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vormnT Iw Nis <br />JL' .L<JJ 1♦ - <br />end Payment ta: Phone: 800-559-3274 <br />.O. Bux 2875 Phone: 7071348-3700 <br />'acaville, Ca 95696-2875 Fax: 707-448-3499 <br />yww,,hazwastcrem0val.c0m <br />.....,ter <br />EPA ID # CAR000171017 INVOICE # L <br />U.S.D.O.T. # 1494667 <br />D.T.S.C. # 3544 DatNfi'- <br />CA # 274461 <br />::ustomer ini3srel�— `- <br />1431 E. Church Street <br />Stockton, CA 95205 <br />E.P.A. # <br />Additional Contacts: 209463-9046 <br />. 14 21 a 30 • 45 ■ 60 • 90 + 160 • 365 <br />H <br />WIC <br />Customer <br />1031 E. Church Street <br />Stockton, CA 95205 <br />Phone <br />209 9414497 <br />'PROPER SHIPPING DESCRIPTI( <br />MANIFEST NUMBER QUANnTY UNITS <br />rtctcs��l rLl_�'tk 1 C.r� ua� <br />❑ I Og 13 15g 0 309 0 55g 0 S P F <br />EmptyDrums Provide Cl Remove C7 <br />l Al l A2 5g <br />PPM <br />Clor-D-Tett 040M Test Kit: Test ❑ FOSS O Fail 0 . io of Labor LAB Packing/SiteGenerator KnovAedge itC leaning <br />Transportation Charges/Additional Truck Time/Addrt AIF UOF Oily Debris <br />Clean: N Labels Oi t <br />TAX <br />BY <br />PRICE I AMOUNT <br />SERVICES REQUESTED TOTAL CHARGES: <br />We �� P. <br />ACCO t shipping name and are ctasslfied, packed. mocked. and <br />I am Ch <br />acts in proper candrOdc <br />�An (or transport by rJghv+av cc'=a`�ng to apPYcaue state and notlorwl govemmont regvla KQble and that Ih have se eciedrmeatpract cableimathoc <br />GfiNERAT011'S CERiIRCAAON: I troroby declare that the contents at tuts consignment ore iur.y and accuro[ery desk Toed above by Proper rotor, t ify h t I <br />am <br />labeled. and are in all roup <br />have a prog which mrrJrn¢ad the present anu future ttreat to hu ncsn health ontl the Env I c n r eM:. if l ed o s thei,geiy g ria to the <br />ram n place to reduce the VOWT" and tox'.city of waste generated to the degree I have detetMlned to be econom c r P <br />of VeaUrient. storage, or disposal m wast tty ave lcble u me <br />a Good faith effort fa mindispo al waste generotton and select the Dost waste management method that Is ava3able to me and that t can Cotard. All used r from thtiiOnS CI afar listed cbova <br />Will be Transported only io a tacliry pe,tr,iitad by the State of California to produce used of.. into recycled OK O2 a taciNty that is requPed to comply with federal r u;dtlons app! <br />deGate � scar anal 01 a that the o 0'�n is true and convcl. <br />InduWal Lubricating <br />marmc trans l of used �'to on oel.vanab9 aryon.on regC Venue ding kno nes at thins ecl octan Yds be In Sa a� otvn his waste has been dlsGos©d. The Customer agrees to pas reasonable costs a acn <br />ll <br />tees incuned In the eo' a teutture Govemtnent MaNne OHner a <br />DISPQSAL/RECYCLING FACILITY: oticctton Station Industflal Agt <br />�tyNyp t+Aarn1 <br />uiwtYi.rbora dnMLLV i 13Dyt91I�en1WR W ( l2430AlmcrrdDow <br />i { k�..r' W Inc - t�vo ( i � �'" i I t0.' I awr"no Road dD l a s; cora tat to �„ �r cxp Ch �if29 <br />M iiRoe+l3DB 00 , f1tat5dCr i6Aatw d >jil"I CA 9dL[a <br />>M,, rNa; <br />3 �+ ,kar, Cit 3r,133 t -775 5,r 9rA1 N:'D'A�E�4 =, <br />I c�wa, Ch 9GfitC T,'S �;1 � rrrr �1000D e04 oat M.j can oSsroto 51tk541 :1'�C cu mami� _ <br />5107 1 CAD 9W446274 <br />f, F <br />-101 <br />r Q <br />/ t <br />f % naWre Drivers Sli noVe <br />Print Name Cier1®r13t0s ih <br />1 hereb rti _ ffipt 1 ave_rond G��w Requires that you ko Phrt'i'�g �g fl oftLodi�ng on file no t� tv ass than 3 years, <br />e r verse side of chi_ s arm. r <br />State La 4 <br />