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-tRONMENTAL SERVICES, INC. <br />a EPA FD # CAR000171017 <br />o-3700 U.S.D.O.T. # 1484667 INVOICE # 4 2 j� 0 1 <br />,//-448-3499 D.T.S.C. # 3544 <br />CA # 274461 Date—; <br />BILLING/MAILING ADDRESS <br />,p1, Address <br />,,y � ;4 � State "< Zip City State Zip <br />E.P.A. # ok�_J �`Ll�cj Uql I Phone <br />Phone Numbers: Office:.) ? I J Fax <br />Contact: <br />E-mail: <br />Cell ( <br />Fax <br />PRODUCT - SERVICE INFORMATION/PROPER SHIPPING <br />DESCRIPTION <br />Non-RCRA Hazardous Waste Liquid (Used Oil) <br />WASTE <br />CODE <br />MANIFEST NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />CA 221 <br />67r" - 5 71�; <br />C a' <br />Non-RCRA Hazardous Waste Liquid (Used Anti -Freeze) <br />CA 134 <br />t <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 />Waste Flammable Liquid, N.O.S., 3, UN 1993, PG II (Gasoline -Diesel) <br />Waste Aerosols, N.O.S. 2.1, UN 1950 PG <br />Empty Drums Provide D Remove D 5g ❑ 1 O ❑ 15g ❑ 30g 0 55g ❑ S P F <br />Clor-D-Tect Q4000 Test Kit: Test ❑ Pass ❑ Fail ❑ Generator Knowledge ER PPM <� <br />Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing <br />Additional Equipment Supplies <br />Hazardous Waste Labels <br />Used Oil Disposal Fee <br />Other <br />TAX <br />We Accept) C1J � I 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, pa , 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 gener, tor, 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, if 1 am a small quantify 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 o 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 Solano county. I declare under penaltyofperjury that the for oin is true and correct. <br />DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government Marine OTher InduOil al utxolating <br />QEvergreen 011, Inc. General Environmental Management, Inc. = Onyx Environmental Services Ramos Environmental <br />6880 Smith Ave., Newark, CA 94560 11855 White Rock Rd., Rancho Cordova, CA 95742 1125 Hensley St., Richmond CA 94801 1515 S. River Rd, W. Sacramento, CA 95691 <br />$10.795.4400 CAD 980887418 916.351-0980 CAD 98 510.233-8001 CAT 080 014 079 916-371.5747 CAD 044003556 <br />Commercial Filter Recycling Industrial Oil = DK Dixon Q Other <br />33210 Western Ave., Union City, CA 94587 1291 Laverne Ave. amoth F s OR 603 1300 Chevron Way, Dixon, CA 95620 <br />510.487-9227 541.884.9124 OR 9 9 75 800-127-2879 CAT 080 012602�� <br />L0I 1 " /// 4% <br />Print Name Gen at Si ure Driver's Signature <br />State Law Requires tha you ee this Aipt/Bill of Lading on file no less than 3 years. �— <br />To Re -Activate or too btain Customer may contact DTSC C 1-800-618-6942 <br />