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FREMOUW E,4VIRONMENIAL SVVIUES9 1NU. Send Payment to: Phone: 800-559-3 EPA ID#CAR0001710I7 P.O.Box 287= Phone: '07 8-3700 U.S.D.O.T.#1484667 INVOICE # y :, Vacaville.Ca 95696-2815 Fax: 707-448-3499 D.T.S.C.#3544 Date a'wvv,hazwasteremoval.com CA#274461 `- SITE ADDRESS BILLING/MAILING ADDRESS Customer - Customer E.P.A. # Phone Fax Phone Numbers: Office Cell Contact: PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION 7 14 21 30 45 60 90 • 180 • 365 W/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT Empty Dru:s Provide O Remove D 5g 0 109 ❑ 159❑ 30g Cl 559❑ S P F Clor-D-Tett Q4000 Test Kit: Test ss ❑ Fail 0 Generator Knowledge ❑ PPM Transportation Charges/Additional Tiijck Time/Additional Labor/ LAB Packing/Site Cleaning Clean: Y N labels - Oil A/F LOF Oily Debris SERVICES REQUESTED BY TAX We ® P. O.# TOTAL CHARGES: — Accept • GENERATOR'S ctitnFICAnoN: _. aea c•s-�_•-- ^•e :`•^s-en'a^r-e-•nre'c'.:and cccurote.y described above by proper shipping name and are classified,packed,marked,and oae ec.c-c cre c esa=c; naL ter cc a'r'c - =�c^c.r.'yr n cv crccrc'r;z rc capFcoole state and notiona!government regulations. Ill am a Jorge quantity generator,I certify that I hove c '-.one-c-ec-ce--e c'-rte c-a":1 : r o'wos-e generated:o The aegree'have determined to be economically practicable and that I have selected the practicable method o`treotmer*s+crcge,ar riots= C--191-7a:Jcb-e-c tre,vile^�rir_m!zed'�e oresert and future 4hreot to human health and the environment:OR.if 1 am a small quantity generator,I have made o good fat^a.c-!a•^;c, le T. «cs:e_erere*:or on se:ec"ne ben este rnor.cgemew method that is available to me and that I car afford. All used oil from the generator fisted above will be tronspo:^.ea or!,,/:c c'oci:;q•pe—fitted by-ne Sr to of Catacmic To produce usea oil into recycled oh OR a facility that is required to comply with Federal regulations applicable to the monagemen!of used o:. A.: a eva�t irsamoficn•age. ^.g known Cr suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney fees incurred ir.'he collec'icr c`this obligation, Venue:or Purposes of:his obli ation shill be in Solana county. I declare under penalty of 4rjury that the forgoina Is true and correct. DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government Marine Other I industrial I Lubrfcating O .. -,...reg:r.•:ray�.ro.-.:.. ' :Pc�iry .. .. .. g.._- .. -�•drr,.V rye f ..`. f.' .t .. C.. ... .. .- 39 .- P� Qfrte ..• afo e Genrr s Signature '—�.—. �J b&er's Signature State law Requires that you keep this Receipt/Bill of Lading pn file no less than 3 years. To Re Activate or to obtain an EPA#-Customer may contact DTSC Q I-Ann-pct A-A9211) ZTT/ZTO[8 ONI SOAS ANB AfIONH I3 66V£BVVLOLT XVA TONT TTOZ/ZZ/80