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EREXIOUNV E4T .VIRONMENIAL SVICES9 1AC. <br /> �.nd Pay mcnt to: Phone: ?_0-5=9 = EPA LD=C_AR000171017 O <br /> P.O. Box'S'= ?hone: - -- +5---00 I. S.D.O.T.'1484667 ` INVOIC # <br /> X acaville.Ca 95696-28"5 Fax: -C 7448-3499 D.T.S.C.#3544 Date�n i1'/ <br /> �u�'.hanvasteremoval.com CA#274461 <br /> SITE ADDRESS r BILLING/MAILING AD ESS <br /> Customer 'Brannon Tire 1rantinii ,Ire <br /> Customer <br /> 4505 Claremo t venue 0 Box 2446 <br /> ''A �^�r;J tiirj(;<1(11? "'A 95201 <br /> E.P.A. # Phone Fax <br /> Phone Numbers: Office, Cell <br /> Contact: "1ar.es <br /> PRODUCT - ERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 14 21 • 30 • 45 60 90 180 365 W/C CODE <br /> / WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> : i: i ` rte_ aL <br /> I.01'o <br /> -- <br /> _ 7ti MT <br /> .. <br /> ,'•:�s,E =,-. —_c^ _ ._.. , :; : _ .:�-`_�•; - . :asohncL�:as;�. �irr:�1 <br /> Empty'Cr r-s P ae Re—: ave 0 5g ❑ 1 Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ ass 7 Fail D Generator Knowledge g-. PPM { j <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clear.: " N !Labels OF _ � � A/F UOF '�` Oily Debris <br /> +' k� <br /> _ •.I tr. <br /> SERVICES REQUESTED BYwe TAX <br /> P. O. # TOTAL CHARGES: <br /> GENERATORS CERTIFICATION: -e'e=, _5._s - -- ._ •--=c-;'g--_ =-e _ - -- e...cescriaec above by proper shipping name and are classified.packed,marked,and <br /> ace eC.=-C_ _- -. - _ :_ _ c- -- - - ,.•- -_ .-c...e c-; c ro-o'government reguletlons. If I am o large quantity generator.I certify that I <br /> nave c —rr= gree ^cue ce-errrinec to oe econamfcolly practicable and that I have selected the practicable method <br /> of treo-rrar•7. - ^^ <br /> svv cge c p sc c_-e c,c ca e e:-c^- 4-nlzed 1^e oresen'one tu-u-e`^rec-to human neolth and the environment;OR.if I am o small quantity generator.I have made <br /> o goo c::^e"r'c :os'e ge^e o c c io se ec- -e ces'wove available to me and that I can afford. All used oil from the generator Ilsted above <br /> ";'i be r`o-=c--- = - -= • -- - -e- __' *-'----'o-a c•od.;ce-,;sec-': n'�rec:Ued oi;OB a facility thof is required to comply with Federal regulations applicable to the <br /> - a^'e y::,-s .-° a=•c ' _ <- - ;_soec'ea-o_c'a!asscc`o'ed w;t :s­cste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> ecs ^c- ==e= ='' =c=c' - -- = be is 5alCnC county. l declare under penalty of perjury that the forgoing is hue and correct. <br /> DISPOSAL/RIT <br /> ECYCLING FACILY: Collection station V Industrial Agriculture Government Marine Other Industrial Lubrtaating <br /> ;. .r: ;..moi Nrly4anl-Dr.Em'. <br /> �4 <br /> P11 f @ Generators Signature. 4D ��e,eSidnature <br /> State Low Requires that YOU keep this Receipt/Bill of Lading on Ble no less than 3 years. <br /> To R -Activate or to obtain an EPA#-.Customer may contact DTSC @ 1-80(?-A 1 R-A9,0 <br /> ZTT/9TO[n ONI SOAS AMR MI10111HUH 66V£8V1rL0LT XVA ZO:bT TTOZ/ZZ/80 <br />