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DEC-15-201510:47 From: To:12094683433 Page:4/4 <br /> FREN10" EPVIRQNMtNTAL SAVICES INC. <br /> Send Payment to: Phone: 800-559-3274 EPA ID#CA000171017 <br /> 6940 Tremont Road Phone: 707-448-3700 U,S,D,C,7',#1484667 INVOICE # <br /> Dixon,CA 95620 Pax: 707-448-3499 D.T.S.C.#3544 <br /> www.hazardousdisposal.net CA#274461 Date <br /> Sire AooREss BILLING/MAILING ADDRESS <br /> Customer Pro-Tj l iCh A 146 Rwnair Customer_ern_ ni inh A i On F2enair <br /> 25Moffat Bivd Aftn: Aecfs. Payable <br /> Manteca, CA W331 255 Moffat Blvd <br /> Manteca, CA 95336 <br /> E.P.A.# OAL 000 266 Phone <br /> Additional Contacts: (209) 239-9250 PAYMENT TERMS: NET 15 <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> WAST7 14 • 21 . 30 . 45 . 60 • 90 + 160 • 365 WIC CODE <br /> MANIFEST NUMBER QUANTITY UNiTS PRICE AMOUNT <br /> ODE <br /> swyit <br /> , p <br /> ,p <br /> 0 <br /> TR.R <br /> SERVICES RREEQ�U,EESSTEEDf BY � �; TAX <br /> We <br /> Accept , l P.O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION' f nereuy declare that the contents of this consignment are fully and accunafely described above by proper 3hipplrxg Home and are classified.packed,marked,and <br /> labeled,and are In all respects In proper lore <br /> for transport by hlghway according to applicable state and national govcmmcni regulations.If I am a large quantity gcncrotor,I certify that I <br /> hayC a program in pKice to reduce the volume and toxtclty of waste generated to the degree I have dotcrmincd to ba cronomically practicable and that I hove selected the prartirabtc melhod <br /> of tmatmcnt,storaTe,or disposal currently ovallable to me which minimized the present and future threat to human health and the cnvironmcnt:OR,if I am n anal nUontily gcnwofor,i have mode, <br /> 0 good faith effort o minimac my woste nencmtion and scicct the best waste manancmcnl melhod that i;<rvoilabic to me and Thal I con offord. Ail used 4B lion)the generolor tWled oboe <br /> wdl ba fmncpoded only to a facility permitted by the State of Califomio to produces wed al into mz.ya'cd oil OR a Fadlify fhof is required fa aomply with radcral ragulotion%applicable la*w <br /> rr onogem�nl of used oil. All rclovant information regarding tmawn or suspccfcd hazards ossocialed wilh this waste hos been Ci3Cl�saCi,The Cuslon9er wines 10 poy reo >nable Costs and ollorriey <br /> ire hrcuncd in ihn co'lcction of ttus obF.ation. Vcnuc for purpozinsof Iffm obfi olion sh011 be in SalvnO countIruc and correct. <br /> tSPOSAL/RECYCLING rACILITY: Colfvction Station Industrial Agriculture Govemmant /k4arine Other nduosiil Lt,bQlntlng <br /> N1 .� <br /> �• 27�1[t3+c�cd . <br /> f YU„re,,7Za�-1�3 2 <br /> r fir if s <br /> r1.,f �,..rf •:; 1.01"'� E':tA1 f�1 (,c;f. id <br /> print Nalne j Genatatbes Signotvre / Rr�vet s Signature <br /> 1hereby certify that I_boyp read and have ilhe authority to bind the abovg listed generator to the terms on the revers9 side of this_forttt., <br />