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Send Pa%mFTREMOhU. oo59-V -E&VIRONMENTAL S6RVICES, INC. P.U.Box 28'5 Phone: 07-448-3700 U.S.D.O.T.# 1484667 INVOICE # 5 Vacaville.Ca 95696-2875 Fax: 07-448-3499 � %� � /ry_a,:^ D.T.S.C.#3544 %-w- .hazwasteremoval.com CA#274461 Date SITE ADDRESS BILLING/MAILING ADDRESS Customer Customer A;-an,nnr I iroz E.P.A.# + ).. Phone 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 -:•�; - _ :C�JJ Yftlfz'_ ter. 'J�-' r �/ .rip,CL _i'-.c,"i. ;�%r a �t� •^ �.J J' 10 -- - ��. _�, .n... �._ rK 1^iii. .-•`� LC:. i;l •`•° - - _ � _ ..:!':. .y _ `1'L' -� J:,C^,Ira_ !•nCn' :7-. Empty Drums Provide Remove 1 Al 1 A2 5g ❑ 10g ❑ 159 ❑ 30g❑ 55g ❑ S P F Clor-D-Tect 04000 Test Kit: Test ❑ ass❑ Fail ❑ Generator Knowledge ;1--PPM Z Transportation Charges/Additional ck Time/Additional Labor/LAB Packing/Site Cleaning Clears Y N Labels - i ^ Oil(', ��. A/F ;�. UOF_y' < Oily Debris /;1 A r SERVICES REQUESTED BY TAX 1 s.or, Accept = a_-- P. O. # TOTAL CHARGES: GENERATOR'S CERTIFICATION: a-, '-_-_.o- c:" -- - co-;'g-mea-�•a ,.,,o^.-,cCCuro teiV described above by proper shipping name and are classified, rabevo,crd are it d::rescec-s -crcce•cc-a'c-'_ --- pocked,marked,and have a a C--gn`'°'ccc=c'^g c ocpticcble vote and notional government regulations. !f I am a large quantity generator.I certify that I pr gran'r o:cce _ ecuce a cc-_y c^C_c a',-=-'e ge-e,vec rc•-e ceg'ee!`ove de-e'mined to be economicoay practicable and that[hove selected the practicable method o}'ood dith,effort -g.c•'ze c_ ^C a-_'- •- -�•-,tied ^.e present cnd future rhreaP'o Kumon heol}h and the environment:OR,if!am o small quantity generator,I have made a' . faith apart'O'^:r'•r:yg my;;ds!g H`re,a-;,.-,C,a a;ec;�e c-�..•�,cs!e•noncgemer•metnaC}nor is cvailable to me and}hot I can afford. All used oil from the generator tilted above wdl be tronspo•-eo c%'y ='Cc;*'-,-p C e a,ad oi!into recycled of oR a facility that is required to comply with Federal regulations applicable to the mcnagemen!of seC c e e c- c' n e o' g kn. v.•n or sus ec+ed ha2a'ds associated with}his waste has been d(sClosed. The customer agrees to pay reasonable costs and attorney fees incurred it the cc'?ec ., c'tt•;s oo a.:pn. Ver-e'c•puracses of R•:s ob§ otion shcil be in Solono county. I declare under enalt of er'u that the for oin is true and correct. DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government Marine Other Industrial LubrtOoottng :T'L;5'•1cwiar10,s Ll;,Earsi P RName.` �� AGenerator's Signature Driver's Signature State L NhRequires:that You keep this Receipt/BRI of Lading on Ne no less than3 years. To Re' ate or to'o"b I +EP�1.#-Customer mov r-nntrsetri7.*-o I_nnn-Ai A_AOd9 ZTT/9ZOl(j OKI SOAS ANH AflONHHA 66b MLOLT X6d 90:6T TTOZ/ZZ/80