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Send P3%mFREMOUw-5E4VIRONMENTAL SRVICES, INC. ^ ^ <br /> P.O. Box, 28'5 Phone: "01-448-3700 U.S.D.O.T.#1484667 INVOICE # t . <br /> Vacaville.Ca 95696-2875 Fax: 70?-•448-3499 D.T.S.C.#3544 <br /> t vw�.haza asteremoval.com CA 111274461 Date V cY <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer R n n jI Customer Brannon 1 Irp <br /> # <br /> l;i a <br /> E.P.A. `f1 :�.� �-r�ic}�� C Phone <br /> Additional Contacts: <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 • 30 • 45 • 60 • 90 180 365 WAC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> rC•'. --r —a:: iyaslB ,cut SrakirC 4L 1. <br /> Empty Drums Provide ` Remove , 1 A 1 1 A2 5g ❑ 1 Og ❑ 15g ❑ 30g ❑ 55g ❑ 5 P F <br /> Cior-D-Tect G4000 Test Kit: Test O ass ❑ Foil ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional ruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N LabelsOil - A/F UOF - - Oily Debris <br /> 4 I <br /> SERVICES REQUESTED BY TAX I`,00 <br /> We P. O.# TOTAL CHARGES: 7J <br /> Acce t Ly <br /> irrrtt� <br /> GENERATOR'S CERTIFICATION: I hereby deCcre'hot f e convents of this consignment are fully and occuretely described above by proper shipping name and ore classified,packed,marked,and <br /> labeled.and are in all respec's in;:racer ccndition for tnensport by highway according to applicable state and notional government regulations. If I am a large quantity generator,I certify that I <br /> have a program in place to reduce!*.e volume and' xicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method <br /> of treatment,storage.or disposal currently available i me which minimized the present and future threat to human health and the environment;OR.if I am a small quantity generator,I have made <br /> a good faith effort to minimize my waste generation c nd select the best waste management method that is available to me and that I can afford. All used oil from the generator listed above <br /> will be transported only to a facility permitted by the tote of California to produce used oil into recycled oil OR a facility thol Is required to comply with Federal regulations applicable to the <br /> management of used oil. All relevant Information re rding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurred in the collection of this obli ation. venu 3 for Purposes of this obligation sholl be in Solana county. I declare under penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: C011eCtio Station Industrial Agriculture Govemment Marine Other Indus'I•al Wbr&, ting <br /> 2735 N aiands 0. Easl <br /> 5urz.._, ..1:.-, ":!tnfs :y,•" �;mtUe3 <br /> tir5• W. to <br /> - — <br /> Generator's Signature <br /> Dave Sfgnatur <br /> Sta law Requires that you keep this Receipt/Bill of Lading on Rle no less than 3 bars. <br /> ZTT/££Ol�j DS11 SOAS ANIH MII011i A 66V£8bt'L0LT XVA LO:VT TTOZ/ZZ/80 <br />