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r M=1, Ir-1-JV4 -11 -1 __ 11— 1JJl'JI JJTJJV <br />FREMOUW ;NVI Z.ONMENTAL ZERVICES, INC. <br />Send Payment to: Phone: 800-559-3274 EPA ID /I CAR000171017 <br />P.O. Box 2875 Phone: 707-448-3700 IJ.S.D,O,T. // 1484667 INVOICE # 4 6 b 2 <br />Vacaville, Ca 95696-2875 Fax: 707-448-3499 D.T.S.C. // 3544 <br />www.hazwasteremoval.com - CA N 274461 . , Dater <br />Custome <br />Address �v V Q L'_r r 2 K <br />City State Zip <br />E.P.A. # <br />Phone Numbers: <br />Contact: 1a % <br />itNG ADDRESS // <br />Address <br />�CJ <br />City <br />Phone _ <br />Fax ( ) <br />E-mail: <br />State Zip _ <br />Cell ( ) <br />Fax <br />PRODUCT - SERVICE INFORMATION/PROPER SHIPPING <br />DESCRIPTION <br />Non-RCRA Hazardous Waste Liquid (Used Oil) <br />WASTE <br />CODE <br />MANIFEST NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />CA 221 <br />Non-RCRA Hazardous Waste Liquid (Used Anti -Freeze) <br />CA 134 <br />Non-RCRA Hazardous Waste Liquid (Oily Water) <br />CA 223 <br />Non-RCRA Hazardous Waste Solid (Oil Contaminated Debris, Soil) <br />CA 223 <br />Non-RCRA Hazardous Waste Liquid (Latex Paint) <br />CA 291 <br />Drained used oil / Gasoline / Diesel / Filters <br />N -A <br />Combustible Liquid, N.O.S., NA 1993 (used oil) III <br />CA 221 <br />Waste Paint Related Materials, 3 UN 1263, PG <br />W aste Flammable liquid, N.O.S., 3, UN 1993, PG H (Gasoline -Diesel) <br />Waste Aerosols, N.O.S. 2. 1, UN 1950 PG <br />Empty Drums Provide Remove 5g ❑ l Og ❑ 15g ❑ 30g Q 55g ❑ S P F <br />Clor-D-Tect Q4000 Test Kit: Test ❑ Pass ❑ Fail Cl Generator Knowledge ❑ PPM <br />Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing <br />_ <br />-Additional Equipment Supplies <br />Hazardous Waste Labels <br />Used Oil Disposal Fee <br />Other �iE-�l"1s`Cl�..� (JJ✓ I r)l (_ (t�L_,Ut t- YL�� vP A? <br />r _- <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described bove by proper shipping name and are classified, packed, marked, on <br />labeled, and are In all respects In proper condition for transport by highway according to applicable stale and national government regulations. If I am a large quantity generator. I certify ilial <br />have a ee I have <br />ned to be <br />of Iroatme program orage, or disposa currently volume <br />a ollable toand xicity of waste me which minimized tted to the he present and (future threat to iuman health andtheally en i onm eanbl OR if I am a that I have <br />mall quantitty generator, I hoved the practicable nlN <br />a good faith effort to minimize my waste generation and select The best waste management method that is ao8abte to me and that I can afford. All used o1 from tine generator listed above <br />will be transported only to a facility permitted by the State of California to produce used o7 Into recycled oil OR a focilay 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 anon <br />fees Inc Unetl In the collection of this obligation Vanue for yr oses of this Doli tion shall be in Solana county. I declare under anal) of et u 1hOi Iha for oin Is trueand co ecl Lubrlcatlnt <br />DISPOSAL/ RECYCLING FACILITY Collection Station Indusirlal Agriculture Government MarJne Other OR on <br />Evergreen 08. Inc. © General Environmental Management, Inc. Onyx Environmental services Ramos Environmental <br />'Bab Smith Ave., Newark, CA 94560 11855 While Rock Rd., Rancho Cordova, CA 95742 1125 Hensley St., Richmond CA 94901 ISIS S. River Rd, W. Sacramento, Ca' <br />510. 95.4400 CAD 980887418 916.351.0980 CAD 980884183.. .. 510-233.8001 CAI 080 014079 916.371-5747 CAD 044003616 <br />Industrial OR DK Dixon 0 Other <br />Commercial Filter Recycling [�] , 7300 Chevron Way., Dixon, CA 95620 <br />33210 Western Ave., Union City, CA 94587 1291 taverna Avc,. Klotpa( t�Folls. OR 97603 NO.727.2879 CAT 080 012 602 <br />510.487.9127 <br />541.884.9124 ORD 98098077S <br />Print Nam Generator ttft6t6rb ;, �• Drivgs Signature <br />State Law Requires that yo eep this Receipt/Bill of lading on file no less than 3 years. <br />To Re -Activate or to obtain an EPA -9 - Customer may contact DTSC @ 1-800-618-6942 <br />