL. <br />Waste Corrosive Liquid <br />GAL. <br />Non-RCRA Hazardous Waste, Solid <br />(Oil Contaminated Debris) <br />-' t=` ' <br />_ <br />LBS. <br />Waste Flammable Liquid, n.o.s., 3, <br />UN1993, PG III <br />GAL. <br />Waste Flammable Liquid, n.o.s., <br />GAL. <br />(Paint Related Material), 3 UN1263, PG III <br />Transportation Charges <br />HOURS <br />Drained Used Oil Filters <br />EACH <br />Empty Drums <br />EACH <br />Additional Labor <br />EACH <br />Other: <br />Other: <br />Other: <br />Test Pass ❑ Fail ❑ PPM 0 <br />DISPOSAL/RECYCLING FACILITY: <br />Collection Station <br />Industrial <br />Agriculture <br />Government <br />Marine <br />1. Commercial Filter Recycling Inc. 2. Crosby -Overton 3.. Other <br />33210 Western Ave. 1630 West 17 St. <br />Union City, CA 94587 Long Beach, CA 90813 <br />CAL000091507 CAD028409019 <br />GOVERNMENTAL COMPLIANCE FEE $ <br />Late Charge to all balances not paid within 30 days. <br />Total Charges <br />Drum work invoice additional late charge $35.00 <br />I hereby certify that all the information submitted in this and all attached documents contains true and accurate descriptions <br />of the waste. All relevant information regarding known or suspected hazards associated with the waste has been disclosed. <br />Driver's Signature Generator's S'ignatu're ` <br />