Laserfiche WebLink
F RE <br /> �rnd Pa�m>cnTto: -110 NV ENV —FPA ID=CAROOO 1 10 17 <br /> IRONMENTAL SbRYICES, INC. <br /> P.O. Ra',_S Phone: -0111-1C--00 U.S,D.O.T.#1484667 INVOICE # 12744 <br /> Vacaville.Ca 95696-28-5 Fay: -0--448-3 499 D.T.S.C.#3544 <br /> u-"w.hazwasteremo%-al.com CA#274461 Date <br /> SITE ADDRESS - r BILLING/MAILING ADDRESS <br /> Customer <br /> r illll(]fi i(L' Customer Lam;r5 n eta f ire <br /> , ockton. .;A .;. Stockton, r�,l� 95201 <br /> E.P.A. # ^r� - �Il II ~ ``� Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: <br /> V <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 /> 00 <br /> 00 <br /> crno`y Dru7n5 r---.-.,:de Remove D 5g ❑ l Og❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> C:or ec'Q,*X-•_es' C 'es`❑ a ss ❑ Fail ❑ Generator Knowledge I- PPM <br /> rarsC-co-ges Aadi-ionc T cr Tune/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: y N Labels Oily . A/F F., ; (-'jUOF /G 0 Y '7 Oily Debris 0 ©� <br /> SERVICES REQUESTED BY TAXWe <br /> Acce t ® P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: .._. -__.-_ - -_ =r = _ _ :_r - __ _ - ca.. .aescnaeb above by prooer shioping name and are clossilled.packed.marked,and <br /> _-_e� -_ ::_ _ __- _=c e __ _ _ ._- - - _ _ _ o.s o-:c ra'ianai governmen'regulations. if,am a large quantity generator.I certify that I <br /> z:-. •c--e ceo-ee -C�a ce-e•^-•^ec to oe economlcelly orecriceble and that I have selected the practicable method <br /> -e2 _c•ese--c^`_'__'- -_ ^healrc cid rhe ern•:onment;OR.it I am a small quanlitygenerator,I have made <br /> _ ^.a.':ob!e rn me and rnc!'car off rd. All used oil from the generator listed above <br /> - - - - - -- _ __ _ _ =c_ __ _se = - _ _ OR a focili'v Phot is require ra comply w th Federal regulations applicable to the <br /> -•-"' ' -' - '••---r-- '--^-^°-'=^C Z:'-='�'^'s---5-.e has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> ees -ac - -a cc ac' -_�c ^c -_e c apses ^"s as^aeo-s-c c^; S one Cc.wy. :declare under penalty of Dedury that the f <br /> orgo,ng Is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture -1 ovemment Marine Other I Industrial I Lubricating <br /> oil Oil <br /> r H#r err r X35 Ptswtands Dr.,Eel <br /> Print erne <br /> gem-erator's SignatureDrivt3l's Signature <br /> State Low Requires that you keep this Recelpt/lifil- lading.on file no less than 3 years. <br /> To ReActivate or to obtain cn EPA#-Cust6rylerancty contact mSr.a I-ann-Al a-A9e,) <br /> ZIT/TTOIE ONI SOAS ANH MIIONHHA 66V99tibL0LT XVA TO:bT TTOZ/ZZ/80 <br />