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SPS BROT <br /> Send Payment To: A.B.E <br /> WASTE OIL ETC. BILL OF LANDING INVOICE <br /> Arens Brothers Environmental Inc. 4), 1-866-220-2412 V G <br /> 4066 StageCourt#F1 0 0 3 <br /> PlacervilCA 95667 i4 """rJ10NMV4`t1' <br /> Off Ice: 1-800-220-2412 -530-621-3044 EPA ID#CAR000162636 <br /> Fax: 530-622-3606 D.TS.C.#4033 <br /> CA#305421 Date Iii - to <br /> CUSTOMER -A)'-5qve- CUSTOMER EPA# CAL 000-3 2-77 3 Lf <br /> JOBSITEADDRESS LIU-3 Chi r- Dr. NOTES A),e -50 <br /> cci , P.O.# <br /> CUSTOMER PHONE NO. CHECK NO. <br /> FAX CONTACT-EsL-/i CASH RECEIVED$ <br /> PRODUCT INFORMATION WASTE MANIFEST GALLONS PRICE <br /> SERVICE INFORMATION CODE NUMBER QUANTITY PERGALLICIN AMOUNT <br /> NV9191,P-04 tfaz tol-li iWe'St-4 9:�^ 42�9 A-)� 1 -4 — <br /> 1>0W ,r+4bre4oeLwn! 027, 5 qVill,1516M, 7S , <br /> &S, LC�VVr6)yi5DVJmq1AJ k4mg .— -1301- qC0,3 �- IcLl 150- 1E0 — <br /> Ld (Wit' 50- <br /> PRICE <br /> Test U Pass Ll Fail LI PPMLubricating Oil 3 Industrial Oil E) <br /> Designated TSDF <br /> Ll Total Charges <br /> C3 <br /> lt-&1`60r-5 (7T(A5fyfAh1- LL&, Transporter'sSignature <br /> Other!-;-raA1-SARI-e 6-1 fA h V46,'? LWTf)"P50f7L/V Transporter's Name <br /> ADDITIONAL INFORMATION <br /> Customer Billing Name Purchase Ordedir contract <br /> Customer Billing Address city Sale Zip <br /> Customer Phone Numbers Fax Cell Pager <br /> Special Instructions: <br /> (Uii,45 Ivi 0N4 L <br /> Notes: rpA-,.Q11,ACA-CC1( rv- <br /> GENERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and acculately described above by proper shipping name,are classified, <br /> packed,marked,labeled,and are in all respects in proper condition for transport by highway according to applicable state and national government regulations. R I am a large <br /> quantity generator.I certify that I have a program 13 place to reduce the volume and laxicity of waste generated to the degree I have determined to be economically practicable <br /> and that I have selected to pracbeable method of treatment storage,or disposal currently available to me which minimizes the present and future threat to human health and <br /> the environment;OR,it I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the beat waste management method that <br /> Is available to me and that I can afford. All used oil collected from the generator listed above will be transported only to a facility pe"farl by the State of Cafil to produce <br /> used oil into recycled oil. Gemiralormirtifies waste isfiree from PCBs ancitorchlorinabon. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR USED OIL. PLEASE SIGN AFTER READING. <br /> Arens Brothers Environment Services,inc,hereby advises used oil generator that your shipment of used oil may be transported to a facility that is required to comply with federal <br /> regulations applicable to management of used oil,but are required to meet these more stringent requirement,and some out-of-state facilities that process used oil also meet <br /> those requirements. These include more stringent leak detection and prevention requirements,engineering ci,difications of tank Integrity,and financial assurances for closure <br /> and accidental releases. It Is lawful to send used oil to out-of-state facilities that WMPIY only with federal used oil management standards and not these more stringent require- <br /> ments. This notification is for information purposes only. <br /> I hereby certify that all the information submitted in this and all attached documents contains true and accurate description of the waste. All relevant information regarding known <br /> or suspected hazards associated with the waste has been disclosed. Venue for purposes of enforcement of this obligation shaj!,be El Dorado County. I declare under perjury <br /> that the foregoing is true and correct. <br /> Generator Signatur <br /> Customer's Signature <br /> Print Name X �(d V-et✓- <br /> Off Ice:530-621-3044-Cell:530-306-3565-Fax:630-622-3606 <br />