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FREMOUW ENVIRONMENTAL SERVICES , INC .
<br /> Send Payment to Phone: 800-559-3274 EPA ID # CAR009171017 CSLB A- Eng # 1022665
<br /> 6940 Tremont Road Phone: 707448-3700 U,S ,D , O,T. # 1484667 Small Business # 56427 INVOICE # , t
<br /> Dixon , CA 95620 Fax: 707-448-3499 D,T, S ,C, # 3544 Date ' '
<br /> www. hazardousdisposal . net CA # 274461
<br /> SITE ADDRESS BILLING/MAILING ADDRESS
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<br /> Additional Contacts : r ; f� 110 16109 a;��j• �� � �� PAYMENT TERMS :
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<br /> PRODUCT - '"SERVICE FNFORMATIONJPROPER SHIPPING DESCRIPTION / BILL OF LADING
<br /> 7 14 21 30 45 60 90 • 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT
<br /> CODE
<br /> � t ;\ td •tR9 lnt.,.-f., :7,,; - rt .,l.. t . .t nd .,!,..:.,c.. '� nn ttl rwt + -17 Ri Q./� ". I Il{ no ,. 7qr, nit
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<br /> Srirtlr.9l:ei icftr ! �ifigD i Ce •' Inrludina un to ifir. an rite n!a 1 Stop 150. 00 160, 010
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<br /> SERVICES REQUESTED BY 5560/ 18 :;S - Ted Eremomv reali :SQCd by Don 209V*368~M61 TAX 1715
<br /> TOTAL CHARG
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<br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and ore classified, packed, marked, and
<br /> labeled, and are in oil respects in proper condition for transport by highway according to applicable state and notional government regulations. If 1 am a large quantity generator, l 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 I 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 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 for oin is true and correct.
<br /> DISPOSAL/ RECYCLING FACILITY: Collection Station Industrial Agriculture Government Marine Other InduOsil Lubrfoiiating
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<br /> Itl? 1 gerr!rr5o Ra:rd �.;J: 'i 1 I rrl5rd f:`i if Acre:
<br /> f ian .bx;e. C•h 2; 12:1 4 nenllgN>! i+`<^`n
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<br /> . Print_Name / I ,tGenetdtoes Signdture Drivers Signature
<br /> I hereby certify that I have read andlf6ave the authority to bincl'the above listed generator to the terms on the reverse side of this form .
<br /> i n , n _. . nnn - I Stntp I nw Rpnnirps thnt vnu IfP. pn this Rprpint /Rill of Lndinn an file no less than 3 veers .
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