Laserfiche WebLink
0e6/17/2010 THU 9: 07 PAX • • 12001/001 <br /> FREMOUW ENVIRONMENTT.AL SERVICES, INC. <br /> �nd Payntent to: Phone: 800-559-3274 BPA ED#CAR000171017 <br /> 'Box 2875 Phone: 707-448-3700 U.S.D.O,T.#1484667 INVOICE# 23422 <br /> Vacaville,Ca 95696-2875 Fax: 707-448-3499 D.T,S.C.#3544 Date <br /> www.hazwasicremoval.com CA#274461 <br /> SITE ADDRESS ay or Farms ISPacific. atLLINO/MAILING AD Ra� Or' arms act is <br /> Customer Customer a <br /> �W <br /> Tracy, CA 95376 Tracy, CA 95376 <br /> CAL.0001x.35.2!711 D/� <br /> E.P.A.# Phone <br /> Additional Contacts: <br /> Jose- <br /> PRODUCT - 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 /> cicl%srxIL-�b0. G-- N`cu, <br /> Non-KCRA HUMous Wagfe e <br /> Irdous Mgo Solid(Oil Contaminated Debris,Soll) eA 223 <br /> P849'WaShff 68-11fti L-A 223 <br /> Empty Drums_ Provide © Remov D 1 A t A2 5g LlI Og❑ 15g❑ 30g❑ 55g El S'P F <br /> Clot-D-Tett Q4000 Test Kit: Test 6 Pass d Fail EllGenerator Knowledge ❑ PPM3oa <br /> Transportation Charges/Addltionol Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: 0 N Labels 011 P/V g/iS//u AIF 1fq UOF nl��} Oily Debris !J <br /> SERVICES REQUESTED BY �S°` TAX <br /> We P.O.# TOTAL CHARGES: <br /> Acca t <br /> GENERATOR'S CERTIFICATION:It hsreby declare that the contents of this consignment ore fu7y and accurately doscrsbed obove by proper shipping Home and are classified,packed;rnarked,and,.. <br /> labeled,and ora h al respects n props[cond:I(on for transport by highway according to apprcable state and national government regu!otbns.If I om a large quantity generator,l certiy that I' <br /> hooe'6 progrom In place to le¢uce the volume and toxicity of waste generated to the degree I hove determined to be economics y procllcoble and)hot t have selecled Tisa proclkgb,e method <br /> of.lreaI nt,storage,or d1sposal currenty ovolabie to me which m�nin*ed Ins present and future lineal to human health and the envronmenl;OR,if I am a small quantity generator,I have made <br /> a good ah effort to min'rnr2e'mywosto generation and se the best waste management method that Is ovol'obfe to me and that I can afford.AS used oil from the generator listed above <br /> vbi ba sonsported any to a lacify permitted by the State Californ:o!o produce used of in recycled a.1 OR a facility that Is required to comply with.Fedefol regulations opplicobte lathe <br /> man ern of used o I.AL relevant information regard knwm or mpocled hazards associated with this waste las been dacrosed. the customer agrees to pay reosonobb cosh and attorney <br /> leas tuned in the co3ecron of In's ob tion.venue fo les of this obi tion shat be In Solana coup .I declore under ens ot pee that the for is true and correct. <br /> Ind�strld Lubdcating <br /> I P SAl Y I G FACILITY: C I ct[on Station I cfu ri l c t re v eht urine Oth Oli <br /> 44661 Road 3M 6Wd Smith Ave. 10216em/Ma Road 401 W.Channel Road 2M NwAunAs Dr.,Ea91. <br /> 1 Dave,CA 95616 2 Newark CA 945M 3 San Jose CA 133 4 9erI O,CA 94510 6 Femiey,W 8SO <br /> 510.795-4400 CAI)982446874 610-795.4400 C.ilD9808B74 1 CADQ59494310 610641-2128 CALr)003fliM 775-576.2780 NV09MB95338 <br /> rr ... <br /> tint a e, V G erato s lig to D' en's SIgnature <br /> hareby certify shat I have read ancil h veihothe <br /> u ori to bind i e above listed en rat r to terms on the reverse side of this form. <br /> Stale Low Requires tholl you keep this Re ipt/Bill of Lading on file no less than 3 years. <br />