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FREMOU EbVIRONMENTAL S f6RVIC �`S, 1N C;. Send Pa%mens to: Phone: 8 -5.c9-_ EPA M=CAR000171017 //�� r��y P.O. Box 28-4 Phone; 10.-448-3"'00 U.S.D.O.T.#1484667 INVOICE # 4 G U 9 Vaca%ille.Ca 95696-2875 Fax: 70r-448-3499 D,T.S.C,#3544 www.hazw•astcremoval.com CA#274461 Date SITE ADDRESS BILLING/MAILING ADDRESS Customer �r"i rr? r ' )re, Customer ?-grannor, I !re, 4901; Claremont LVerl;ie' r.1,1 �.`)t`kit'1� 9520.1 E.P.A. # �'�^ rail i 536 V 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 MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT CODE Empty Drums Provide = Remove 1 A 1 1A2 5g ❑ 1 O ❑ 15g ❑ 30g ❑ 55g ❑ S P F Clor-D-Teat 64000 Test Kit: Test❑ Pass❑ Fail ❑ Generator Knowledge W- PPMf,06; Transportglon Charges/Additional T ck Time/Additional Labor/LAB Packing/Site Cleaning Clean: Y ;N Labels Oil A/F rti' UOF.' "._ ._ Oil Debris r, a 1 Y G`. `� / r m G- y SERVICES REQUESTED BY TAX 8.')C' We P. O. # TOTAL CHARGES: Accept GENERATOR'S CERTIFICATION: -e•er.aec=,e,-=, __- _ cro eccurcten•described above by proper shipping name and are classified,packed,marked,and abe ec.cmc ee'r c esoec s c ace cc- r'c -scc c:-nlgnwcv acceding:e cap''ccae sto'e cnd national government regulations. If I am a large quantity generator,I certify that I have a program in picce to reauce-he:o-4r"e a^c:oz-;'v of wcsre generated to the degree!have determined to be economically practicable and that I have selected the practicable method of treatment,storage.or disposal currently oveilab'.e ra rre•+.hich-minimized the oresent anal huture threat to human health and the environment:OR,if I am a small quantity-generator,I have made a good faith effort to minimize my waste genercticn and select the best waste management rnetnod that's available to me and that I can afford. All used oil from the generator listed above will be transported only to a facility permitted by the Stale of California to produce used o1 into recycled of OR a facility that is required to comply with Federal regulations applicable to the management of used oil. All relevant information regard ng known or suspected hozcrds associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney fees incurred in the collection of this oblgation, Venue for purposes of this obli otion shop be in Solono coup . I declare under penalty of peqLny that the foraoinq Is true and correct. DISPOSAL/RECYCLING FACILITY: Collection Station IndustrialAgriculture Government Marine Other Industrial Lubricating Oil 011 0--�5 NsWIa'"Dr,East Pltnt Na. Generator's Sign—af-ure D al's Signature State La Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. To Re- ctivate or to obtain an EPA#-Customer mov contact DTSC®1-800-618-6942 ZTT/6TOM ONI SOAS ANH Af10KHHd 66VCRVVLOLT XVd EO:bT TTOZ/ZZ/80