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FREMOUVV EIJVIRONMEN TAL SWV1CiES, 1N C%. <br /> Send Pa%ment to: Phone: 00-559-_- EPA ED r CAR000171017 t`�J O <br /> P.O.Box 28r.5 Phone: 07-•348-3,00 U.S.D.O.T.#1484667 INVOICE # �r 3 <br /> Vam-ille.Ca 95696-287: Fax: 7-448-3499 D.T.S.C.#3544 - <br /> w%%-w.hazwasteremoval.com CA#274461 Date 4. ,,1 fi`' <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer u 1•n Tire. Customer r, - <br /> ..t• 4t' l•1 '/"� -.1 i� t, •�� '�YY. f-{•Y V <br /> ti ,': .✓`O1 ,�:I'J: •l moi: �Ut,, i <br /> E.P.A. # ,'Y V 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 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Empty Drums Provide = Remove 1 A 1 1 A2 5g ❑ l Og ❑ 15g❑ 30g❑ 55g ❑ S P F <br /> Clor-D-Teat Q4000 Test Kit: Test ❑ Pass❑ Fail ❑ Generator Knowledge .zr- PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: . Y N Labels Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX <br /> We <br /> Acca t P. O,# TOTAL CHARGES: <br /> GENERATOR'S CERnflCATION: I hereat'dec:cre-of!?,.it cortents of'his consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and <br /> labeled,and are in all respects:n oraper cor,cWo^for.cnsoc^by high•.vcy according to apofcab;e state and national government regulations. If I am a large quantity generator,I cern that I <br /> have a program in place to reduce the volume and to:cry of waste ganerated to the degree I hove determined to be economically practicable and that I hove selected the practicablemethod <br /> of treatment,storage.or disoesol current;y ovclicble to rre which.rim?mizec'he present and future trtreci to human health and the environmeni:OR,if I am a small quantity generator,I have made <br /> o pond faith effort to mini size my waste gene ctior c d se:ec' ^e bas'waste'r•cragemer'method!hc's available,a me and that Icon afford. All used of from the generator listed above <br /> well be transported oriy to a.aci.�ty,oermitled„}• ^e S. to o'Co?crn:c to produce used o:1 into recycled ail OR a facility that is required to comply with Federal regulations applicable to the <br /> management of uses ail_ Alf ralevon•:nformc!icr repo ding zre••v^o'suspected razaros associated with mis waste hos been disclosed. The customer agrees to pay reasonable coals orxi attorney <br /> fees incurred in the collection o'this obli otio^. ver_e far purposes of�nls oblf aria.^.shell be in Soleno count . I declare under penalty of e u that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Govemment MarineOther Industrial I Lubricating <br /> i�,�F rorOrvea <br /> 0'i lir <br /> r •r-e r 'a Ll�.. F11 „- i <br /> SS Newland9 0T.,East <br /> -' 05403 <br /> Prfnt.Name. Generator's Signature <br /> State Low Requires that you keep this Retelpf/Bill of Lading on file no less than 3yrears. <br /> To Re-Activate or to obtain an EPA#-Customer may contact DT-S('(0) 1-RnO-A I A-,MZ15 <br /> ZTT/9ZO ONII SOAS ANIH MR01 HUH 66VR9VVL0LT YVA 50:PT TTOZ/ZZ/90 <br />