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FREMUUW ENVIRONMENTAL SERVICES, INC. <br /> Send Payment to: Phone: 800-559-3274 EPA ID#CAR000171017 CSLB A-Eng#1022665 <br /> 6940 Tremont Road Phone: 707-448-3700 U.S.D.O.T.#1484657 Small Business#56427 INVOICE <br /> Dixon,CA 95620 Fax: 707-448-3499 D.T.S.C.#3544 8 7 0 0 8 <br /> www.fremouwenvironmeiital.com CA 274461 Date <br /> SITE ADDRESS B LLING/MAILING ADDRESS <br /> Customer U ..f di ;let Sales I d ., <br /> Customer_1�,0zad T1a9l _aawlLcl ,.,_ <br /> 4907 E. Watedo0 Read TM' Accts, Payable <br /> St ktan, (A 4P07 E. Watefloo Rodd <br /> ftcto , CA 95215 <br /> E.P.A. # x �Cfg'�.+ ' Phone <br /> Add[t[onal Contacts: 16 i.'-11411! 2P19-913- ` 0911 <br /> PAYMENT TERMS: NET 15 <br /> BKt�-V—F 'wo'haw <br /> PRODUCT--SIRVIC1:INFORMATrION%PROPER SHIPPING DESCRIPTION/BILL OF LADING <br /> 7 • 14 • 21 • 30 • 45 • 60 • 90 • 180 • 365 W/C WASTE CODE MANIFEST NUMBER QUANTRY UNITS PRICE AMOUNT <br /> S'1: '.4 p. i�fa47ri7ialliB,iS;-.,.,:`a:1M:.i'�j.,'.l �':,f4t• 1?Sw°lTil.[rYi U1223 ,J2nWl2" 9 27500 <br /> el.: f.,,-ii :i: i.'l.__ Ftp;1�� :iY.i:=:rN'✓, tV/A Fill Sam <br /> 55oi.i:'..s?,;:::ars.':. :'Riftp-ilwm5ftt NA <br /> 45.{141" <br /> SERVICES REQUESTED BY < 8i o0,IT I PN FI)al1�'�tiwv►a phone C $ft r, 80C,ti Hit lv '?)3"g31-6'` TAX 17.750S <br /> We <br /> Accept t is Flo P.O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of thi ca ignmenl ore fully orad accuralely described above by proper shipping name and are classified,packed,marked,and <br /> labeled,and are in all respects In proper condition For ironsporl by highway occording la applicable state and national govemment regulations. If I am a forge quantify 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 practicob!e method <br /> of treatment,storage,or disposal currently available to me which minimized the present and future threai to human health and the environment,OR,If t oma smaN quantity generator.;have made <br /> a good faith effort to minimae my waste generation and select the best waste management method that is available to me and that I can afford.All used oli Tram the generator fisted above <br /> WIR he transported only to a facility permitted by the Stole 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, AN relevant information regarcling 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 obd atian. \enue for purposes of this obl' tion shall be In Solono coup . I declare under nallity of a=that the T na is We and correct. <br /> a1SPOSAL/RECYCLING FACILITY: Collection Station I Industrial Agriculture Govcmrnent Maine Other Irrdustrfal LUtxleatirep <br /> Print Name -- � Geners�tor's 5ignoture Driver's Signature <br /> I hereby ceriify that I have recd and have the aulherity to bind the above listed genemior to the terms on the,reverse side of this form. <br /> F1Rt-Rev.08118 State Law Requires that you keep this Receipt/Bill of Lading an file no less than 3 years. <br />