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FREMOU F�NVIRONMENTAL WRVICES, INC. <br /> Send Pa%"ment to: Phone: 8 0-5 5 4 EPA ID=CAR000171017 © <br /> P.O.Box'2875 Phone:_ " 7-448-3700 U.S.D.O.T.#1484667 INVOICE # / ��' J <br /> Vaca,w"ille.Ca 95696-28?5 Fax: 7 7-448-3499 D.T.S.C.#3544 I <br /> ww--.hazwasterelnoval.coM CA#274461 Date lr r- / C <br /> SITE ADDRESS _ BILLING/MAILING ADDRESS <br /> Customer 1- non --ire Customer �ra(�I?ni i ' it U <br /> 49()5 Claremoc t Al/enlJe .�. 4, <br /> ll�i i I ;,.�.?ti V <br /> E.P.A. # �'k= " r Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: ! !ems V._, <br /> PRODUCT - ERVICE 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 /> _ tlrl Y <br /> .... -- .. '• -..�,: ._..: _.ice _ •• ..;31' <br /> Empty Drums Provide Remove 1 A 1 1 A2 5g ❑ 1 Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test 7 Pass❑ Fail ❑ Generator Knowledge Q PPM / <br /> Transportation Charges/Addition ruck rime/Additional Labor/LAB Packing%Site Cleaning <br /> Clean: Y Labels Oil r. - A/F / UOF. C Oily Debris k 1 <br /> SERVICES REQUESTED BY l r TAX 8!lrl <br /> We <br /> A ce t P. O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: a eo.cec c e ^c e _ c'-!ccrs'ynment cre'a'y and accurately describea above by proper shipping Home and are classified,pocked•marked,and <br /> :aae ed a:c a e a..•esae:s r a re _-- -- S �, G:.- c•;cccc,ding'o abpt:coble stove and notional government regulations. If I am o large quantity <br /> have a orogrcm,r aicce c ecce-^e.c_-e c^c cx -,c` cve Zenera'ed'c'he degree!hove determined to be economical! g v Ned the prator,cticable <br /> I certify that I <br /> of treotmerl.storcge,c•Gsacsc c.:-e-�-_,c.c'=.e -•-e;,r r-,,ec'he present and future threat to human health and the environment:practicable <br /> ltam smollseUeacned the practicable method <br /> quantity generator.I have made <br /> o good faith etta to r`^ze -;-cste gererc-:cr r.d se4c. ne besr waste management method that is avalob!e to me and that I can offord. Al used oil from the generator listed above <br /> will be tronsporred on`v rc c'ccii ty oermi`ted by•ne toreo�Califorric'o produce used oil into recycled oil oR a facility that s required to comply with Federal regulations applicable to the <br /> monagemen•of used cit. At'•e!evon ;^orTct ae•e rdlny;mown.or suspected hazards associated with this waste has been dsclosedo pay reasonable costs and attorney <br /> . The customer agrees f <br /> fees incurred in the collection o±thi<ocE anon, von a fcr purposes of this ob!( ation shall be in So!ano county. I declare under penally of pequry that the forgoina is true and Correct. <br /> DISPOSAL/RECYCLING FACILITY: moll - yQD,_Statlon Industrial AgricultureGovernment Marine Other indusstriat Lubricating <br /> -•• '` .._ . .y-_._ ` .I'....7 ;-.sit.:rillir/FfYil <br /> Oil I <br /> -11nit Ngme <br /> Generator's Signature Dn I's Signature 1 <br /> Stat law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. JJ <br /> To R -Activyle Or to at;Ntpin an EPA#-CUStornef�rriov contnct nTSr rd 1-Ann-Al A-,cod') <br /> ZTT/SZO ONI SOAS ANH AfIONH Id 66b£RVVLOLT XVd 40:6T TTOZ/ZZ/80 <br />