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5••-ii 4t' <br /> Send Payment To: A.B.E <br /> Arens Brothers Environmental "' <br /> WASTE OIL ETC. BILL OF LADING/INVOICE <br /> 4066 Stage Court#F1 F 1-866-220-2412 �, o <br /> Placerville, CA 95667 OtvME��t► N_ 5442 <br /> Inc. <br /> Office:1-866-220-2412 •530-621-3044 EPA ID.#CAR000162636 <br /> Fax: 530-622-3606 D.T.S.C. #4033 <br /> CA#305421 Date <br /> - t <br /> CUSTOMER �- , l i--.� .t<� f ,�, CUSTOMER EPA#C'...� <br /> - i��r �l_l "2 7 <br /> f r: , <br /> JOB SITE AODRSS l t 'r• C_- c1 ! K Ii I NOTES <br /> - �;< :r�-; , �� P.O.# <br /> CUST6NIRPHt0t�4,. -!� ' t 7 I O CHECK NO. <br /> FAX CONTACT `f , CASH RECEIVED$ <br /> PRODUCT INFORMATION WASTE MANIFEST GALLONS PRICE AMOUNT <br /> SERVICE INFORMATION CODE NUMBER QUANTITY PER GALLON <br /> Used Oil, Non-RCRA Hazardous Waste,Liquid CA221 j <br /> Used Antifreeze,Non-RCRA Hazardous Waste, Liquid CA133 <br /> h y_ <br /> Oil,4r Water, Non-RCRA Hazardous Waste, Liquid CA <br /> ICE I <br /> Non-Hazardous Drained Used Filter ; I M <br /> Test • Pass r Fail❑ PPM , " Lubricating Oil❑ Industrial Oil❑ <br /> De 1 nated TSIJF <br /> k Total Charges <br /> ❑ i ? <br /> ❑ i i Y / �% ✓ z /,/ TranspoRers Slgnature— <br /> 7 <br /> ❑ ��f ='� ( r) Transporter's Name i%�•�tT G �. <br /> ADDITIONAL INFORMATION <br /> Customer Billing Name Pu chaos o de x Contract <br /> Customer Billing Address coy state ZIP <br /> Customer Phone Numbers 8 cog Pyr <br /> Special Instructions: <br /> Notes: l <br /> GENERATORS CERTIFICATION:1 hereby declare that the contards-of this consignment are fully anti accurately 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.If I am a large <br /> quantity generator,I certify that I have a program in place to reduce the volume and toroth of waste generated to the degree I have determined to be economically practicable <br /> and that I have selected to practicable 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,if I am a small quantity generator,I have made a good tadh effort to minimize my waste generation and select the best 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 permitted by the State of California to produce <br /> used oil into recycled oif.Generator certifies waste is free from PCBs and/or chlorination. <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 requiredto comply with federal <br /> regulations applicable to management of used oil,but are required to meet those more stringent requirements,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 certifications of tank integrity,and financial assurances forclosure <br /> and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these more stringent - <br /> requirements.This notification is far information purposes only. <br /> I hereby cartify 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.Venus for purposes of enforcement of this obligation shall be EI Dorado County.I declare under perjury <br /> that the foregoing is true and correct \ j <br /> I \ Generator <br /> � �SiSglan9a-ntau <br /> 11CIi Cus�rfert4et <br /> Office:530.621-3044.Oell 530-306-3565•Fax:530-6223606 <br />