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EPA FUITFI 87 00.22(Rev,3.05) Previous editions ob, <br /> GENERATOR'S INITIAL COPY <br /> FREMOUW ENVIRONMENTAL <br /> Send Payment to: Phone; 80SERVICES, INC, <br /> 059-3274 EPA ID N CAR000171017 <br /> P 0.Box 2875 Phone; 701-448-3700 U.S.D,O.T.#1484667 INVOICE # <br /> Vacaville,Ca 95696-2875 Fax; 707-448-3499 19715 <br /> www.hazwastcrmovai.corn D,T.S,C,#35" <br /> SITE ADDRESS CA#274461 Date <br /> 11111LILING/MAIUNG,ADDRESS <br /> Customer_ A J F & Mai4 CAD Customer "N <br /> 7906 N. El Dorado Street <br /> Stockton, CA 95207 7906 N. El Dorado Street <br /> Stockton, CA 95207 <br /> E.P.A. -aL=20A2J- Phone <br /> Additional Contacts: 209-9 7-2987 <br /> air, aA09 <br /> PRODUCT - SJRV CE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 # 14 • 21 s 30 9 4S . 60 a go a 180 - 36S W/C WASTE MANIFEST NUMBER QUANTITY <br /> -- CODE UNITS PRICE AMOUNT <br /> Drained Used Oil/Gasoline/Diesel Filters WA <br /> )JOn-RCRA Hazardous Wade Sot(&f" <br /> :gA30 GM <br /> Exduded Recyclable Material(Latex Paint) N/A <br /> Waste Paint Related Materials, 3, UN 263, PG11 1311D001" <br /> 3311r)(11a <br /> NC)n-RGRA H;17;;rdau,l; Wiim��Flud) <br /> Waste Aerosl*flammable.(Egii not exceeding I capai:4).2.1 <br /> 19 11� age ,W950 331/00,01 <br /> Combustbe Liquid, Ili NA1993, PG-111(Halogenated 01) '1""' <br /> Non RCRA Hazardous Waste Liquid Sludge) 'CA 223 <br /> Empty Drums Provide C:] Remove M' I A I I A2 5g Ll 10g U 15g 0 30g L3 55g P F om- 52 e <br /> Clor-D-Tect Q4000 Test Kit: Test 0 Pass U Fail U Generator Knowledge U PPM <br /> Transportation Charges/Addifi?41 Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: nY N I Labels Oil N[A I A/F 04 L4. UO'F )//A Oily Debris _o+ <br /> SERVICES REQUESTED BY TAX <br /> We <br /> Ac4;Qpt P. O.# TOTAL CHARGES: 23 <br /> GENERATOR'S CERTIFICATION: I hereby declare that the ccinferts of this consignment pre fully and o7rt'i des-^1bed above Dy i rhipp4nqname and are classified,Packed,marked,and <br /> obeled,and am in co ni in Drape(Condition for trorltoo(t by highway according to appi-:foie and nci government regulotioris. if I on)a large quantity geni i certify that I <br /> have a program in Place to reduce the volume and roxicitry Of waste generott!d to the degree i hove determined to be ecoro"caly prqrfcol;W6 and that hove selected the Practicable method <br /> Of treatment,storage,or disposal currently ovaiicmie to mel which minini the present and future threat to human"eoft and the environment;OR,if I am a:moll quantity generator,I have made <br /> a good faith effort to mini my waste generation and select the best waste management method that li avoilaii to me and that I can afford. AN used oil from the generotoe listed above <br /> wiii be transported only to a facility Permitted by the Statelot zolifornio to Produce used oil into recycled a ot a facility That;s required to comply with Federal regulations oppilicable to the <br /> management of used oil, All relevant information regarriii known or suspected hozorcis asiSOCIaTedl with this waste i been disclosed. The customer agrees to pay reasonable costs and ottorney <br /> fees incurred in the colloctfort at this Objigqfici Venue for pijrpo,,es a'This 001ijotion 51 be in solono coirty. i declare under pencity of Perjury feat the for o true and correct. <br /> DISPOSAL/RECYCLING FACIUTY: Collection Station AgriCuffure I Go\,emment I_Mcsti I ii� Indusi I Lubriccriti i— Oil oil <br /> I I Vgrft FS Tischrlmal Solviore,L LC I JEfft I'latXonseraCE3.Inc I JAMOonlimqwmili r i Biff skv Fnvin..o.—i %AN.1r. &—=M1 <br />