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FREMOU " E' 'VIRONMENTAL 4RVICES9 IAU. <br /> ��nd Pay min; to: P ene: _00-:�9-3_ EPA ID=CAR0001-101' <br /> P.O. Boy 'S Pane: 0"—s�fi-3'00 U.S.D.O.T.= 148466- INVOICE # <br /> N acaN illi. Ca 94696-.9 F �:: i!'_;tg-3199 D.T.S.C.=354.4 ``�� <br /> -•z-x. azwa teres a�al.ca� CA#274461 Datey`T_/7' /Z <br /> 5!TE ADDRESS BILLING/MAILING ADDRESS <br /> CU5tO merRmnna Customer Brannon Tiro <br /> 4905 Claremo t Avenue P.O. Box 1988 <br /> Stockton, CA 9 207 / Stockton, CA 95201 <br /> E A- Phone <br /> Additional Contacts: 209 77-9000 <br /> k0 p <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> t 3C • d5 6C • 90 180 • 365 WIC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> `!:13'dOUS Waste L W 'Used Oil` �' CA 221 S' ;J/` l Zv Gallons <br /> ti ti"-i,� ri � r i i (Jsea n -F ) A Gallons <br /> I <br /> �4n- ^R;, �� rbc a Waste LQUIDNWatwi I CA 223 <br /> l• In l Filters NIA I 55.00 <br /> I <br /> • CA 223 ' <br /> Parts Was`a service CA 22L <br /> Nor RCRA Hazardcus Waste uqui (Brake Fluid) CA 343 <br /> N19!P, .Vaste F-iamimatk LqLgd. N.0 S. . PGII'Gasoine-Diesel) PUD0181 <br /> I <br /> ErrpfyDrur-s = c. ce = Re-ove Al '.A2 5g ZI 1O Z7 15g ❑ 30g U 55g U S P F <br /> Clo --eC 04l'r.-e5- <. -es' U ass Ur g <br /> Fci' � Generato Knowled e PPM <br /> Transoortctior C',arges/Aaditi al njck rime/Additional Labor/ LAB Packing/Site Cleaning <br /> C!ecr, ry Labels- UO <br /> Oi! /U- A/F F .� Oily Debris p <br /> l/ <br /> SERVICES REQUESTED BY ' TAXWe <br /> •00 <br /> Ace , P. O. # TOTAL CHARGES: <br /> GEnERAT0R-5 CER_IFICA^.ON _ _____ _- -g___ -, _ -" _ __ _ - _" -_ . esc^oeG 000ve ov ower shipping name and ore classified.packed,marked,and <br /> c^^a governs-,er+reguiano^.s. If I am a large quantity generator,I certify that I <br /> _ econ-_ ccl`v aracticable and that I hove selected the practicable method <br /> - -_ =-= =- --- a c _ --^heath and ^e en-orrnent:OR.if I am a small quantity generator,I hove made <br /> -" - - - -r -•_=_ -- = __--_ - _ -= - - _ ^e"oa c:,,:;ca a:o me o^d that'•cor otlora. All used oil from the generator lisied above <br /> -_a________ _ _ __ _ _?OR c --Ssv rra•is reovirec to comply With Federol regulations applicable to the <br /> _ <br /> =••_sem ai bee^disclosed -he customer agrees to pay reasonable costs and attorney <br /> Pe- - - - ''o - ^SC a ^dec'are uncer enol of perjury that the for oin is true and correct. <br /> DISP AL/RECYCLING FACILITY: I - Collection Station Industrial Agriculture Govemment I Marine Other InduOltstrial Lubricating <br /> Oil <br /> '` <br /> Etiergaen CK he-Drs '�5 E96 11 to ( )Clean Harbors Sar Jose LLC I I Blg Sky Enmronmsrtal I I Clearwater Ermronmental Mgml <br /> +.y96 !1 T: d CY i6 Ar_t•(tg 1 B . Road 401 W.Channel Road 2430 Almond Drove <br /> Dam '�A 956 1= may, q' HCl.. 3 San CA 951.33 4 Benda,CA 94510 5 S Luer Springs,CA f�429 <br /> ' 4C tL'94'r 'e 371 I3 hVT OOOG CAD 0514194310 510.641-2128 CAL 000301639 7755779001 NVD982358483 <br /> Print Name e r � <br /> suers Signature <br /> I reb cern that I have read and have the t to d the bov list d en rotor to the to s on the reverse side of this form. <br /> 990/9901pl OMI SOAS ANH AnOTHEA 66b£86bLOLT YVA Z£ :9T TTOZ/ZZ/80 <br />