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FREMOUNVE! <br /> 34VIRONMENTAL SbRVICES9 INC. <br /> �;cnd Pa--ment to; Phone: 800-559- EPA DD#CARGOO 171017 <br /> P.O. Box 28'.; Phone: 707-448-3700 U.S.D.O.T.#1484667-7 " INVOI��E'#� <br /> . Z <br /> 07 <br /> Vacaville.Ca 95696-2875 Fax: - 8-3499 D.T.S.C.#3544 Date <br /> w%whazwasteremoval.com CA#274461 <br /> SITE ADDRESSBILLING/MAILING ADI5ESS <br /> C <br /> Customer of.1 T j r e. Customer �r. <br /> E.P.A. Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: <br /> PRODUCT SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 9 30 45 9 60 ?0 180 36S W/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMO <br /> lj"t <br /> .00 <br /> 7, <br /> W 1 <br /> Empty Drums Provide D Re rr ove O 5g El I Og.0 159 EJ 30g El 559 Q S P F <br /> Clor-D-Tect Q4000 Test Kit: Test ZI Pass Z) Fail El Generator Knowledge 0`11PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Pacog/Site Cleaning <br /> Y Labels LIOF Oily Debris Clean: I A/F <br /> SERVICES REQUESTED BY ITAXI I <br /> We P. 0. # <br /> TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -e-e=.zez::;,e -C---9 cc-4—er'cre fu::y and accurcte!y described above by proper shipping name and are classified,packed,marked,and <br /> =e -= -c- - - - =-'c•-';-snor ccco.,C!,r=7o applicable STote and national government regulations. if i am a large quantity generator,I certify that I <br /> ea <br /> ='e iz�� <br /> -=C::C-':le=---e'-e.=�-le---3-�xi=:-,C'�05'0 genercfed to'he degree I have determined to be economically practicable and that I have selected the practicable method <br /> c!'re,.- s'cro;e ::!5cc-= C:--e-.c,=.cc.e" -e"'cr,minimized i"oresent and future threat to human health and the environment;OR.if I am a small quantity generator,I have mode <br /> d'� <br /> go ze-. .cs,e gene-c:i:on c 5ele=—e bes.-oste rnonagement method that is available to me and that I can afford. All used oil from the generatorlisted above <br /> s=7-ez 'zz ze--e=c.'-e S'C*e C,teai`cr:,;c'o produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the <br /> -c-==e-e- -re= <br /> "•=-. 'e;, �:-g kr�c sus 'ec o2cm,associated with this waste has been discbsed. The customer agrees to pay reoSOnable costs and attorney'ees' Z.c-C; <br /> Lroncses of no county. I declare under penalty of perju that the for of-le be in Solo 'y is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial I Indu <br /> Agriculture Government AAcrine Other ostilof <br /> Lubricating <br /> oil <br /> -.95 Newlands Dr. Fast <br /> Reri-:.a. NN' 894(p <br /> A <br /> -GenpiratorsSignature <br /> s. Drivers Signature <br /> State Law-Rouires that YOV keep this RoicelotlBill of Ladino ort filloono less than 3 years. <br /> T6 Re-Activate Or to Obtain on FPA 0-(-.jlqfnmprhnn,nntA 11T- (a I-Ann-AIA-/.QA') <br /> ZTT/6000 0111 SDAS ANN AfIONH&I 66VCSVVLOLT YVA 00:VT TTOZ/ZZ/90 <br />