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FREMOUW F"TVIRONMENTAL rTRVICES, INC. <br /> Send Payment to: Phone: 800-559-'7Z74 EPA ID#CAR000171017 15221 <br /> P.O.Boz 2875 Phone: 707-448-3700 U.S.D.O.T.#1484667 INVOICE # <br /> Vacaville,Ca 95696-2875 Fax: 707-448-3499 D.T.S.C.#3544 Date <br /> www.bB asteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer United QMH SBA Arch Dead Customer <br /> 4025 Arch Road 1151 W. Robinhood Drive, # B 4 <br /> Stockton, CA 95125 Stockton, CA 95207 <br /> E.P.A. # CAC 002 639 151 9109 Phone Fax <br /> Phone Numbers: Office 909-951-0801 Cell 2099610999 <br /> Contact: Ro Rirrte�ll <br /> PROD U'C"'T-SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 • 14 • 21 30 • 45 • 60 • 90 • 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Drained Used Oil/Gasoline/Diesel Filters NIA <br /> Non-RCRA Hazardous Waste Solid(Oil Contaminated Debris,Sol) CA 223 <br /> Non-RCRA Hazardous Waste Liquid Latex Paint _ <br /> Waste Paint Related Materials 3 N1 63 PGII 331inoolAy t 3'l5 5 <br /> NoA-RCR.A.Haza-pdows Waste Liquid(Brake Fluid) eA 343 <br /> Combustible Liquid,N.O.S.,NA1993,PGIII (Halogenated 01) <br /> Non RCRA Hazardous Waste Liquid(Oily Sludge) A 223 <br /> IRsrii ® l3 gtvrn 41 - <br /> - 14l <br /> R l 5'= <br /> Empty Drums Provide O Remove O IAl IA2 5g ❑ lOg ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning ';t— <br /> Clean: <br /> Clean: Y N Labels Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX Q o� (i <br /> 1(pD <br /> A ce t ® ® P. O.# TOTAL CHARGES: J Vq Z . <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and <br /> labeled,and are in all respects In proper condition for transport by highway according to applicable state and national government regulations. If I am a large quantity generator.I certify that I <br /> have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and thaj I have selected the practicable method <br /> of treatment,storage,or disposal currently available to me which minimized the present and future threat to human health and the environment:OR,if I ono a small quantity generator,I have made <br /> a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. All used oil from the generator listed above <br /> will be transported only to a facility permitted by the State of California to produce used oil into recycled oil OR a really that is required to comply with Federal regulations applicable to the <br /> management of used oil. All relevant information regarding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> tees Incurred in the collection of this obligation. venue for pu oses of this obit anon shall be in Solana count declare antler penal of e'u that the for oin is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection StaTion Industrial Agriculture Govemment Marine Other Indusmal Lubdcafing <br /> 011 oil <br /> I IYeohe E9Teohniml6oluiom,LLC I 1 Ead Pmkction Same,Mc. I I GEM Rambo Cortlaq LLC BrB Sky Eawmarl 21sT Denali <br /> 57alfwastjolelsoom ZC270EbMer6LUMA ff9561M0,11m RE. X. w.Chnevd Red bemell;Dr,East <br /> I Ph..*AZ 96013 2 tlePveN,CA 91515 3 Pnwho Cori CA 95742 4 B--CA N51 Fmllef,NJ <br /> 80036efm Amo00&iT.1@7 /08-4209516 C7;nerators <br /> 976351C9B 980891 4511-2126 C 301 9 7/65752 9/101145138 <br /> Print Name Signature s Signatur <br /> State Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br /> To Re-Activate or to obtain an EPA If-Customer may contact DTSC Q 1-800-618-6942 <br />