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Send r nEivly U W ON VIRONMEN <br /> Pavment to: Phone: 800-559-3274 TAL RVICES, INC. <br /> P.O.Box 2875 Phone: 707-448-3700 EPA ID#CAR000171017 <br /> Vacaville,Ca 95696-2875 Fax: 707 448"3499 U.S•D.O.T.#1484667 INVOICE # <br /> www.hezwasteremoval.corn D.T.S.C.#3544 <br /> SITE ADDRESS CA#274461 t)$tE <br /> Customer. BILLING/MAILING ADDRESS <br /> Customer <br /> 153 N. Thames Rte. �r.,>�+ <br /> 4.:�war-------——- _--.--- <br /> �.c�l, CA 242 �� Eft Way <br /> Grove, CA 95624 <br /> E.P.A. # �A ��' <br /> "-- Phone <br /> Additional Contacts: 209 M 838 0- <br /> � �g +y <br /> a:V� .) i+K75J <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> / • 14 • 21 30 4S • 60 . 90 180 365WASTE <br /> W/C CODE MANIFEST NUMBER QUANTITY <br /> UNIiS PRICE AMOUNT <br /> ur:ati�x;lis>,d Llti I Cz�t_ �. :,sgi t`�ors <br /> A <br /> t <br /> r1tA <br /> W—"Pitt Rdai-tu <br /> UN1W3 Wa*Fk,mttt b ligular K(3 <br /> itkx}-RCRA Nl�arf# y tso�id dfk*e Fkm 0A 30 <br /> �`+da e6r,�a1DEMn►xsmbte hridttaca�dn3I' C;c yil2.f,LJJ,41%0O ---- <br /> 3}Jf? I I <br /> C4�� 5 yam.U0�,y�10S.,t*-I 93,ill(1 �� <br /> Tdgd CO) 41/F --- <br /> �in:�E2wr3ETl��,��+yyyit{+949A ri16 3 - 343 <br /> Empty Drums Provide (�' Remove 1 A 1 1 A2 59❑ 109 ❑ 15g ❑ 309 ❑ 55g❑ S P F <br /> Clor-D-Tett Q4000 Test Kit: Test❑ Pass❑ Fail ❑ <br /> Generator Knowiedge ❑ PPM <br /> Trans. ortation Charges/Additional Truck Time/Additio1111 n111al Labor/LAB Packing/Site Cleaning <br /> Clean: 'r N Labels >'� Oit <br /> A/F i <br /> -11 <br /> UOF Oilv Debris <br /> SERVICES REQUESTED BY /'z'� tTrrvej.t-Ort7 :sv�i-6aalr•t?Pt' <br /> I•o4ur 0$4(Cdbd Iw b,: TA X <br /> Acce t `rM P. O.# <br /> iENE cl,an S re in a re$p N: hereCv declare that the contents or this consignment are fu a TOTAL CHARGES: <br /> love 0,and are in ca respects In proper condition for tronsport by highwey accord re applicable mnd accura`ety described above b <br /> a'reve o program iny proper snipping name and oro c'arri'ed,Packed,marked,and <br /> place to reduce the volume and toxicity of waste generated to the degree 1 have tat ern d notned to be economics <br /> astate and nations government yproe.tans. If I am a large quantity generator.I certify that l <br /> )go't faith <br /> storage. it dniza,m cvoste g available to me which minimized the present and future threat to human health and the env-vonmen{;OR,it I am I small quantity s goad tciih effort to mirpmize my waste aY praetfcabfe and ingt i hove refected the practicable method <br /> ,vill be tron'Torted only to q rocillty permi9 a the 5•gteeor Catifom the ®atlq oste�a�ent fnethod)hof is avodable to me and that I con aient; All used 0 fiom the <br /> Produce used oil into ret q n generator.I have made <br /> nanagemont of used oN. AM relevant inlormotton regarding known or Ycted off OR a faculy that Is required to ca generator acted above <br /> 'es'nn ned Ino ccaeClion of tins anon. Venue fa <br /> suspected hazards associated wah ihi5 T mato w tin Federal regulations appacable to the <br /> ores of this ebq ellen shall beh Solana coupchla�re u«nsde�sd°sed. he customer agrees to pay reasonable <br /> �ISPOSAL/RECYCLING FACILITY* Collection Scosts and af!omeytation Industrial A tiCVltUre Gover'n's a Marinene foOthefs true and co ect. <br /> Indurtrlal lubr!cotinp <br /> ]seal3.roFte#g1 FkXW/!L(: 1 (isOtB'Ld Qt�s'-tCi18 11 Gil <br /> 90°�� dfbt%i ReH3tA2 1 Ii?eaca::kawEaih+4ze�y 3,,J�rr.,�r <br /> rJove,s7tso 2 Ght17,Rud311 td0'aRwFLadlieLd �l,'esiw.t"iwe� � i i�deik+auaCsay�wp'tk,ke a <br /> 3 lMiMC AA tZpNS J Dpi,CA ri t r1K&U111e lir k0-4d <br /> �t bV01R.M M>D8 AV= JI0-Si14M i.:%Lj"7rtt6 *Aft" <br /> �,-, 'erxFo`� �^,...cp '' � ;�' .� '1 3�t•�@!�l��NTs3 <br /> not Name _1C .. . <br /> 1 ttereb�eerti 1 v <br /> mr Generator's Signature <br /> ._1 ac!and hove the a�tht7Cit�e t4�ins!tt1g_abQvg lisf d ��vet's Sig nature <br /> State Law Requires that you keep this Receipt/Bill of L ding on fileino tesschharr 3 years. h rgv�_t �l�of this fQ_M <br /> 5AN4QAi4 Gi UNTy - <br /> ENVIF.ONMENTAL <br /> HEALT11 CER3 TMENT <br />