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FREMOUNVE4VIRONMENTAL SVVICES, INC. <br /> Send Paii ment to: Phone: 8100-559- EPA ID#CA.R000171017 INVOICE # J A 6471 <br /> P.O. Box 28': Phone: 710-1-448-3700 U.S.D.O.T,#1484667 f <br /> Vacaville.Ca 95696-2875 Fax: '7127-448-3499 D.T.S.C.#3544 <br /> w-w•w•.hazw•asteremoval.com CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer eFa .ri . c Customer ! 'aniion Tire. <br /> jD <br /> -45201 <br /> E.P.A. # v�� t��'�' ;�C` �' 1 Phone <br /> Additional Contacts: <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> WASTE <br /> •14 . 21 30 • 4S • 60 90 180 365 W/C CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Empty Drums Prcvide - Remove = 1 A 1 1 A2 5g ❑ l Og i] 15g❑ 30g❑ 55g ❑ S P F <br /> Clor-D-Tett Q4000 les'K`t: Tes` ZI Pass D Fail O Generator Knowledge.Z-- PPM <br /> "rc^sporo'ic- C^cores;Add tio-"c 'ruck-ime/Additional labor/LAB Packing/Site Cleaning <br /> Clean: Y t\ I:abeis Oii A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX <br /> WeP. O. # TOTAL CHARGES: <br /> Accept <br /> GENERATOR'S CERTIFICATION: - - - `e c_-e-_- n- <br /> __rsige^ - uiy ecd aamarked,cccfe:y described above by proper shipping name and are classified,packed,maed,and <br /> cne:eo.c-c are'^c ,eszez's cue-=c-;'c-' -'rsc=-c.^`g-.+'a occording!o applicab!e state and national government regulations. If I am a large quantity generator,I certify that I <br /> rove o p-egro- c ace•c•ec_ce•tee c_re c^c-cz c:-o',cs-e generated to•re degree I have determined to be economically practicable and that I have selected the practicable method <br /> of'rec'rne sic cge.c-d'sccsc c_-en-,a.cl.co'a'c-a -in'r-tizea'.he present and future Weal'o human heath and the environment:OR,if I am a small quantity generator.I have made <br /> c good'a:-e'!cr'•o-'--ze-:was-e ceoe,v" - ^c se:ec"-e pes'-cste mencgemen'method Ihet is available to me and that I can afford. All used oil from the generator listed above <br /> wi!!ce`rc-s_n_ed ce^-lec ov Safe c'Cc i`o•^.ic fe prod:,ce used oil into recyciea on OR o.facility that is required to campy wfth Federal regulations applicable to the <br /> c^ra^a --sec a" L e e:c =-c _ c �__„_ s_seec'ec-eze-ds associated with;his waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> 'ees`a_^ec ^s z: ec' c' -'s cc cc c^^- e -:c sic;oe;r Soiano counr . i declare under penolly of pedury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: �Q ,-c_Ion a onIndusirlal Agriculture Government Marine Other Industrial Lub c <br /> Oil <br /> .05*aulands Dr.,Easi <br /> - v '6nwo N�/ 4JC8 <br /> nt NameGenerators Signature Driver's Signature <br /> Stot P Law Requires that you keep this Receipt/BIR of Lading on Me no less than 3 years. <br /> Tin P_Arf•ivnta nr to nintnin nn FPA .0_ .............a_4 rater n , onn L;o ,n— <br /> ZTT/9£OIE OKI SOAS ANH MIIONRHA 66VRRVVLOLT XVd LO:VT TTOZ/ZZ/80 <br />