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FREMOU ENVIRONMENTAL S*RVIUES, IN U. <br /> Send P2A ment to: Phone: 800-559- EPA ID#CAR000171017 <br /> P.O. Box 2875 Phone: 101-448-3700 li.S.D.O.T.#1484667 INVOICE # 13850 <br /> Vacaville.Ca 95696-2875 Fax: 707-448-3499 D.T.S.C.#3544 <br /> w1Ww.hazwasteremoval.com Date CA#274461 " <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer P f '{ Customeranngrl Tir= <br /> moi• ".ip•s•'Iiori �".V"ir�(.iF'•. 6J.L,:. ``:�" .�4•�U <br /> / <br /> .� <br /> -.,,�•t,�l, �-. ;, :-:{ •.;'�r.�.�,,;r,;•, �� �F^ftp <br /> E.P.A.# e <br /> 1 ", r * V Fax <br /> l +a .I Phone <br /> Phone Numbers: Office Cell <br /> Contact: _.tj�lrlizcz ;., ii; -.. <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 /> __•c - - _ _ _ .ten .. <br /> Empty Drums Provide Remove 1 At 1 A2 5g ❑ l Og ❑ 15g❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tett Q4000 Test Kit: Test J P oss Z3 Fail ❑ Generator Knowledge 0 PPM <br /> Transportation:Chcrges/Additionai Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAXWe aiiiiiiiiiiiiiiii <br /> A ce t ys' P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -elen. __c_ -e_r e-s=` s zo-s'g-rne^c-e'.:rr c^c=:L:re'e'v describec above by oroper shipping name and are classified.packed,marked,and <br /> esc_:.. -:-:__ _ _ _. c:c=card:-; nnn!:nc<5'a-.e c^c netiono!govemmen-regulotiorns. If I am a large quantity generator.I certify that I <br /> -cue �•:;n— -c c:e•:•e__:_ _ _ __ c _ : _- - = Ge—e—=—e=-c--e neg-ee I-ia:e ce7o-mineci to be economicony practicable and that I hove selected the practicable method <br /> a e Te s =;'- z--e' c _ -:-r— _ec:re p•eset-•a d ce'nreot'o qumon heath and the environment:OR,If I am o small quantity generator,I have made <br /> a food'd F e+'c^•c ^y cis a ge-e z=e.ec"-e ces v:cste^inrcge^nen ethod tho., <br /> is available tome and that Icon of ford. All used oil from the generator fisted above <br /> v til be tronsoo'^eo e^y`c a`oc ^?'`+neI'Ted --.e S'. •e nr Cc:FLenic:c produce.;sea oil into recycled oil OR o tocility that is required to comoly with Federal regulations applicable to the <br /> management of used c;,. Al:re:e.n -`arrar!a eror'!ng'c:c'..�or susoecred hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attomey <br /> fees incurred in the collection.o':his oor� ation. Venue ovourposes of this obligation shall be in Solono county. I declare under penalty of pe' ffsot the forpoing is true and correct. <br /> DYPC)SgL/RECYCLING FACILITY: goliectfon Station Industrial Agriculture Government Marine Other InduOs�Aal caring <br /> \�.'-_ _ ..� nEr fY. K • Co+da.'c 1 ) luy EM <br /> �( )5;c:'-�•c'vronmen2: /! _'isl Gran I <br /> R•i :01 P. Chwine!Road 1)95 Newlands Cir.,Ess( <br /> .a ... _ _ :.t•' - .._. _ {, � i:'r.- .. '±4F•ft r, =•Emlej•. 894M <br /> 7. <br /> Ptint.Mame Generator's Signature <br /> 9 ver Si¢ re <br /> State Law Requires that you keep this Receipt/Bill of Lading on file no les an 3 years. <br /> To Re-Activate or to obtain an EPA#-Curtnmpr mnv nnnfnrf;TRC Rnn_s I A_COa9 <br /> ZTT/RTO[M OUI SOAS ANH MfIONH H 66VRRVVLOLT M ZO:VT TTOZ/ZZ/80 <br />