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fiend PaymFrREMO}UW tEl VIRONMENTAL S�VICES, INC. EPA ID'"CAR000 17 1017 P.O. Box .8-; Phone: -07-448-3-1,00 U.S.D.O.T.#1484667 INVOICE,# 4243 Vacaville.Ca 95696-2N75 Fax: '07-448-3499 D.T.S.C.#3544 % Date 13 wa-•.hazwasteremoval.com CA#274461 SITE ADDRESS BILLING/MAILING ADDRESS Customer Rrannon' ranTire Customer ;ra Bion Tire ai'Prinoni .41.9i 1!_ca P inx 249 •,,:-.;,•;,-.� ;;- - - -.,,k�,_,,- ;;=, :�fir.�i # -�`1,L �(�('/ :a r1 .S� ✓ Phone E.P.A. 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 -" r0 55.U0 i,- _:_ -•- -" - � �:- - - :�C3;,'1:. '?S2i' tut Empty Drums Provide - Remove 1A1 1 A2 5g ❑ 10g ❑ 15g❑ 30g O 55g ❑ S P F Clor-D-Tett 04000 Test Kit: Test❑ P ss❑ Fail O Generator Knowledge §L-.-PPM Transpor ,o!ion CFarges;Additional TL ck Time/Additional Labor/LAB Packing/Site Cleaning Clean: Y Labels /` Oil >- , i A/F ti �" F, UOF Oily Debris �j a SERVICES REQUESTED BY TAX 8.01 We P. O.# TOTAL CHARGES: Accept GENERATOR'S CERTIFICATION! I hereby declare shot the ontents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and labeled,and are in all respects in'proper condition for tris sport by highway according to applicable state and notional government regulations. If I am o large quantity generator.I certify that I have a program In place to reduce the volume and toxi ity of waste generated to the degree I hove determined to be economically practicable and that I have selected the practicable method of treatment,storage.or disposal currently available to which minimized the present and future threat to humor health and the environment:OR,if I am a small quantity generator.I have mode a good faith effort to minimize my waste generation.and elect the best waste management method that is available to me and that I can afford. AD used-oil from the generator listed above Will be transported only too fatality permitted by the Sto of California to produce used all into recycled oil OR o facility that B required to comply with Federal regulations appileable to the management of used oil.All relevant Information regarding known or suspected hazards associated with this waste hos been disclosed. The customer agrees to pay reasonable costs and affomey fees incurred in the collection of this obligation. Venue for purposes of this obligation shall be In Solana county. I declare under penalty of pe ury that the forgoing is true and correct. DISPOSAL/RECYCLING FACILITY: Collection Station Industrial j Agriculture Govemment Marine Other I lndustriol Lubrfcatin9 1 I n nl:,: 2:si C_Miry Eldl •d - ._ +. ir, :"J'M Ne d" rid3 Or..Ea91 rr y d�"r ;KWe r` Generator s Sire Drivers Signature State Law Requires that you keep this Receipt/Bill ofLa g on file no less than 3 years. To Re-A ovate or to obtain on EPA#-Customer mnv rnntnnt nrtc(a t-Af)n-A t A-,coao ZTT/TZO[2 ONI SOAS ANH AflO HHA 66VRRVVLOLT XV3 EO:6T TTOZ/ZZ/80