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FtJhTV ]ITOlZENTAL SERVICES, INC. <br /> SendPayment t o PhoneTST, 800 559 3274 EPA ID#CAR000171017 CSLB A Eng#1022665 <br /> 694QTremontRoati 'Phone 707148 3700 U S D O T#1484667 Small Buszness#56427 INVOICE # 3 <br /> Dixon, �9620 E 707-448 3499 D T S C,#3544 <br /> wwwfir�monwenvtroTtmental com p y- _.,rsCA#274461 <br /> Date <br /> SITE%1DDRESS ^'BILLING/MAILINGdDDRESS _ w ' <br /> Customer, t i a l t t � CUstc mer I i b # <br /> ZE <br /> 1�201- <br /> T77 <br /> TN: W1 <br /> �� � � t v <br /> � Adiirttonal Conacfis PAYMENT TERMS: NET 15 <br /> a r - -„ <br /> p�j s i <br /> ..: 7 . PRODUCT .^ IC i1lORlVtA1T6N%PROEl2`SIPPtN DE$CRIPT10N7BILherr <br /> L`OF LADING - <br /> YIIASTE �.., <br /> 7`• 14 1• 0 • 45 •,b0 • 40 • 180 • 3b3 W/C CODEMAMFEST NUMBER QUANTITY liNiTS PRICE AM011Ni <br /> ttl21, <br /> Ra <br /> Mini# <br /> L -a _ '' t�� �t ': 7, 41L�06 _.-rid L�? <br /> 3Y.O.c�',:� QLtitt ` { .. U+kk`LLSB 3i*1rr^ <br /> m <br /> 76.00 710-1 <br /> r <br /> i tett/3t+at1. tttttt twit -i <br /> MA <br /> n �* <br /> i <br /> FMA <br /> Ve <br /> E <br /> i } <br /> M X <br /> ti <br /> i <br /> a <br /> e <br /> r <br /> : s <br /> le <br /> 76 <br /> SERVICES ,REQUESTED BY ?� Ph '��friT3 e5 btiCf Yit:20 - <br /> TOTAL CHARGES. r <br /> ticce t <br /> GENERATOR'S CERiiFICAtION i herebydecfare that the contenfs`of this'consignmentore fu)ly and accurately described above by propershipping name grid are cldssified,packed'(Walked,and <br /> labeled;aril are m all fespects lrr";toper condition for transport byhighway deco{ding to applicable state gntl national government regulations:l,F,)am a large quantity generator,fcertify ftiat <br /> have aerogram in place to reduce the volume pridtox city of waste'generated to the degree I have determined to be economically practieabl'e aril that I have selected,the practicable method <br /> of t eatnient storage;ordisposal currently gvailable to ne which minimized the present and future, atto human health and the environrpent;OR,if 1 am a small quantity generator,I have made <br /> a good faith effortto minimae my wastegeneration and select, best waste management method that is available to me and that t can afford,.ATI usetl oil from the generatorlis#ed_.above <br /> vtll be fransportetl oniy`to a fa"cility permiftei by'the Stdfie of Califamia Yo.produce U"sed oil into recycledoll OR a facilitythat is required f6 comply With Federal regulations applicable�to the <br /> mdnagement of used otl All relevant mformgtion;regardjng known?oisuspected haiards associated with this waste has been disclosed.,The customer agrees to;pay reasonable casts and attorney <br /> fees incurietlnthe colleetfon`ofthis ob6 ation.=Venue for u uses afitnsnth anon shall be m Solgno eoun : 1 declare under enol 'of e u fihatthe for ain is true and correct: <br /> DISPOSAL/RECYCLING FfaGILIM. Collection Station intlustrigl f�gricutture Government Marine Other Induasihiat' Lubriaclating <br /> Ott ' !�t���ktctt''` tti =i0 <br /> Print Name Ge ator s Sign re Driveris Siggnature <br /> I hereb cern that i have read and have the a ori to, the above listed generator to the terms on the reverse side of this form. <br /> ni u:.., non n State Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br />