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FREMOU E)WIRONMENTAL SVVICES, INC. <br /> -'zcnd Pa%ment to; phone: 8 559-3-IW EPA ID#CAROOO 171017 <br /> P.O. Box 28'5 Phone: 70 8-3700 U.S.D.O.T.#1484667 INVOICE # <br /> Vacaville.Ca 95696-2875 Fax: 707 8-3499 D.T.S.C.#3544 <br /> ,%wix.hazwasteremoval.com CA#274461 Date oo' <br /> SITE ADDRESSQ T, 7 <br /> BILLING/MAILING AD"ESS <br /> Customer If Customer re <br /> C;i- <br /> '52(" <br /> W, <br /> E.P.A- L V/ Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 • 14 • 21 • 30 • 45 0 60 0 90 0 �180 WASTE 365 W/C CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> N.-IC 4 <br /> /(C <br /> 7.0 <br /> Empty Drums Provide Remo e 0 5g U I Og U 15g U 30g Q 55g 0 S P F <br /> Clor-D-Tect Q4000 Test Kit: Test ZI Pas U Fail Z1 Generator Knowledge.2-"4m <br /> Transportation Charges/Additional Tru k Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil 7.�A/F —FU I OF Oily Debris <br /> SERVICES REQUESTED BY I TAXI <br /> We <br /> A p t TOTAL CHARGES: <br /> cce P.O. # <br /> GENERATOR'S CERMICArION: MEN <br /> ..r+c-c 2-cc�rc'e'%oescribed onove by proper shipping name and ore classified,packed,marked,and <br /> aos ec 2-z'z'e zze- ::-:: zZ' c:-n. =--*!'Cco.e s'otec-i:�natior�oi govemmentregulat:on5. If d-large quantity generator,Icerfifythat l <br /> -= ­ .: - - -- <br /> -=,e c z�*--7= e-z'ez c-,e cegree,-C%,e delertrined to be economically proct p <br /> z' ble and thel.I have selected the practicable method <br /> c 7---reser fu!,�e'nreo''a-union health and the environment; <br /> -e =:'e;e-e-'.r s a:---e ze!- that: ant.,OR,if I-affo small quantity generator,I have made <br /> s ovallabie to me and that I can afford AN used oil from the generator listed above <br /> -:c 0=-j::e OR a facility that Is required to comp wig;Fedei;al regulations'ne "'ec -e z.z:.e-cc ;eco:'�n,c ecvciea--;, <br /> -ec .- y lotions applicable to the <br /> —e-e-z'-se= a,= <-z,-,or s,soec'ec rozo,-ds cssoc7o!ecw''t-,this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> ees:rz:--e=---e cz ez--- zDc:! <br /> e--e'c- :'305811 cf 1's shc!l be in solar. y. I declare under penalty of p ry that the dor in is true and correct, <br /> industrial Lubricating <br /> =ine I Other 1 00 1 <br /> co-n! L--P-'t <br /> DISPOSAL/RECYCLING LING FACILITY: �qfie.hlon Station lld.s�hrlcil :toriqytture Government <br /> Oil <br /> 21A(;Gnkey Er--A <br /> NqW;,1d9 East <br /> 'z: INV '9940P, <br /> w <br /> . <br /> 53l 7 <br /> L)r3 r;r3 <br /> 9—'w Gan6rat&4&gnatLini <br /> DdV60 Signature <br /> State Low Requires that You keep this Receipt/Bill of Lading on file no less than 3 years. <br /> Toa Re-Ac <br /> RNate or to obtain an EPA#-Customer mnv r.nntn(-.f n7,,r ra i-qnn-AiA-Aoz') <br /> ZTT/L0012 ON1 SOAS ANH MfIONHHH 66VCRt'f'L0LT XVH 69:£T TTOZ/ZZ/90 <br />