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FREMOU F"TVIRONMENTAL *RVICES, INC. Send Pa%"ment to: Phone: 8 -559•_ 4 EPA ID=CAR000171017 P.O.Box"28%5 Phone: 7 7448-3700 U.S.D.O.T.# 1484667 INVOICE # 5772 Vacaville.Ca 95696-2875 Fax: 7 7-448-3499 D.T.S.C.#3544 www.hazwasteremoval.com CA#274461 Date SITE ADDRESS BILLING/MAILING ADDRESS Customer Customer 2 r a—nn�_ o _ L.•. G. E.P.A.# '1r` - 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 CODE MANIFEST NUMBER 7QUANTITY� UNITS PRICE AMOUNT 1 - - _-- _— -G:--'rJv✓� t��a�•!.7 ��,� 1 :� axv -'iJl^ -'a iii Empty Drums Provide = Remove = 1 A 1 1 A2 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F Clor-D-Teat Q4000 Test Kit: Test ❑ Pass❑ Fail ❑ Generator Knowledge-PPM 4-' /,?f,00 Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning Clean: Y iN Labels f j Oil A/F :, UOF `< l:." Oily Debris �j SERVICES REQUESTED BY TAX 1 8.00 A ce t . P. O. # TOTAL CHARGES: GENERATOR'S CERTIFICATION! cered-:dec'xe'rc•.e==--en's--".n cens:gr.r•:enr a•e t„;t,ord accvoteiy described obo.•e by proper shipping name and are classified,packed,marked,and ;abeled.crc cre;r a>resce-ts`-•a oae s- 'r ar'- ••c-sc_ c';n7gr vay according tc cparccc;e,oie cnd national government regulations_ If 1 am a large quantity generator,I certify that I have c program.n::ace'c'e---:e"e,:: —e_^o :kic:y o'.vote gererwed to the degree'have deiermined to be econorrcolly practicable and that I have selected the practicable method of treotmert.s•o,oce cr cscosc.- c":cc present arc:—e v.^'c- 5n mSZBC re presearc iutcre threat to rumor.health and the environment;OR.if I am o small quantity generator.I have made c goad'C ,,a"c'7c ^"-.:e a rs-e•c'-- -a se;_::,--e bes-wcs,e ncragemem,method rho'is available'o me and'hot I can afford. All used oil from the generator bled above will be tronspcnec o-,•c c'ac-"oer•-:-ec or--.e S'cre of co:,crrda:o produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the manage^en•or_sed c'r. !'•e•e•:an, -e am"19 knc"1 a•suspected hazards associated with this waste hes been disclosed. The customer agrees to pay reasonable costs and attorney tees incu rec;r ine co2ec`=c''"is cn cc'ioc. ver. e!,-,ourpases of this obli orlon shoes be in Solono coun . I declare under penalty of perjury that the forgoing Is true and correct. /DDIS+-P�OSAL/RECYCLING FACILITY: Soller.tJen•3tcttan Industrial Agriculturs Government Marine Other Indust Lubrtcating. f/ - � ". - c7' >4}•t-tn rrlt t..r.:3r tel'vbf'TUyi=tVll ;/ ... c_r.• alt .i :.hevr r;:mi P.ewlands Dr.,East -57=27&) N/D.9MM03 Generators Signature Drivers Signature Stat Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. To e-Activate or to obtain an EPA#-Customer may contact DTSC 0 1-800-618-6949 9TT/6ZO IE ONI SOAS ANH AfIONHHA 661;£8tibL0LT XHA 90:VT TTOZ/ZZ/80