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FREMOUW EVIRONMENTAL IS,RVIC;ES, INC. Send Pa%'menT To: Phone: 800-559-W. EPA ID;CAR000171017 -` P.O.Box 28'5 Phone: 7 1448-3700 U.S.D.O.T.#1484667 INVOICE # 4 5 Vacaville.Ca 95696-2875 Fax: 7-448-3499 D.T.S.C.#3544 " www.hazwasteremoval.com CA#274461 Date SITE ADDRESS BILLING/MAILING ADDRESS Customer T'rnV Customer D, -r-;„e 4 J} i.iarE?il; t ,�a.Vp[;1iE? Box 2' 96 -nocKton. `'-L. ' , / ;:!C}L'' ar1 i. V.""�. 4+ ('C.�V i E.P.A. # 1' .l' `�^ �. V Phone Fax Phone Numbers: Office Cell Contact: -:g. .�c 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 i)iJ Empty Drums Provide - Remove 1A1 1 A2 5g Z3 1 Og ❑ 15g❑ 30g❑ 55g ❑ S. F ! - Clor-D-Tect Q4000 Test Kit: Test ❑ Pass❑ Fail ❑ Generator Knowledge ❑ PPM ' Transportation Charges/Additional Truc<Time/Additional Labor/LAB Packing/Site Cleaning Clean: Y N Labels Oil A/F UOF Oily Debris SERVICES REQUESTED BY i _ TAX - We Acce t M O� id M 11P. O. # TOTAL CHARGES: GENERATOR'S CERTIFICATION: y arc ccc rcrey.cescrbed above by proper shipping name and are classified,packed,marked,and rice ec,c-.=c•e'^ •es=ec-5 _'=_s=:_C. accarc'-g 70 aap:icobie<_twe crc national government regulations. If I cm a large quantity generator,I certify that I -ave a--cc-c^-'-^�=e•_•�a_c_•`e.__ _ _r _�e^.e-c'sa'o'^e aeg�ae!hcve ceter^ined To be economicoiiv practicable and that I have selected the practicable method o,ve je--.s o c.e - -- _ =_ _ a z cc e _ - -.xec ^e areser c c;e trtea' 0 n,lncr heolth and the environment:OR.if I am a small quantity generator,I hay mode -go e-•c- _ - __- _ e-e._._- =_- _=es• as•e age-e-•:-.e?rec frc'';ovo;!cble to me and that I can offord. All used oil from the enerotor risted above I;!!ne•-a-sa-roe c'. -r ce-;e-e,:, c`”-`-="="e c°=a ^-a-=a'_cuce,;sea :r-a recyc,ec c'i oR o feci;ir;!hcv's required to comply with Federal regulations applicable to the mcnoger ems.c`_sec_'. .=. "e;, c- -c—a -s -_ _-s._spec ea nozares csso=ierec with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney fess incurec rra=c:e.^.=r c`r'-;;ate;-c'ar -e- a 1=r c_tcases of tis ooiioiion shat;be in Solano county. I declare under enall of pe'u tho!the far forgoing is true and correct. DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Govemment Marine Other Industrial Lubrieatin® OI it .j Print .. �_ . .. ..,_ ':a i.. :.. -..r r!7p. tVCI`33'><C�a-'•'mac Prin Qme Generator's Signature Drivers Signature Stat Law Requires that you keep this Receipt/Bili of Lading on file no less than 3 years. To e-Activate or to obtain an EPA#-Customer mnv cnntnr-t nT.er ray I-Ann_A l n_40e1) ZTT/LZO[n ONI SOAS ANN MIlOfHHA 66VE8f'VL0LT XVd 50:bT TTOZ/ZZ/80