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1916 E. March Lane 1916 E. March Lane <br />Stockton, CA 95209 Stockton, CA 95209 <br />NA 91111111KI, <br />AddMonal Contacts: <br />.►Ia,ERt�alnh �na.a5d119 5 <br />PRODUCT - SERVICE INFORMATION PROPER SHIPP N amono.4. <br />I G <br />v v <br />e e a A I <br />X V \lvlEi \ iL-12-.1 <br />1®� 14./1%IJ' j,l7 tie <br />Send Payment to: <br />Phone: <br />800.559-3274 <br />EPA TD # CAR000171017 <br />AMOUNT <br />Drained Used Oil / Gasoline 1 Diesel Filters <br />P.O. Box 2875 <br />Phone: <br />70700 <br />U.S.D.O.T. # 1484667 <br />INVOICE # 1915 4 <br />Vacaville, Ca 95696-2875 <br />Fax: <br />707-44 99 <br />D.T.S.C. # 3544 <br />Z <br />www.hezwesteremoval.Com <br />Exduded Recyclable Material (Latex Paint) <br />WA <br />CA # 274461 <br />Date <br />WE ADDaESS <br />Waste Paint Related Materials, 3, UN1263, PGI <br />MILLING/MAILING ADDRESS <br />Customer —_March <br />Customer <br />Waste N. .S- 3 UN1993 PGII G Diesel <br />1916 E. March Lane 1916 E. March Lane <br />Stockton, CA 95209 Stockton, CA 95209 <br />NA 91111111KI, <br />AddMonal Contacts: <br />.►Ia,ERt�alnh �na.a5d119 5 <br />PRODUCT - SERVICE INFORMATION PROPER SHIPP N amono.4. <br />I G <br />DESCRIPTION <br />7 - 14 - 21 • 30 - 45 • 60 . 90 e ISO. US W/C <br />COASTE D <br />MANIFEST NUMBER <br />aUANntY <br />UNITS <br />PRICE <br />AMOUNT <br />Drained Used Oil / Gasoline 1 Diesel Filters <br />NIA <br />Nor>-RCRA Hazardous Waste Solid (Oil Contaminated Debris, Sod) <br />CA 223 <br />Z <br />Exduded Recyclable Material (Latex Paint) <br />WA <br />Waste Paint Related Materials, 3, UN1263, PGI <br />3311DO01 <br />Waste N. .S- 3 UN1993 PGII G Diesel <br />Non-RCRA Hazardous Waste I *Quid (Brake Fluid) — <br />Waste Aorosotti f lammable, (Each not exceedltlg IL capadly),2.1,11Nta50 <br />rA 11,111 <br />331AD001 <br />Combustible Liquid, N.O.S., NAI 993, P3111(Halogenated 01) <br />Mill <br />Non RCRA <br />CA 223 <br />Cirri v v `Z5 <br />Empty Drums Provide Remove O 1Al 1 5g ❑ 109 ❑ 15g ❑ 301 SSg P F <br />Lpm <br />) <br />Clor-D-Tett Q4000 Test Kit: Test ❑ Pass ❑ Fail ❑ Generator Knowledge ❑ PPM <br />Transportation Charges/Addition ruck Time/Additional Labor/ LAB Packing/Site Cleaning <br />Clean: N <br />Labels <br />Oil <br />0 e <br />SERVICES REQUESTED BY <br />TAM <br />We <br />Accept <br />P. O. M TOTAL CHARGCS: <br />L <br />vmcwlil s l .Lehr ..JfaSlre: i needy decide mar me contents of •his consignment are II and accurately desrrtbed Ol by DfolSer shipping no" and me classified. packed. Ma zi and <br />labeled. and we in ail respects n proper cond'.Nx for transport by highway according to opplicobe state and nafi0ndl government ell Ons. If I am a forge quantity generator. I cei that <br />hove a program in place to red.:ee the voWme aria toxicity of waste generated 10 the degree I have determined to oe econonlcobs• practzable antl that I have selected Bas prochcoble mettx>p <br />of heotmenl. storage, or disposal cunen±ly avaioble to me which reiNmixed the present and fl (Meat to human health and rhe enakornnenf OR. I!! am o small gvontly generator. hive made <br />o good faith effort to minimae my waste generafior antl select the best waste monogement method that 3 available to nw and that I can afford. Al used W from `he generator bled del <br />will be transported Only to o facility perorated by me State Of California to produce used OI'into reoyaled OI of a (doNty roar i1 reaN;,ed t0 Comply w in Fedend r-gAcfrons applicable faith, <br />management Of ns9d oil All relevant informOt!on fegording know, or suspectep hazards associated with the waste has been d'eclased. the ntioly 1 agrees i0 pay r,OSorlOde costs and attpmev <br />f805 inCUrtetl in the collection Of this ODN tori Venue tar f of this OOF Ian shall be In $dada CO�n <br />deC_10Tt0__rE2,l Of. that the forgoing f hue and Correct. <br />DISPOSAL/RECYCLING FACILITY: C011eetion Station InduxMal Aa_ rlculturo Government modne_ [Sns---wr I Indviel I21 1Luof <br />bleuenp <br />I i Verne E3 Tecte" SM ,LLC I I EaM Prizaam Session M.. 11 GEM Retail Cwem LLC I Iate AtfrowmeMel Cff"Ew <br />519e Weft Je4eremg SYN 6kl,ler et.lAM• "We.+elw.lb ntw eenert Me weleeieti uee <br />I Ph" K 66003 2 Hsrseerl, CA .91515 3 RFlctte Ciller, U 95742 A Bellew CA "511 6 ,ri M' so"&65 <br />"llanAZOOD=7Dm 408lCM00DIS" ata351L66D C1DIIII) 163 510"112128 CALemJ016)9 7759527M <br />KAL)k �Ey� <br />Prnr Name Generator's Signa1l e <br />Stale low Aequket that you keep this AeeNpt/AW N Lading on Ale no le» Ran 3 yeas. <br />To Re -Activate or to obtain an EPA q - Customer may Contact DTSC 4 1.811618.6941 <br />