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y' 5l <br /> Send Payment To: 3 82 2 <br /> Independence Independence Environmental Services, LLC <br /> 438'D:Shaw Ave#3.77-.... 54)( l <br /> Environmental Fresno, Ca,9371.0 <br /> EPA ID Number <br /> Services CAL000397021 <br /> indyenviro.com <br /> 800-971-8010 SATE " <br /> GENERATOR/JOB LOCATION BILL TO <br /> NAME .. PO# <br /> ADDRESS PHONE NO. <br /> CITY STATE ZIP GENERATOR EPA ID NO <br /> PRODUCT CODE MANIFEST NUMBER QTY UNITS PRICE TOTAL <br /> Non-RCRA Hazardous Waste, Liquid GALLONS <br /> (Used oil) 221 . :f <br /> r` <br /> Non-RCRA Hazardous Waste,Liquid 133 GALLONS <br /> (Used Automotive Antifreeze) <br /> Non-RCRA Hazardous Waste,Liquid 223 GALLONS <br /> (Oily Water) <br /> Drained Used Oil Filters DM/55 <br /> Non-RCRA Hazardous Waste,Solids 223 <br /> Non-RCRA Hazardous Waste, Solids <br /> Nan-RCRA Hazardous Waste,Liquid <br /> Waste Paint Related Material 214 <br /> Waste Flammable Liquids 213 <br /> Waste Aerosol Cans 331 <br /> Universal Waste, tamps <br /> Universal Waste,Batteries p 1 <br /> Empty Drums, New ��� Gr f C- <br /> Empty Drums, Disposal <br /> r <br /> TSDF-OIL/COOLANT TSDF-OIL FILTERS TSDF-011IOILY WATER TOTAL CHARGES <br /> World Oil-San Joaquin. LLC Commercial Filter Recycling Riverbank Oil Transfer <br /> 14287 E, Manning Ave 33210 Western Ave 53DO Claus Rd <br /> Parlier, Ca,93648 Union City,Ca,94587 Riverbank,Ca, 95357 $ �` 1 <br /> 559-498-0240 510-487-9277 209-863-8181 <br /> CAL000102751 F2' CAL000091507 CAL000190816 <br /> Generator Signature <br /> Generator certifies that it has established a program to reduce the r <br /> volume or toxicity of the hazardous waste to the degree determined ; `• <br /> by generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to bind the Generator Print Name Date <br /> above listed generator to the terms on the front and back of this form. - <br /> 6 <br /> Driver Name Driver Signature �� Date <br /> C- r� � ter,r - 2-. <br />