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FREMOUW E)AIRONMENTAL SFJW10ES9 INC. <br /> 1-tend Pae meet to; Phone: 800-559-32"1111111111111' EPA ID#CAROOO 171017 <br /> P.O. Box'2875 Phone: 707 448-3700 U.S.D.O.T.# 1484667 INVOI-QE # <br /> Vacaville.Ca 95696-2815 Fax: 707-448-3499 D.T.S.C.#3544 <br /> www.hazwasteremoval.com CA#274461 Date <br /> SITE ADDRESSBILLING/MAILING ADDRESS <br /> Customer 8rannon i ire. Customer ire <br /> J- <br /> E.P.A. # <br /> Phone Fax <br /> Phone Numbers: Office Cell <br /> 4 <br /> Contact: -i a;.es <br /> PRODUCT - S -.RVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 • 14 • 21 • 30 • 45 • 60 9 90 • 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Sr. <br /> 7 <br /> Empty Drums Provide Q Rerrove 0 5g Q I Og L3 15g C3 30g U 55g E3 S P F <br /> Clor-D-Tect Q4000 Test Kit: Test ZI Poss U Foil El Generator Knowledge Cl PPM'-- <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F UOF Oily Debris <br /> w <br /> SERVICES REQUESTED BY TAXI <br /> We <br /> Acceot P. O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: .-e,ez-=e:c-e-c—ea—e-sc—i Ore 4'-!:v ono cccL:rc4e!v described above by proper shipping name and are classified.packed,marked.and <br /> =-=S:�C77 C,�.;-,-,u),occord:r.g-ccppiicabie 340te and notional government regulations. If]am a large quantity generator,J certify that] <br /> ave <br /> c c-:;g-c- c zce-z-ez-ca--e =-�:*zy:,:'-.-.f-os?e gereroied to f�ie degree 1*love determined to be economically practicable and that I hove Selected the practicable method <br /> -1`sccr:!:!C :--e-'. =.z�=e-:: 7e ,- —�--zec- an�-e o'eie- `:;';,•e f�,reaf to human health and the environment OR,if I am a small quantity generator,I have made <br /> a g ze_. ..aF.e z_c:5e ec,_7e ne5_ CIS!e-Z: C.-e-ne!---e,"d ti'0!;s available to me and that i can afford. All used oil from the generator rested above <br /> cc ze— l:s 3. -e Z,=,e-1 'c==-;ce-sec n-:-,c*e--,,*c;ed a+OR a facility thct is required to connolyrvAllh Federal regulations applicable to the <br /> -ec.=,. <br /> ,ee; -z<-r-1- 60z-11d!r5s0cio!ecwi-,h this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> =�:-- e:c- a`+'-s 30"PaVon-nost oe in Solaro county, I declare under penalty of poury that the tornoing is true and correc� <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Govemment Marine Other LNnclusirlcil Lubricating <br /> Oil oil <br /> -r tyy Elyl.! <br /> %PAL <br /> P,;. crate <br /> Generators Sign6turg Drivers Signature <br /> State LaN Requires that you keep this Recelpt/B111 of Lading on Hie no less than 3 years. <br /> To Re-A:Jlvate or to obtain.an EPA 4-Cuqtnmp.r mriv(-.nnfnr•+nTqr o I-AAn-A 1 P-AQAI) <br /> ZTT/900 18 SINII SOAS ANH AfIONHHA 66VEMLOLT YVA 00:VT TTOZ/ZZ/90 <br />