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FREMOUW E1 VIRONMENTAL SJORVICES9 INCe <br /> Send Pa%ment to: Phone. 80 5.9 EPA ID. 1 <br /> 1 G '?C <br /> P.O. Boz 28-4 Phone: "0: 8-3700 U.S.D.O.T.# 1484667 INVOICE # r 1 L3 L V <br /> Vacaville.Ca 95696-2875 Fax: '0,-448-3499 D.T.S.C.#3544 Date <br /> www.hazwasteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING ADDRESS r <br /> Customer Brannon Tinn Customer �i annon i ire <br /> 1'. <br /> 1r ;- / <br /> E.P.A. # '��H {J <br /> L �}�. �( � J.��S v Phone <br /> Additional Contacts: <br /> arms <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 /> Ij <br /> Empty Drums Provide = Remove i A 1 1 A2 5g ❑ 1 Og ❑ 15g ❑ 309❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ Pass Z1 Fail ❑ Generator Knowledge p PPM <br /> Transportation Charges/Additional ruck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y .N Labels , Oil;( ti A/F - UOF- Oily Debris' /6/ 0(1 <br /> SERVICES REQUESTED BY TAX1 .7, <br /> We -- <br /> Acce t P. O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION -rec-de_c a `c a cc-'e-:c' -'s c"^s;;;n-e^t c e'::itv and occuroteiy described above by proper shipping name and are classified,packed,marked,and <br /> ooe:ed.c,c o•e'^c escec s r rcoe cc-,�'r'c --c-Scor'o:^.'c^nvcy cccerdirg to cppiicoble stole ore notional government reguiations. If I am o large quantity generator,I certify that I <br /> have c c;egrc–'^c c_e'c•ec_ce•-e c_-e c-c cu�:-:•of v:os-e generated to the cegree'have determined to be economically practicable and that I have selected the practicable method <br /> of treatmer•,s;crc^e.c iaGSC c,,rrer-.evc"cc:e o�e.•:h;cr-rrinimized'he o•esem ane future threat m human health and the environment:OR,if I am a small quantity generator,I have made <br /> a good'ci'^effcr^!o^'^.'m`ze .ove generator ^d selec-the best wove management method that is available to me and that I can afford. All used oil from the generator listed above <br /> wRl be trorsperseo any rc c'ac'=ty cemr-'rec o•:'re S;cte o'Co'�i±o•nic-c produce used o;l into recyc:ea OR OR o facility that is required to comply with Federal regulations applicable to the <br /> menege•r a^`c'„sec ai. s •e'evc-- ^`c^ coeg c•d'-r i:—=--c-sosaec-ed`ozc ds assccie'ed wi'.h this waste hos been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees^.cu tea c±''r s vciigc'cc. •e±cr^.:rposes of..is ob:i olion shop ba ht Solana count . I declare under penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: --CallectlonStatiSlt Industrial Agriculture Govemment Marine Other Industrial Lubrlcatlne <br /> i�Scl::enFuryEktl <br /> 5'Jgwlaurss i_i:.,Exi <br /> .. - .. - ,. . _ ... -. _ _. .. . .. •nit:) i'w ti.�ta($ <br /> 1,. is. t , <br /> R'eIt Name Generator's Signature Drive='s Signature X <br /> Stat Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br /> Tn <br /> ZTT/ZED 1n ONI SOAS ANH MIIOIHHd 66VE86bL0LT XVd L0:6T TTOZ/ZZ/80 <br />