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FREN- IOUW E'VIRONMENTAL *RVICES9 INC. <br /> Need Pd,Z:eLc P 1ene: EPA ID=CAR0001-101 i <br /> P.O. HuY :r-4 P`?C-nc: - -LR "00 U.S.D.O.T.= 1484667 INVOICE # <br /> \ata%ille. ( a 9569h-.8-4 Fa_X - t- »�5 =»99 D.T.S.C.=3544 <br /> �.�� ate :me�al.com CA�274461 Date O J <br /> SITE ADDRESS BILLINBrannon Tire CWal /MAILING AL.JRr�dnnon Tire <br /> Customer Customer <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA 9 207 Stockton, CA 95201 <br /> E.P.A. = CAL 000 1 538 . Phone <br /> 209 77-9000 <br /> Additional Contacts: <br /> ike <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> • - �' 3c • 45 • 60 • 90 180 • 365 W;C WASTE I MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Non-RCRA Hazardous Waste Liqui (Used DI) CA 221 G /yG l5 <br /> NorI-RCRA Hazardous Waste Liqui (Used Ant�Freeze) CA 134 Gallons 1.00 g <br /> Non-RCRA Hazardous Waste Liquid (Oily Water) CA 223 Galkins <br /> Drained Used DI i Gasdine / Die sell Fitters WA <br /> Nor-RCRA Hazardous Waste Sold(Oil Cortarro-ded Debris, Soil CA 223 <br /> Flarts as er ce CA 223 <br /> n-HURA Hazardous Wnte Liquid(BrakeFluid) CA 343 <br /> Waste Flarmlabie UqM, N.O.S. 3. UN1993, PGII(Gasobv-Diesel) 1/D018 <br /> n <br /> � I Gc <br /> E D �:ce = Remc�e a. A2 Sg '� 'Og ❑ 158 308 ❑ 558 F <br /> C'c -ec O Tes' C "es` ass Z1 coil > Generator Knowledge PPM <br /> -rans.^.or*atio C�-a•ges/Aaditior.a! nick Time/Additional Labor/ LAB Docking/Site Cleaning <br /> Clear: � N Labels OIA/F UOF <br /> Oily Debris <br /> 114 <br /> SERVICES REQUESTED BY TAX rM <br /> V"e <br /> Acce ` P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTINCAnoN: __ 77: ; _- --k 7_7 s= - _ _ c..cc _,.,_sc bec obcve by proper shipping name and are classified,pocked,marked,and <br /> y` - — ```- c - c `y paver en reguo'ops f am a forge quantity generator,I certify that I <br /> '-e ^ro I� ra C'.cebe anC thal I have selected the practicable method <br /> _ _ _ �e cr•d ronrnent O.R.it'am a small quantify generator,I have mode <br /> ' co e r _c^o`orc All used oil from the generator listed above <br /> __ - - _ - -ce----- -5z: OR- a'Vs'ec;; ec 1c comms with Federal regulations applicable to the <br /> -_-- -ez e - -- -0 vase ncs keen dsclosec -he cos'omeragrees to pay reasonable costs and attorney <br /> cc' ,. a ne:r 500.-COL. ' declare under Penaltyof perjury'hot the for oin is flue and corect- <br /> DISPOSAL/RECYCLING FACILI - v Collection Station v'I Industrial Agriculture Govemment merino Other I Industrial I lubrcatine <br /> 011 OII <br /> EvetSreer R _ 6 =Rryeer N,Inc I '.Clear.4arbm San Jose LLC I ]Big Sky Ernironmertal I )Ciear**er Ermronmersl Mgmi <br /> '- aW 1t ;i:AK Jnip AA ii0 Ber4rmalt08a 4U1 W Charnel Road 14JUAImOnuUTYe <br /> :Q-05 J 9561-- ve.arK vt S Jose,CA 85133 E Benda,CA 94510 5 Silver Sprirngs,CA 89Q9 <br /> 51C7Sf� AD 342 A 51`0-7354419C. CAD 741E t{M CAD0594,943 510541-2128 CAL00LT�Q1639 7755779001 NVD B483 <br /> v .' <br /> Print Name Generatoes na re *Drtveeslggna <br /> I herebycern that I have read an have the authorityto the abov listed generator t the t rim on the revs a side of this form. <br /> 990/V90 1A ONI SOAS ANH AflOKHMA 66VESVV LOLT YVA TV :9T TTOZ/ZZ/80 <br />