Laserfiche WebLink
FREMOUW E V- VIRONMENTAL S*RVICES, INC. <br /> Send Pa'%ment to: Phone: 80( 5�59- EPA ID=CAROOO 171017 <br /> P.O. Box 28'5 Phone: `0-448-3'700 U.S.D.O.T.#1494667 INVOICE # 14664 <br /> Vacaville.Ca 95696-28t5 Fax: 70!-448-3499 D.T.S.C.#3544 C <br /> www.hazwasteremoval.com CA#274461 Date z — <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Ti Customer Tire <br /> W)- <br /> E.P.A. # l iC'J v Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: '.111�-r <br /> PRODUCT - SEERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 a 14 21 • 30 45 60 90 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> SSP <br /> 7 1 I)A 0 <br /> A-) 5.00 <br /> Empty Drums Provide = Remove 1 A I I A2 5g -Z1 i Og 0 15g D 30g Ell 55g LJ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test-Zl Pcss.Zl Fail :3 Generator Knovvledge�Q PPM - <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y Labels Oil A/F LIOF <br /> Oily Debris <br /> SERVICES REQUESTED BY <br /> WM I — I TAX <br /> Accee pt Aw 0i As P. 0. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: : Zc-s -- <br /> describec atcve by shipp-rg name and are classified,pocked,marked,and <br /> a,,'e; gr =-c cr�G 70 ;=r.ccc:e s-o;e cna noiono:gcvernment regulation's. I-'j am a large quantity generator,I certify that I <br /> 'd _.C. ce'o a=-:::e-e-0:--e C-C n'--,zve ze-e-c-ec 7c ne oegree;hoe dete,-mined to be eCCn0'n:C0J,)'practicable and that I hove selected the practicable method <br /> of treatment smrage.cr o*sco:c =-7e-, e -e -c- lie c-resen,c,c%;t--etr.ec-o')„rcn kecith and the environment:OR.if I am a small quantity generator.I have made <br /> ci good faith eflo�to- <br /> t-; e cgereri-.methcoi;nc'is avoroble to me and that I car.afford. All used oil from the generator fisted above <br /> ze-'-os-e '-e cles- <br /> will be tron5por-e on:y-0 0 loci Lerrn�,Tec b,'-ne o:Co-;fo,ri;c'o orcouce'used o;j into recycled <br /> management of,used cs; A: o. 01 OR a facility that is required to comply vift Federal regulations applicable to the <br /> ic—cs cssn::3,ec wln!ns waste has been disclosed. The customer agrees to Pay reasonable costs and attorney <br /> or -ec-L <br /> this <br /> a.. <br /> fees incurred in the cc;!ec'o--, n: C <br /> a-.icrl sro,'oe;n soicric cony. I decio e under penalty of E2gury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrialndu <br /> _LAgriculture Government I <br /> Marine Other 031triall I Lubirloatin <br /> 0, 9 <br /> XIR5-Nriv <br /> Dr.,'cam <br /> rvrrihiv NY Moe <br /> 75-7�"�f-tu n./P 1311 <br /> f <br /> Print Name <br /> Gerperator's Signature DIlver's Signature 'Al <br /> State Lamp Requires that you keep this ReceiPt/11111 of Lading on Hie no less than 3 years. <br /> Tn RP. Artivnt. <br /> ZTT/ZZO[M ONI SOAS AMR AflOKHHH 66VCRVVLOLT YVd TSO:VT TTOZ/ZZ/90 <br />