Laserfiche WebLink
FREMOUE&VIRONMENTAL WRVICES, INCO <br /> Send Pat ment to: Phone: 8 0 <br /> Phone: -4 a):;EPA CAR000171017 <br /> W <br /> P.O. RD% 2875 Phone: -V1-449-3700 U.S.D.O.T.# 1484667 INVOICE # 5 9 01 <br /> Vaca%ille.Ca 95696-2874 Fax: -1 )7-449-3499 D.T.S.C.#3544 i) /I—. <br /> www,hazwasteremoval.com CA#274461 Date Z- <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> CustomerRrp rp <br /> Tip; Customer a q cn��r, <br /> 6-L 0 C K I().r -t 9- -1 r:1, U- -11110111 <br /> E.P.A. # Phone <br /> Additional Contacts'. <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 /> q- <br /> Empty Drums Provide = Remove 1 Al 1A2 5g L-3 1 Og Q 15g C3 30g Q 55g 0 5 P F <br /> Clor-D-Tect Q4000 Test Kit: Test Z) F ass ZI Fail 0 Generator Knowledge,-;k-.--PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Oil A/F <br /> Clean: I Y N Labels V-1 Oily Debris LICIF <br /> SERVICES REQUESTED BY -TAY <br /> We <br /> P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: C0,5;g,,-C_;c:.v arc cccurotely described above by proper shipping name and are classified,Packed,marked,and <br /> ;cbe:ec.arc are c.resLec-s',L-cz— -,m c- - <br /> =-Z z g',c coolicabe state and national government regulations. if I am a large quantify generator,I certify that I <br /> have a program,=acero --e gere,cte3 Tic the cecree!hove determined to be economically Practicable and that I have selected the practicable method <br /> o'trec,1rner-.;-wc;e.or cfsonsc: =,c acre-c e­7 - <br /> 'c� and'�'ure!hrect lo numan health and the environment;OR.If I am a small quantity generator,I have made <br /> 0 good faith effort to minimize my wos-9 gerera-,ior orin selec!-he best--,as�e management method that is available to me and that I can afford. All used oil from the generator listed above <br /> 'A#be 701SPOIlec cry-c c ne,—;--ec c,,—e S-c!e c,cc4.-ornic ro produce used w into recycled cif OR 0 facility that's require Federal regulations appffcable to the <br /> mancigernew of used ;:. d to comply with Fed <br /> fees <br /> 'ecc, no k-c,.*.,r or suspected hazards cssocicted with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> ec <br /> ,eesincurredinthe col 'de^:e r,:,ses ol this ob;iga!ior,shalt be in Sol -lore under enol[ m <br /> I Inid.Stri.l.n.c.unTy. I de lore ty of Perfury that the for out is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: ction St. Indusirl I <br /> I Agriculture Government Marine Other <br /> iL 011o <br /> OII <br /> Dr,L Em! <br /> Y. <br /> 1- <br /> /* <br /> -int <br /> .IntNorne Generators Signature <br /> DdVer's Signature <br /> State Law RequIres.that you k4wirttlit-Recelpt/Bill of Lading on file no less than 3 years. <br /> To Re-ActivotA nr to nhtnin nn FPA it-r,icfnm^r nre/`Tire I orV%z I o,to <br /> ZTT/OCO[n OKI SOAS ANF[ AfIONHHA 66Vf:9f1VL0LT YV9 90:VT TTOZ/ZZ/90 <br />