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r�KLMUU W L+ � V IKVl�1Vlr,l� tAl. �r.�v l�.r�k�, �.1��-• <br />Send Payment to: `Phone: 800-559-3 EPA ID # CAROM 171017 N.��O10E # 59807 <br />6940 Tremont Road Phone: -707-448-37 U.SD.O.T.#1484b67 <br />Dixon. CA 95620 Far. 707-418-3499 D.T.S.C. to 3544 ` °' <br />n,; _ <br />%-w.hayardousdisposbl.net CA # 274461 Date <br />$171 ADDRESS FILUNGY"IUNG ADDRESS <br />Customer Marr`h Jianchl ChAVro P Customer March fit. Bianchi Chevron _ <br />1916 E. March Lane 1916 E March Lane <br />Stockton, CA 95209 Stockton, CA 95210 <br />AT TN- COQ <br />E.P.A. # ^ i " - Phone <br />Additional Contacts: 20M,%09115 PAYMENT TERMS: NET 15 <br />..Ir tw_r rr nAA ATen KI 1D D(%D FD CNIppI NIC: riFSC R I PTION <br />7.14 2l • 30 45 • 60 YD 100 365 W'C <br />NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />� } <br />7Each <br />Service <br />4WA'1EMANIFEST <br />'_l1 z'-7 <br />rumicI <br />75.0( <br />75.00 <br />x <br />SERVICES REQUESTED BYTAX <br />,;-V15._DIR reaIRSIOLIVGot <br />L3 <br />e1100. To Moir <br />e <br />ed criv to <br />IDISPOSAL/RECYCLING FACILItY: I Collection Station Indushial <br />❑ wm u <br />4'Y 951 t Int $ N 013 A: <br />5r:Mfi HanP <br />TMASS--m WT?WOM <br />PrintlV-dm@ Generators Signa}ure <br />I hereby certifv that I have read and have the authority to bind the al <br />Fl01-Rev. 02/14 State Law Requires that you keep this Receipt <br />turn• �..........`... 1 _-�;. <br />r descdmed above by poWsrfapkra naera and no ci packed. mc.kea, and <br />rd mllorv�l gavammeM regula9ons- If 1 am a laye q�entiiy peDe'a'a, 9 cenity that 1 <br />nited to be econemlcalN pratttcaale aM Tirol1 hwe selected the Roc9caHo mNnoa <br />dwllable to me and MW caann afford- M used o7 from Te gereraior Railetl labovo ode <br />OR a WHY that 4 Mauled to eomp)r with federal regulations appicable to the <br />s waste has been d"Sed. The custamd agrees to paY feasMabla cats and of honey <br />Ide^Jare under half at u Y�1the ltt do is iruc a+a cameo. <br />-uttu A Cioverrrr/snf 1 Madne I OtherIMvsON of LubdOlaollr.R <br />. C <br />,rte CYl-fr><' <br />till of Lading on the no less than 3 years. <br />