Laserfiche WebLink
FRE,MOUWE VIRONMENrIAL S VIUES, 1NU. <br /> ar <br /> Scrid Pmerit to: Phone: 800 559- EPA ID#CAR000171017 <br /> P.O. Box 28'5 Phone: 707 8-3700 L-S-D.O.T.#1484667 INVOICE# <br /> Vacaville.Ca 95696-28'5 Fax: 707 8-3499 D.T.S.C.#3544 Date <br /> w%w.hazw•asteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Cusfomer Customer i-I �•' <br /> E.P.A. # - Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: C: - <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Empty Drums Provide O Rem ve 5g❑ l Og O 15g ❑ 30g❑ 55g ❑ S P F <br /> Clor-D-Tect 64000 Test Kit: Test U ass Z) Fail 7 Generator Knowledge-:a- PPM _' <br /> Transportation Charges/Additional ruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil =,!-, _, A/F UOF Oily Debris © ' <br /> SERVICES REQUESTED BY TAX <br /> weTOTAL CHARGES: <br /> Acce t � P. O.# /�•- <br /> GENERATOR'S CERTIFICATION: re•ecv decEcre'no'-� ccrcen;s of rrs consiger';ent ore'65v and occurolety described above b proper shipping <br /> icb a y p p piling Home and are classified.packed,marked,and <br /> o_iec.enc c•e'^c rascec-s cae•c:-a'r:c-'c• •c-sear' nigf..acy eccerdirg io apa5cable stele and national government regulations If 1 am a large quantity generator,I certify that I <br /> ^o e o c c cce -e c-:• :•.;c`;,�r a ge-erorec fo'^e�e�ree i rcve de•ermined to be economicoIN practicable and that I have selected the practicable method <br /> a''reef - Ti-.'- zed- e e_r'cnd fc'vre lhrea"o Kumon health anc the environment:OR,if I am a small quantity generator,I have made <br /> c n _^ e"::-:: e,a gee_ _�c^ e nes,.w este^ rcger^e� •ne•nco rho•s available to me and that I can afford.All used oil from the generator listed above <br /> - -- •- a ^c e aac ce-sec oil n•o reeve eci c:'OR a facility that is required to comply with Federal regulations applicable to the <br /> ra saaecceC cr•cs assoc'o}ed with'Ks waste hos beencfisclosed. The customer agrees to pay reasonable costs and attorneye65oe'n.Solaro cou^t . i declare under penallyof perjurythat the forpoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: `Collection Station Industrial Agriculture Government Marine Other industLubricating <br /> P j Name Oil <br /> 77 SGenerator's Si9�ature Driver's Signaturetaaw Requires thq(you,keep tls ` <br /> Receipt/Bill of Ladtny on file no less than 3 years, <br /> Jo R Activate or to obtain an g'A-#-Customer may.contaet DTSC 0 I-&M-A,I A-R9d) <br /> ZTT/OTO OHI SOAS ANIH Af10HHHA 66VCRVVLOLT YVA 00:VT TTOZ/ZZ/80 <br />