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FREMOU ENVIRONMENTAL �RVICES9 INCe <br /> Send Payment to: Phone: 8 -559- 4 EPA ID#CAR000171017 �• q <br /> P.O. Box :875 Phone: 70/448-3700 U.S.D.O.T.# 1484667 INVOICE # .�..`� �l 9 <br /> Vacaville.Ca 95696-28?5 Fax: 0 448-3499 D.T.S.C.#3544 Date <br /> x,.u-w.hazwasteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING ADDfESSy - r <br /> Customer Customer. <br /> 91J Cirremon A.vPr•.1Q f`.; '?;�?88 <br /> tcv ktcn, C.4 2 , ,I„ 'C'A 95101 <br /> E.P.A. # Phone <br /> Additional Contacts: <br /> Cnar-ies u9 4�7 9f)00 <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 . 14 21 . 30 . 4S • 60 • 90 • 180 • 365 W/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> J_ _ <br /> `.5.00 <br /> mac:; <br /> i <br /> Empty Drums Provide Remove 1= 1 A 1 1 A2 5g ❑ l Og l7 15g❑ 30g ❑ 55g O S P F <br /> Clor-D-Tett Q4000 Test Kit: Test❑ Pass Cl Fail ❑ Generator Knowledge.O PPM _ <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil ---- A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX 377 <br /> We <br /> Acce t ® P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: ^e ems;cec'c a -_ a ccre-rs c'. ^`s co syrmer•cre',::y and accurctely described above by Proper shipping name and are classified,pat ed,marked,and <br /> 'abeied.c-d are _c "'° -^"tae•cc-a''c-'c cccord'r7'a opo8coble state and national government regulations. If I am a large quantity generator.I certify that I <br /> ha` c c ea.ce -e•= e c'ed ro'�e Pre ree i hove deter—fined to be economically practicable and that I have selected the practicable method <br /> a`treo e .; ge - s s„ c_•-e-• a.a rr _c•re present ano future threat ro-wman health and the environment;OR.if I am a small quantity generator,I have made <br /> o goad e c , - -c:s,e�e•e- ^c V-e nes,.vcs;e mornogement merhod thor is available to me and that I can afford. Ali used oil from the generator listed above <br /> wi;!be•ra^saa^ed ,•c c•x'.n•Pre•—tree a.--e S•a•e c`ca-?cynic fo produce used ail into recycled all OR a facility that is required to comply with Federal regulations applicable to the <br /> merccer•.er.c`-sea c;. e e.cn '^'o.-•a ic^•e crc'^.g<^o•.vn or apecred hczords associated with tins waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurred -re cct:ecnor a; -,is oDfi c cn, ver a`or purposes o`this obli ation shofi be in Solono county. I declare under enol of a'u Ihat the for on s true and correct, <br /> DISPOSAL/RECYCLING FACILITY: collection Station Industrial I Agriculture GOvemlment MarineOthBT- Ips ORrla1 til(tlnp <br /> - Eli. (;anh;ry EMI <br /> .- .c J r r J J t:Ki f•b:Wi2r�L'r,tat•( <br /> RIit1 Generator's Signature ` —^*"" Drivel's Signature <br /> Stat Law Requires that you..keep this Recelpt/BIII of Lading on file no less than 3 years. <br /> Tri _Ar•+6.nie....+n Ak4-:- co. u r-.._,^�__—_---_•__....�.. ...... .... ...... <br /> ZTT/T£0In OUI SOAS ANH ARONHHA 66V£8VVLOLT XV3 90:VT TTOZ/ZZ/80 <br />