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FREMOUW E�r TVIRONMENTAL S- ,RVICES, INC. Send Payment to: Phone: 8 -559-3�;-f EPA ED#CAR000171017 ��]] P.O. Box 28"5 Phone: -07-448-3700 U_S.D.O.T.#1484667 INVOICE # 1 L V2cav ille,Ca 95696-=8'.5 Fax: '0--448-3499 D•T.S.C.#3544 www1azwasteremoval.com CA#274461 Date l ^ SITE ADDRESS BILLING/MAILING ADDRESS _ Customer Brannon i ire Customer Brannon Tire fy P � �'90 %I�FC�i?101'''t »�i�,::;E rte.�, . Box '1988 %fir^ICA 9524.r " E.P.A. # J` i _. '5.r Phone Additional Contacts: es --1 i 9v0l PRODUCT - iltRVICE INFORMATION PROPER SHIPPING DESCRIPTION 7`• 14 . 21 30 45 60 • 90 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT CODE Empty Drums Provide = Remove 1 A i 1 A2 5g 7 l Og ❑ 15g ❑ 30g❑ 55g ❑ S P F Clor-D-Teat Q4000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge ,Z PPM Transpor45tior.C`'arges%Addltiora: IRjck Time/Additional Labor/ LAB Packing/Site Cleaning Clear: Y N Labels Oil. _ A/F ,� UOF % Oily Debris SERVICES REQUESTED BY TAX WeP. O, # TOTAL CHARGES: Accept ` GENERATOR'S CERTIFICATION: -s eco cec c'e `_ a-c-•e^'s c'"s cc-sig—r,er•cre'.'y crc accurately aescribed above by proper shipping name and are classified.packed,marked,and ebeiec.a^d are:-a respec s'-.c-cpe-cc-a o-'o.'ro-spar ov^7gn-oy acccro ng'o cop::cob;e state and national government regulations. If I am a large quantity generator,I certify that I have o prcgro.^an p+ace-c-educe t`:e vc,-rne cnc x:c:ty o'waste generated'a the degree i have determined to be economically practicable and that I have selected the practicable method of treatment,storage.or d spose:currency evci cNe' me which minimized the present ono future threat to human health and the environment;OR,If I am a small quantity generator,I have made a good faith effort to m;n1m:ze my woste generct;an c nd select the best waste management method that is available to me and that I can afford. All used o1 from the generator listed above will be transported only to a facility pemtitted by the Stote of California to produce used oil into recycled oil OR o facility that is required to comply with Federal regulations applicable to the management of used oi!. a.re evant'.n'or^a';on ren rding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney fees incurred'.r tae co•,ect2on of Phs oba^at:c-.. v oar uses o`this obii ation sholi be in Sdono county. I declare under penaltyof er•u that the forgoing is true and correct. DISPOSAL/RECYCLING FACILITY: Industrial Agriculture GOvemmant Marine Other Industrial ubrieaflna - ^\ i4r 39408 y. 'IND 99n.— \ r 11 Print Name Generator's Silglatvre Drivers Signature I� State Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. Tn-R _AMivnfa nr to nhfnin nn FDA }} ntcr a , nnn r i n -- 9TT/t£0[2 OUI SOAS AKH MfIONR 1A 66Vi:9f'VL0LT XV3 LO:VT TTOZ/ZZ/80