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FREMOUW ElVIRONMENTAL SJORVICES, INC. <br />Send Payment to: Phone: 800-559- EPA ID # CAR000171017 <br />P.O. Box 2875 Phone: 707-448-3700 U.S.D.O.T. # 1484667 INVOICE # 11717 <br />Vacaville, Ca 95696-2875 Fax: 707-448-3499 D.T.S.C. # 3544 <br />www.hazwasteremoval.com CA # 274461 Date <br />SITE ADDRESS BILLING/MAILING ADDRESS <br />Customer Cherokee Smog & Repair Customer Cherokee Smog & Repair <br />900 S. Cherokee Lane <br />Lodi, CA 95240 <br />E.P.A. # CAL 000 300 647 <br />900 S. Cherokee Lane <br />Lodi, CA 95240 <br />Phone Fax <br />Phone Numbers: Office 209 365 9834 Ce209 365 0525 <br />Contact: Jared <br />PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br />7 + 14 0 21 • 30 . 45 0 60 0 90 • 180 • 365 W/C <br />WASTE <br />CODE <br />MANIFEST NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />Non-RCRA Hazardous Waste Liquid (Used Oil) <br />CA 221 <br />Non-RCRA Hazardous Waste Liquid Used Anti -Freeze <br />CA 134 <br />Nan-RCRA Hazardous Waste Liquid (Oily Water) <br />CA 223 <br />;Drained Used Oil / Gasoline / Diesel Filters <br />N/A <br />s" <br />"— <br />Non-RCRA Hazardous Waste Solid Oil Contaminated Debris, Sail <br />CA 223 <br />Parts Washer Service <br />CA 223 <br />Non-RCRA Hazardous Waste Liquid (Brake Fluid) <br />CA 343 <br />Waste Flammable Liquid, N.O.S. 3 UN1993 PGII Gasoline -Diesel <br />Empty Drums Provide D Remove 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g S P F <br />Clor-D-Tett Q4000 Test Kit: Test ❑ Pass ❑ Fail ❑ Generator Knowledge ❑ PP <br />Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br />Clean: Y N7 <br />Labels <br />Oil <br />A/F <br />UOF <br />Oily Debris <br />SERVICES REQUESTED BY <br />TAX <br />7.75 <br />Accept ,_We 1" � <br />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 are in all 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, I hove 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 />fees incurred In the collection of this obit ation. Venue for purposes of this obligation shall be in Solana county. I declare under penaltyof perjurythat the forgoing is true and correct. <br />DISPOSAL/RECYCLING FACILITY: Collection Station 1 Industrial Agriculture Government I Marine I Other I nd0s1ir l LubhOctaring <br />[ ] Evergreen Environmenlal Services - Davis [ ] Evergreen Oil, Inc. [ ] GEM Rancho Cordova LLC[ Ig Sky Environmental [ ] 21st CenturyEMI <br />Road 308 68M Smith Ave. 11855 White Rock Rd. 1 W. Channel Road c= Newlands Dr., East <br />1 Davis, CA 95616 2 Newark CA 94560 3 Rancho Cordova, CA 95742 4 Benicia, CA 94510 5 Fernley, NV 89408 <br />514795-0400 CAD 982446874 510-7 4400 CAD 980887418 1fra51-00 CAD 90000110 J I V J4 1 L I LO CAL Cup <br />PhAt Nam Wiener s Si ature 0a Driver's Signature <br />State Law Requires that you -keep this Receipt/Bill of L on file no less than 3 years. <br />To Re -Activate or to obtain an EPA # - Customer may contact DTSC @ 1-800-618-6942 <br />