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FREMOUW ENVIRONMENTAL S, VICES, INC. <br />Send Payment to: Phone: 800-559-3 EPA ID # CAR000171017 <br />P.O. Box 2875 Phone: 707-448-3700 U.S.D.O.T. # 1484667 INVOICE # 10270 <br />Vacaville, Ca 95696-2875 Fax: 707-448-3499 D.T.S.C. # 3544 <br />www.hazwasteremoval.com CA # 274461 Date oCJ <br />������_ �N^ 06-BILLING/MAILING ADDRESS <br />Customer ,I I Customer <br />Address 0160 S - C I+lFrVr1-'ZZ Address <br />City wD-V State CA Zip City <br />State Zip <br />E.P.A. # �►LoczD ��© Giq-7 Phone Fax <br />Phone Numbers: Office Fax ( ) Cell ( ) <br />Contact: j Lj%b I E-mail: <br />PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br />30 60 90 180 365 <br />TT Y N <br />HS <br />WASTE <br />CODE <br />MANIFEST NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />Non-RCRA Hazardous Waste Liquid (Used Oil) <br />CA 221 <br />'71 <br />pp�� <br />`YOT <br />GALS <br />L <br />Non-RCRA Hazardous Waste Liquid (Used Anti -Freeze) <br />CA 134 <br />Non-RCRA Hazardous Waste Liquid (Oily Water) <br />CA 223 <br />Non-RCRA Hazardous Waste Solid (Oil Contaminated Debris, Soil) <br />CA 223 <br />Non-RCRA Hazardous Waste Liquid (Latex Paint) <br />CA 291 <br />Drained used oil / Gasoline / Diesel / Filters <br />N -A <br />Combustible Liquid, N.O.S., NA 1993 (used oil) III <br />CA 221 <br />Waste Paint Related Materials, 3 UN 1263, PG <br />331-001 <br />Waste Flammable Liquid, N.O.S., 3, UN 1993, PG II (Gasoline -Diesel) <br />331-018 <br />Waste Aerosols, N.O.S. 2.1, UN 1950 PG <br />331 <br />D001 <br />Empty Drums Provide 0 Remove D 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br />Clor-D-Tect Q4000 Test Kit: Test ❑ Pass ❑ Fail ❑ Generator Knowledge X PPY <br />Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br />Additional Equipment Supplies <br />Hazardous Waste Labels <br />Used Oil Disposal Fee <br />TAX <br />We <br />Acce t <br />P. O. # TOTAL CHARGES: <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked, and <br />labeled, and are in all respects in proper condition for transport by highway according to applicable state and national government regulations. If I am a large quantity generator, I certify that I <br />have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method <br />Of treatment, storage, or disposal currently available to me which minimized the present and future threat to human health and the environment: OR, it I am a small quantity generator, I have made <br />a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. All used oil from the generator listed above <br />will be transported only to a facility permitted by the State of California to produce used oil into recycled oil OR a facility that Is required to comply with Federal regulations applicable to the <br />management of used oil. All relevant information regarding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br />fees incurred in the collection of this obligation. Venue for purposes of this obligation shall be in Solana county. I declare under penalty of perjury that the forgoing is true and correct. <br />DISPOSAL/RECYCLING FACILITY: Collection Station I Industrial I Agriculture I Government I Marine I Other I 111164111 { of <br />Evergreen Oil, Inc. <br />1 6880 Smith Ave., Newark, CA 94560 <br />510-795.4400 CAD 980$87418 <br />Commercial Filter RE <br />2 33210 Western Ave., <br />510-487-9227 <br />Name <br />I" General Environmental Management, Inc = Veolia ES / ERD 0 Ramos Environmental <br />3 11855 White Rock Rd., Rancho Cordova, CA 95742 5 5736 West Jefferson, Phoenix, AZ 85043 7 1515 S. River Rd, W. Sacramento, CA 95691 <br />916-351-0980 CAD 980884183 800368.9095 AZO 000337360 916-371-5747 CAD 044003556 <br />Evergreen Environmental Services - Davis = Altamont Landfill = Bongo Oil LLC <br />94587 4 Road 30B, Davis CA 95616 6 10840 Altamont Pass Rd.,Sn3years. <br />8 22211 Bongo Rd., Fallon, NV 89406 <br />510-795-4400 CAD 982446874 925-455-7300 775-8 -5082 NVR 000080655 <br />Generator's Signature ature <br />State Law Requires that you keep this Receipt/Bill of Lading on file no less <br />Ill Re -Activate or to obtain an EPA # - Customer may contact DTSC @ 1-800-618-6942 <br />