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ERE_NZOLT ' ENVIRONMENTAL S#IRV10ES, INC. <br /> m <br /> Scnd Pa% cnt To: ?gone: S_0-__9-_ EPA ID:L Cr1R0001"1017 <br /> P.O. Box 28'4 Pbone:--)'448-3-00 C;.S.D.O.T.#1484667845INVOIC # <br /> Vacaville.Ca 95696-28'= Fax: - 7-448-3499 D.T.S.C.#3544 <br /> «u�.hazwasteremo�'al-coni CA#274461 Date <br /> SITE ADDRESS l�I'V11 T�rP <br /> BILLING/MAILING AD Tire <br /> rr, <br /> Customer f.V Customer ��n�� - <br /> 49K.)b C'larer cont Avenue (D. x 2 4',�6 <br /> _,fig c 5C`.'! m'^Kion. 015;2 0 <br /> CAS 000 96 536 <br /> E.P.A. # Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: 'areS 'v�4; 1-�1011'; <br /> PRODUCT - ERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 . 14 21 30 45 60 90 180 365 WIC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> tilC <br /> Empty Drums Provide D Remove O Sg❑ IOg ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tec' Q40001-est Kit: Tes'❑ Floss ❑ Fail ZI Generator Knowledge<13 PPM <br /> Trcnsperiar'c C-crges/.Aaditional Tuck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clecn• nbe!r- ,` .. I O�,*, ��. A/F UOF', j Oily Debris 0 OF— t <br /> SERVICES REQUESTED BY •" <br /> TAX <br /> We •..• TOTAL CHARGES: /1 <br /> GENERATOR'S CERTIFICATION: ,; ____ _ - _--_ �_-- _ _ _ -_ -. escrlbed above by Dreper shipping Home and ore classified,packed,mocked,and <br /> =.e s-cre c-d nciiono'government regulations. i`I am a large quantity generator,I certify that I <br /> egVe c:e ae•e^ned to 5e ecor cmiceliy practicable and that I have selected the Practicable method <br /> c- ea -e s:•=_e _ c;c?;_ _ _ _c a•_ -_ --- ._ _ _ _ =.e r^za 'o^union health and the environment;OR,if I am a small quantity generator.I have made <br /> c goo r e,.,*c7 e c -- s e a c e m r genie 2'h Id ncc"s cvailoble to me and thoI I con afford. All used a7 from the generator Wed above <br /> Ul be a s c ea - - _- ,- •-e Sr re ..,,`or „a•ecues sec a •ea:c'ed o?OR a toclllty that is required to comply with Federal regulations applicable to the <br /> r:ed v.-;!i- .'s.•:os?e hes been disclosed. The customer agrees to pay reasonable costs and attorney <br /> aif;.snc:.ce:n Scleno count••. i declare under penalty of Perjury that the foraoina is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: -Collection Station Industrial Agriculture Govemment Marine Other Industrial Lubricating <br /> ar. Oil <br /> Ar- :rr;"n1.,-.> islienFur.'ct,1i <br /> - -. ... Z,f-rJ IV4V.'1h11(tS Dr..t-iLti <br /> .li' -urfN3 <br /> -7c IS <br /> nYNarne Generator's igna ure �- Driver'sSignatUre <br /> Slate L w Requires that-you keep this Receipt/8111 of Lading on file no less than 3 years. <br /> To Re- ctivote or to obtain an EPA#-Custorner.mov contact DTSC(4 1-Ann-R 1 A-A9d9 <br /> ZTT/£T012n OKI SOAS AKH MIIONHHA 66V£8VVL0LT XVA TONT TTOZ/ZZ/80 <br />