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J <br />:J <br />FREMOM E"TVIRONMENRTAL S"'RVICES, INC. <br />Send Payment to: Phone: 800-559-�,4 EPA ID # CAR000171017 <br />6940 Tremont Road Phone: 707-448-3700 U.S.D.O.T. # 1484667 INVOICE # <br />Dixon, CA 95620 Fax: 707-448-3499 D.T.S.C.# 3544 <br />w .hazardousdisposal.net CA # 274461 Date I f _ ! t — I L/ <br />SITE ADDRESS BILLING/MAILING ADDRESS <br />Customer -1 fit_ f Auto ,Motor Customer 1 A (A.4-fio �.i <br />16:30 Ki. Mkon t"Iiay 1630N. Wilson Way <br />Stockton, CA 95205 Stockton, CA 95205 <br />Attn-. Asti Payable <br />E.P.A. #r'1L V o Phone <br />Additional Contacts: 1209) 462-9464 PAYMENT TERMS: NET 15 <br />Indra I nn1o� <br />PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br />7 • 14 • 21 • 30 • 45 • 60 • 90 • 180 • 365 W/C <br />WASTE <br />CODE <br />MANIFEST NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />f,,,r-fDA no t66ne• ^ff1 Cb;p. .,moi <br />T'`:?(tU1 )ik <br />w <br />1 ?tflm <br />ifi Poll <br />1 <br />Fn i I' t i I 4,11H9 i ix <br />�X- - .1 <br />'• <br />2t8'dli Lp \/rh'!NB <br />ed`a <br />EaaCh <br />7 <br />4 <br />ft ..an!Irtht TilkiR•m I L :m^ c -S i°!4''='r.nrn.. r ri <br />tri <br />1 G IJ n R t i 1 Gr . hf 1,Ih �: 4fl <br />�.t h <br />,. K' <br />'> <br />-ch <br />Larrys Non DOT RPaulated Flu ore rlt biriht Tubes Rtt <br />t... <br />41I Box /for Fluorescent T ubes <br />_ <br />B -X <br /><: f;,r <br />8tt Box I for Fluorescent Iittes�:)r. <br />5 CIG <br />IV c' <br />SERVICES REQUESTED BY <br />Ct`td_ .r1:.rta:'6rL,.c.: <br />TAX9kl <br />tai <br />We <br />Acce t vrsA. ®® P. O. # TOTAL CHARGES: <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked, and <br />labeled, and ore in oll respects in proper condition for transport by highway according to applicable state and national government regulations. If I am a large quantity generator. I 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 quantity generator, t 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 />DISPOSAL/RECYCLING FACILITY: I Collection Station I Industrial I Agriculture I Government I Marine I Other I '11—s""" I I—..i. .""e <br />�. !, sa:�Lp. LJ fm:nm.�iruwnnn�nu!6c <br />t1y_S£:11W SW i:'t6L't� GRCJ iiznart Rs�.7 <br />iT'_"a2'"Yt i3X*IW 7)7 iIN <br />01 -Rev. 02/14 State Low Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br />