Laserfiche WebLink
FREMOU EI�VIRONMENr1AL S.RV1C:ES, 1AC.'. <br /> � t <br /> cndPa%mentn: Phone: 8 -559-3. EPA rD=CAR000171017 <br /> P.O. Box 28-4 Phone: -•-448-3-00 U.S.D.O.T.< 1484667 INVOICE # 13? -7 8 <br /> aca%ille. Ca 9=696-28"5 Fat: ' 7-448-3499 D.T.S.C.#3544 Date <br /> vvww.hazwasteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Hrp ! on Tire Customer Rrannon Tire <br /> zou' j -;Iaf efro i Aver- i�-) P i Box 2496 <br /> �CkrrJf t i"A Q � �>"4��iCih4;; G 95201 <br /> E.P.A. # �.� 1915- , Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: i' ) <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 9 <br /> Empty Dur-,s °-a=ide D Reprove D 5g ❑ IOg❑ ISg ❑ 30g ❑ 559 ❑ S P F <br /> C!or-D'ect G :rC-est Kit: Tes* ❑ Doss ❑ Fail ❑ Generator Knowledge :mr—PPM <br /> Trens.00rtc-ior. C^urges/Aaditioro jck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: -Y,JN Labels �� Oil A/F4 UOF=jOily Debris C(= !1 <br /> SERVICES REQUESTED BY _ TAX 3.0'> <br /> We <br /> Accept '0110111M la ® P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -_ _z- -__ -- _ -__-_ _ Ore 4L-.-c^d occ.rc-er,descAbed above by proper shipping name and are classified,packed,marked,and <br /> ---_- -• - ---• == -_-=_ = - -c = _• -^ a s're cno norio^cI government regulations. 111 am a large quantity generator,I certify that I <br /> '-e=e_eeV-c:a oe-e,-:nec To oe econo^;caily procticabie and that I hove selected the practicable method <br /> _---- - _ `_mcn�ecP'n arc the em:i-onment:OR.if I am a small quantity generator,I have made <br /> =a -va7cbie-_—,e a d'hot,ca^afford. AE used of from the generator listed above <br /> z: — -- _- =- -- - c -=--- ----" '•__ OR a!='.4ty ttief is renu:red to comoly with Federal regulations applicable to the <br /> --- - - - - - - - ' - - c'a^O-'O',^.9 as=o=*Dre c��r^'=5-csre cos been u:sc:oseo- The customer agrees to pay reasonable costs and attorney <br /> co cr'an scc,.oe;r.Sc:cnc no,nTy. :declare under penalty of per ury that the forQoing is Irue and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government Marine Other IndusMal Lubricating <br /> Oil 00 <br /> l r. <br /> _ i[o�t>;=a,,renmNrn�1 1 131 ufntUn EMI <br /> •inei M1;d 'JS5 NseAana3 Dr,Eft <br /> . _ ...- - ...: - r':,mA•y.Ph' 43408 <br /> rrInT.Nome <br /> Generators Signature Drivers Signature <br /> State L mw Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br /> To Re= ctivate or to obtain an EPA#-Customer mov Contact DTSC®1-800-618-6942 <br /> ZTT/STOIn OISI SOAS AMR MIIONHHd 666£8VVL0LT XVd ZO:6T TTOZ/ZZ/90 <br />