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FREMOU ' EbVIRONMENTAL S6RVICES, INC. <br /> P;�rn: n; ;,.: Pnone. On_c�g-:_ EPA ID=CAR0001;101' <br /> U.S-D.O.T.= 1484667 INVOICE # <br /> j.aNills. Ca 9>096-.s�c F„s t1'- i�__SQQ D.T.S.C.= 3574 <br /> Ubu.hazes asTer;mo,.ai.com CA 4 274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Brannon Tire customer Brannon Tire <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA5207 Stockton, CA 95201 <br /> A CAL 000196 538 J Phone <br /> E.P.A. <br /> Additional Contacts: 209 77-9000 <br /> Oke <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> • _ • 27 • 3:. • as • 60 • 90 . aO . 365 4X <br /> WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> D stied Used 01?Gasok*I Diesel Fit sats U NIA US 3-:1 2 c6G ` /Y C y G <br /> Non RCRA H i adous Waste Sold(01 Detxis,Sod CA 223 <br /> lydudec Recydai*Material(Latex Pant) N/A <br /> 'rVaste Part ReWited Materials, 3, UN1263. VI 3311DO01 <br /> Waste FLamtabk LicliLrd,N.O.S.(Gwoine. .3.W993.1 34310018 <br /> Non•-RCRA Hazardous Waste Liquid(Braise Fuld) CA 343 <br /> ham” :S'7LS=a"-aw=3C'-r„--,c 1C .JI1.2 .'.�t`!?�C 1/D 001 <br /> Combsrsd*1-1qud. N C S., NA1993, III (H ed 04) 41/F002 <br /> .r--?.=-� _< Aas-_,„r :T. _Ujky—, A 343 <br /> Clot-D-Tec`0400C Tes' r": 7es'❑ ass ❑ Fail ❑ Generator Knowledge ❑ PPM <br /> -rc�so��c`io^ C�o,aes/AcC+io^aI ,ckTirne/Additio al Labor/ LAB PaclI g/Site Cleoning <br /> _cbe!s O'! A/F UOF 0 6 Oily Debris k,4 of <br /> SERVICES REQUESTED BY i TAX <br /> vv <br /> �e <br /> Accept P. O. # TOTAL CHARGES: G <br /> GENERATORS CERTIFICATION r -_e. =_=-e -_ - __ -_ - __ _: a_ c c _ c"oec cc_ve Dv o,oper shipping name and are clossified,packed,marked.and <br /> c__ _ _-_e_ _ _ _ a;gc;e- ,an regulations. It I am o large quantity generator,I certify that I <br /> - - _ _ _ e_ ccl:y p;oc-°cable and thot I have selected the practcoble method <br /> ;-- _ - - --- ___-- _ _ _ _ _ _ _ ._-.d theenviror.merr OR,if i am a small quonlitygenerator.I hove made <br /> -- _ _ _= -._ ____ - ------ - c�'c'ab e-'c me cr aha• can C"cra. All used oil from the generotor listed above <br /> __ OR c_auk'y-a-^$-equired to comply with Federal regulations applicable to the <br /> h sle acs oee c scioseo. lrhe c:stomer ogrees to pay reasonable Costs and attorrey <br /> V- c;es- -_ o oc!c-<_ e r corano co_n-v.�dec'are u, der enolty of perjurythat the for oin is true and correct. <br /> D!5FOSAL/RECYCLING FACILITY: COlfection Station Industrial Agriculture Govemment Marine Other Indussttrial Lub is ting <br /> j I Chen MarGoo SmJob!LLC I Oil <br /> I Evergreen CK Irc-DAIts ; 1 Vwon Ra m1 P.egcin9 hx ( ] <br /> ! t(pt .U Etc Sky Esmema <br /> I)GEM oIRancho Cordma <br /> 1P5CEmSsBefRa! i�d 3C$ 448t KMn She( or W C6m1 Road 11g6Mite mckaoedSr�'r �`rh <br /> 3 .McC1elan, rJ ;Bmiaa CA 91510 5 Rmldro Cordova.CA W42 <br /> 41t1,gy Glp05915(tt0 '10,79rNCC CAD9°1'44%4 91691 001=6106 310-511.2118 CALD0113111639 916351-0980 CADM0884163 <br /> 73 AW A <br /> Print Name Gene nature D0 or i flnature <br /> I ereb certifythat I havereadan have the aut to bin the abov listed nerator to the terms the rev rse side of fhi f rm. <br /> 990/£90[A DUI SOAS ANH AAONi32I3 66tD RVVLOLT I-V3 T£ :9T TTOZ/ZZ/80 <br />