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FREMOUVY E VIRONMENTAL >5 VICES, INC. <br /> Send Pa%ment to: Phone: 8 -559- EPA ID#CAR000171017 <br /> P.O. Bos 287_ Phone: 70/4.48-3700 U.S.D.O.T.#1484667 INVOI E # 1 d.S 2 8 <br /> Vacaville.Ca 95696-2874 Fax: 707-448-3499 D.T.S.C.#3544 2 <br /> www.hazwasteremoval.com CA#274461 Date �o <br /> SITE ADDRESS � _BILLING/MAILING ADESS <br /> Customer brennor Tire Customer Brinnor. Tire <br /> 4,905) Cj=)reM0n. �`Vo :Up. P ,0. Q-ox <br /> Stocktan CA <br /> Stockton, CA 952; <br /> E.P.A.# �-"�'- -� �' Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 . 30 45 60 90 180 365 WAC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> !J:• <br /> Empty Dams Provide = Remove 1 A 1 1 A2 5g ❑ l Og ❑ 15g❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-T.ect Q4000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge-a- PPM / ;" � <br /> Transportation Charges/Additional Tnick Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y'N Labels Oil �:�_..� A/F :' i' r` LIOF',,'Ll jl Oily Debris /I/ I <br /> SERVICE REQUESTED BY41 <br /> TAX <br /> We <br /> Accept P. O, # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -nerebv cec-a'e'-a-7e cr!eO:!s a'-cis consignment e•e 77.v and eccure-ely describea above by proper shipping name and are classified,packed.marked,and <br /> labeled.and ere•,o:•ssaecs �--Coe,ca •'.ate`o• "seer-c-;^ia^way ccaord!ng to copircove sta a and notional govemment regulations. If I om o large quanfity generator.I certify that I <br /> have a program rn place fa-sccce`^e volcrr•e ant'oxi :�of wcsfe generefed fo the degree I hove determined to be economicoliy practicable and that I have selected the practicable method <br /> of treatment,storage.or cisposal cuuent:v ovoilac-e to me whicn minimized the oresenr and future threat to human health and the environment;OR,if I am a small quantity generator,I have made <br /> a good faith effort to minim ze my waste genera7io,,and select the best waste management method that is available to me and that I can afford. All used of from the generator fisted above <br /> will be transported only to o facility permitted by the State of colifomio to produce used of into recycled oil afta faculty that is required to comply with Federal regulations applicable to the <br /> management of used oil. All relevant information regar ng known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees Incurred in the collection of fhis ob cfion. Venue fc r purposes of!his obl' otion shall be in Solan county. I declare under penalty of p%ury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government Marine Other Industrial Lubricating <br /> .L�1 vera naq (In- Cie; 9 1'Vr d k ..r.iv' .. _. `•rr rnrrnat 1S(Cenhxy EMA <br /> �j� - - .; '')t• . vx� _-. :'1�fV?wlRrt�Cfr,Ea..! <br /> e.deo.I'r234ce <br /> -- _ � i:?.?+6 si r ;a•�7f�J i•TsU.990.r'•°33'fo <br /> Pil <br /> ref Nnrna Goner s Signature Drivers Signature <br /> State Low Requires that you keep.lhls•Recelpt/Bili of Lading on file no less than 3 years. <br /> To Re-A tivate or to obtain an EPA#-Customer may contact DTSr a t-Rnn-A t A-Aoe,) <br /> ZTT/£ZO[n DUI SOAS ANH Aa0KHHd 66V£8VbL0LT XVA V0:VT TTOZ/ZZ/80 <br />