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i <br /> FREMOUW ENVIRONMENTAL SERVICES , INC . <br /> Send Ila % meni fu : Phone : 800- 559-3274 EPA 1D x CAR000171017 <br /> 6940 1rcintint Knad Phone : 707-448- 1700 U . S . D . n. T. # I4R4667 INN � n � � <br /> Dixon . CA 95620 Fax : 707-449-3499 D . T . S .C , 4 3544 <br /> V. ',� . I I rah nlE� rn � ii „ Ilniriltai . . , , n ; CA # 274461 Date <br /> SITE ADDRESS RKI , NGMAIIING ADDRESS <br /> Customer ri _ _ Customer <br /> E . P . A . # Phone <br /> -- = ; - - - <br /> Additional Contacts : PAYMENT TERMS : NET 15 <br /> PRODUCT - SERVICE INFORMATION / PROPER SHIPPING DESCRIPTION / BILL OF LADING <br /> 7 14 . 21 30 • 45 • 60 • 90 • 180 • 365 W ; r WASTE MANIFEST NUMBER QUANTITY , UNITS PRICE AMOUNT <br /> CODE <br /> i <br /> R;�j: ftr. • . <br /> i <br /> T ' 1 <br /> i <br /> t <br /> f <br /> i <br /> SERVICES REQUESTED BY ITAX <br /> We ` - <br /> Acceai P . O . +"• � TOTAL CHARGES : � <br /> GENERATOR'S CERTIFICATION - - <br /> OR <br /> D Si' OSA { / ktCYCLING p aCIUTY : ' C01f@CtlOn Station I Indusirip Agricuifure Government Mprrne ether I { <br /> Print Name Genera?ars S gnature Drivers Strinture <br /> I hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse side of this for11-1 <br /> I t .; State Low Requires that you keep Ihis Receipii8dl of Ladinq on file no less than 3 years. <br />