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1187 VANDERBILT(IR.#2 <br /> CALIFORNIA OOLA T C VICE MANTUA, (A 95337 <br /> _ A Division of Fremouw Environmental Services, Inc. OFFICE: 209-239-5587 <br /> Transporter EPA# (AR000171017 FAX: 209-239-6316 <br /> SERVICE ORDER: 0082A <br /> Mountant Valley hxpr +.s(taxable 9.L5°/b) MANIFEST# <br /> 10!9 Hcssenier Ave l e5z;,6 iA)0 CC,) ;` <br /> Manteca,CA 95_413o <br /> 2t1�•8�3-Z 16K <br /> EPA 11),#:CAR 000 015 56J Caskmiler#:1816 Contact:Hatt sc'tttrn-t:L l terms.F(' )*ke �titeAl�e :aett A44-* <br /> • • ® • • ' • <br /> 050 %aste antifreeze lick <br /> 000 Used ch(bt.Ivrasoluie 1 0ters <br /> UU t't:Iir-i CKA I#arttous Waste Li uta <br /> Tank Serial Numbers: Non Taxable Sub To <br /> r^ S d <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DU C.,,) <br /> 1 <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)*NO PLACARDS REQUIRED- STATE CODE 221 <br /> J NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED* STATE CODE 134 <br /> J OTHER: <br /> ZI DESIGNATED TSDF: <br /> J EVERGREEN OIL,INC.: 6880 Smith Avenue•Newark,CA •CAD980887418•(510)795-4400 <br /> J THERMO FLUIDS: 655 South Stanford Way•Sparks,NV 89431•NVD982510711-(775)219-7396 <br /> NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982589459-(801)977-0220 <br /> Lam-D/K DIXON: 7300 Chevron Way- Dixon,CA 95620•CAT080012602-(707)693-6008 <br /> J EVERGREEN OIL,INC.-FRESNO: 4139 N.Valentine Avenue•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> J ALTERNATETSDF: <br /> LI BIG SKY ENVIRONMENTAL: 401 W.Channel Road•Benicia,CA 94510•(510)541-2128 <br /> Clean-./ ' t N LabeJsp ; .� Oil " A/F oe. _7Oily Oily Debris <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the 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 have a program <br /> 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 of treatment,storage,or <br /> 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 have made a good faith effort to minimize my <br /> 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 will be transported only to a facility permitted by <br /> 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 management of used oil.All relevant information regarding known <br /> or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable costs and attorney fees incurred in the collection of this obligation.Venue for purposes of this <br /> obligation shall be in Solano County. I declare under penalty of perjury that the forgoing is true and correct. <br /> Collection Station Industrial Agriculture Government Marine 1, _ ,Other Industrial Oil J,' Lubricating Oil <br /> All amounts not paid within 30 days of Invoice are subject to 11/2%interest per month,18%annually on unpaid balance. <br /> If account is forwarded to collections and or an attoyney customer will be responsible for all collection and or attorney fees. <br /> Vk <br /> PrintName Generator's Signature dri�eF's Signature ~ <br /> I hereby carft that I have read and have the authority to bind the above listed generator to the terms on the reverse side of this form <br /> © ,,.$t to ui <br /> Law re hat you keep this Receipt/Bill of Lading on file no less than 3 years. <br /> 3,43.E T[tx 9.A'S.6`5.001 Itt'a ,Iipw <br />