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,OZeS BROTJiE Send Payment To: i- 4 WASTE OIL ETCsAXX BILL OF LANDING/INVOICE Arens Brothers Environmental Inc. 1-866-220-2412 4066 Stagge Court#F1 Py 3988 G Placervllfe•CA 95667 tRONMSS� Office: 1-BW-220-2412 .530-621-3044 EPA ID 9CAR000162636 Fax: 530-622-3606 D.T.S.C.#4033 CA#305421 Date CUSTOMER Gd y ' Scr t/1' CUSTOMER EPA# pt i ODrJ �Z-7 7 3�F JOBSITEADDRESS `/ZZT LJ,,-. NOTES AP"' 30 `"Jor--k i 4-'i4 r-01 , ?" Z/S P.O.# CUSTOMER PHONE NO. V&-&• CHECK NO. FAX CONTACT if h a© CASH RECEIVED $ PRODUCT INFORMATION WASTE MANIFEST GALLONS PRICE SERVICE INFORMATION CODE NUMBER QUANTITY PERGALLON AMOUNT ti/n?t �/ W, 5 air �" 6. TY Gi r .'7'0i 4! / 0 lr/rLatd u5 PCff" fer'!/ 5iw -4h4f'5 — "g- .-�0 q �o.}�+u 30 -- fqoo r fl :,? o —.. MICE Test❑ Pass❑ Fail❑ PPM Lubricating Oil❑ Industrial Oil❑ Designated TSDF ❑ Total Charges 56g p IGC: Ii^it� Transporter'sSignature C iur! t(C ibor4 �fa rd- ©.Other - - � z c) Transporter's Name ADDITIONAL INFORMATION Purchase Order' Contract Customer Billing Name Customer Billing Address city state zip Customer Phone Numbers Razcall Pager Special Instructions: Notes: i GENERATORS CERTIFICATION'. I hereby declare that the contents of this consignment are fully and accurately described above by proper Shipping name,are classified packed,marked labeled,and are in all rospecls in proper condbon for transportby highway according to applicable state and national government regulations. tl 1 am a large quantity generator.I certify mat I 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 that I have selected to practicable method of treatment storage,or disposal currently available lo me which mhamizes the present and future threat to human health and the environment OR,8 1 am a small quantity generator,I have made a good faith effort to minimize my waste generation and select me best waste management method mat Is available to this and that I can afford. All used of collected from the generator listed above will be transported only m a facility permitted by the State of California to produce used oil into recycled oil. Generator certifies waste is free from PCBs and/or chlorination. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR USED OIL. PLEASE SIGN AFTER READING. Arens nnothers Environment Services,Inc.hereby advises used dl generator that your shipment of used oil may be transported to a faciley that is required to comply with federal regulators applicable to management of used dl,but are required to meet those more stringent requirement and some out-of-state facilites that process used of also meet those requirements. These include more stringent leak detection and prevention requirements,engineering cemlicabons of tank inlegrdy,and financial assurances for closure and auaeental releases. It is lawful to send used oil to out-orslate facilities that comply only with federal used oil management standards and not these more stringent require- ments. TMs notification is for information purposes only I hereby certify that all me information submitted in this and all attached documents contains true and accurate description of the waste. All relevant information regarding known or suspected hazanls associated with the waste has been disclosed. Venue for purposes of enforcement of this obligation shall beEI rads County. I declare under perjury that the foregoing a true and correct. /�{� � N Generator Signature x V Customer's Signature d�; Print Name Office:530-621-3044•Cell:530-306-3565'•Fax:530-6223606