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FREMOU EAVIRONMENTAL S�VICES, INC. <br /> Send Pa%ment to: Phone: 8 0-559-3_ EPA ID#CAR000171017 cc <br /> P.O. Box 28-5 Phone: 7)'1448-3700 U 5 <br /> .S.D.O.T.#1484667 _ INVOICE # /; 7 7 <br /> Vacaville.Ca 95696-2815 Fax: 77 7-448-3499 D,T.S.C.#3544 <br /> %»u'.hazwasteremo-al.com CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Rmnnon Tire Customer k„rannnn Tim <br /> 4905 ��;laromor t .�+�el,ue '�`'. � �3�v 2496' <br /> '-)MCktor; CA 9520 <br /> E.P.A. # L Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: I' 'hwlizq 0C ,.1- l _ <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 • 21 • 30 • 45 • 60 90 180 • 365 W/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> - r^^ ;� - 1.00 <br /> ?•�Q;:C ...ti 1:23 ` <br /> Si; ' E _ C ,+ 114 ��� r ' / D(V., 55.00 <br /> r <br /> r4?5r0 - <br /> Empty Drums Provide - Remove 1 Al 1 A2 5g ❑ 1 Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ Floss❑ Fail ❑ Generator Knowledge,..—Q— PPM J <br /> Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F , act UOFJ = ' Oily Debris �f <br /> SERVICES REQUESTED BY TAX I s.0(i <br /> WeP. O. # TOTAL CHARGES: <br /> Acce t <br /> GENERATOR'S CERTIFICATION: -e-ecv cecc•e•-c- ca-Te--s c'•r.1s ecns;ornren'ore'u1!y ofd occ.,ro!eiy described obove by proper shipping name and are classified.packed,marked,and <br /> labeled,cnd ore`n o;:raice"s crope•cc-c:r'.-=o•-c-.50c-^v^i^y.^.n av acccrcirc ro eppCccble stele and netionol government regulations. If I am a large quantity generator,I certify that I <br /> have a pregrcm:n piece-o red-ce`heclime ere'a ;C:ry of•.rest?generated io the degree I hove determined to be economically practicable and that I have selected the practicable method <br /> of treotrnenf.storcge.cr d:socsc.L::-er.r;;wc:cb a!a rte.+r1cr----:mized the present crd future threol to r,uman heallh and the environment:OR,if I am a small quontity generator,I have made <br /> a good fc:+h e`fo^`c n--'-ae-, .•cs'e ge-era'o'c c se.ecr•-e bet--este mcncgement method that is available to me and that I can afford. All used oil from the generator listed above <br /> w91 be transported o-'.*.To c'c:.iliTv oe.-.;tTed tv-^e S* te a`Ccli'orn'c'a oroduce urea ofi;rto recycled oil OR o facility that is required to comply with Federal regulations applicable to the <br /> manage en,c'usec e'. k, alercr'i-=c•'-.c!Sc^'egc ai-g<rewr•or scsDec let ozc,os asseclaled with this waste hos been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incunea: rte col ec<c-o-'--s oni ever. '✓e a'cr ourposes of this obli c!son shoe be in Soicna county. I declare under penalty ofer'ury that the for-goingis True and collect. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Govemment Marine Other industrial <br /> al Lubricating <br /> Oil <br /> 1st,:enturytW <br /> �f <br /> yr <br /> P t.Norh Generators SI <br /> 6(tature D el's Signature � <br /> State I aw Requlres that you keep this Receipt/Bill of Lading on file no less than 3 years. w/ <br /> To Re. ctivate or to Obtain an EPA#-Customar mnv rnntnrt nTer n 1_Rnn-AIR-aoAo <br /> ZTT/6ZODNI SOAS ANH ARONHM 66VESVVLOLT XH3 bO:bT TTOZ/ZZ/80 <br />