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CS NO. <br /> INC. , CONSERVATION DATE TIME <br /> SERVICE GENERATOR'S <br /> 3256 N. MARKS AVE. INC. NAME '1C1Cvv.3j)1j9 <br /> FRESNO, CA 93722-4919 CONSERVATION <br /> (209) 485-5495 THRU GENERATOR'S <br /> (209) 673-0622 RECYCLING EPA NO. A U 0 <br /> FAX (209) 485-5497 GENERATOR'S <br /> ENVIRONMENTAL PROTECTION AGENCY ADDRESS <br /> 1.D. NO. CAD 981428 022 <br /> CITY, <br /> STATE,ZIPc t.o r) <br /> DEPT. OF HEALTH SERVICES <br /> HAZARDOUS WASTE HAULER MAILING <br /> REG. NO 1943 ADDRESS <br /> CITY, <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this STATE,ZIP <br /> consignment are fully and acurately described above by proper shipping U.S.DOT DESCRIPTION <br /> name and are classified, packed, marked and labeled and are in all <br /> respects in proper condition for transport by highway according to ap- ti F(4waste 4�0 <br /> plicable international and national governmental regulations. I further un- <br /> derstand that I may be held liable for all costs incurred in the legal disposal <br /> of all or part of any material which is picked up but not specifically listed on <br /> the invoice- SPECIAL HANDLING INSTRUCTIONS <br /> I - Oaf <br /> all quantity generator who has been exempted by statue r' �w _' r4� <br /> "Unless I am a smallA.'pJ4 <br /> or by regulation from the duty to make a waste minimization certification GALLONS RE TIVED B.S.&W.% <br /> Linder section 3002 (b) of RCRA. I also certify that I have a program in <br /> place to reduce the volume and toxicity of waste generated to the degree I <br /> have determined to be economically practicable and I have selected the UNIFORM HAZARDOUS WASTE <br /> method of treatment, storage or disposal currently available to me which MANIFEST-DAILY <br /> minimizes the present and future threat to human health and the environ- <br /> ment". <br /> (DRIVER <br /> -L-TRUCK NO. <br /> GENERATOR'S <br /> SlGNATURE- <br /> (GOV. CODE __CONT CODE:---,--, <br /> QUANTITY DESCRIPTION UNIT PRICE AMOUNT <br /> PLEASE PAY FROM THIS INVOICE <br /> TERMS: NET 10 DAYS ON PAST DUE ACCOUNTS THERE IS A FINANCE CHARGE OF 1.5SUB TOTAL <br /> % <br /> PER MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% IN THE EVENT OF <br /> JUDICIAL PROCEEDINGS TO ENFORCE COLLECTION. THE PURCHASER WILL BE TAX <br /> LIABLE FOR ATTORNEYS FEES AND EXPENSE OF COLLECTION. <br /> TOTAL <br /> CUSTOM_P_TSSIGNATURE <br />