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FREMOU R SE4VIRONMEN1 <br /> _0 TAL SVVICES, INC. <br /> Send P2%moot to: Phone. EPA ID r <br /> P.O. Box 28-5 Phone: '0%448-3700 U.S.D.O.T.#1484667 INVOICE # u <br /> ViicaNille.Ca 95696-28?5 Fax: 70 -448-3499 D.T.S.C.#3544 <br /> Date �• .�,�'�'� <br /> w•ww.hazw'asteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING AD�A�SS -1 irf' <br /> Brannon Tire Customer. TITIN <br /> �� <br /> Customer - <br /> 490'5 D.. , rnoni i�vrlllue <br /> r53V <br /> E.P.A. # '� v�tl G 8 Phone <br /> Additional Contacts: _ <br /> nares f :►9 <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> "7 /• 14 • 21 • 30 • 45 • 60 • 90 180 • 36S W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Empty Drums Provide = Remove 1 A i 1 A2 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Cior-D-Tec'Q40X"est K`t: ;est ❑ Pass ❑ Foil ❑ Generator Knowledge 0 PPM-:' <br /> Transportation ChorgesiAddition:al Truck ilme/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F UOF Oily Debris <br /> SERVICES�REQUESTED BY TAX 4.G0 <br /> we <br /> Acce t WE P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -e-ea:oe:c e--c'' ar-e-•s o""s cn-s Cnmert are!-ran <br /> v and cccurcte,,y described above by proper shipping name d ore classified,packed.marked,and <br /> cceled.ro a'e -esc=_c•;'-.,cae-::- `c'`o -_ - national govemmenl regulations. If I om a large quantity generator,I certify that I <br /> ce .:_^•e a-_ :x' -. _ re-ex ed':'-.e degree:hove determined!o be economically practicable and that I have selected the practicable method <br /> a`-ec--e c cg= _ c c=_n Z_ ._ - e •-- -. - a-eserr enc future Threat to human health and the environment:OR.If I am a small quantity generator,I have made <br /> a„ocd'a`•-e-or'o -`e-;.:os-e_e^erc o -c see: =e bes' .-Cs-e a-oge-en•method thc-is available tome and that Icon afford. All used oil from the generator listed above <br /> w;;'ae••a-sc crec:^ ':a'c:'•,.ne—^sac --e'-c•e o`ce:'e^Ic-a a-ca.ce aec oil in�o recyctec al OR o facility shot!s required to comply with Federal regulations applicable to the <br /> mor •- <br /> •cgee'.'o•-sec❑• -.: e.e:c `c­a'c- o c:+cR^ov:^c•suspected npzares assacipred'with tti;s waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurrea in the co:.odor,o'iris ob!i o!ion_ Ver e tor purposes o'this obligation shall be in Solana county. I declare under penalty of pedury that the forgoing is true and correct. <br /> D POSAL/RECYCLING FACILITY: �'Collection Station Industrial Agriculture Govemment Marine Other Indusof �Ioting <br /> oili ntls,trr• 8940, <br /> r _ :rl`'s? „ tis,°_276G NUD3°St3s <br /> P nt Narge' ,. Generator's Signatilre Driver's Signatur <br /> State Law Requires that you keep this Receipt/Bill of Lading on file no lea han 3 years. <br /> Tn _Ar­tivntr:nr to nhtnin­1=13 r­+—, +n7tr`ai ono 11. rn— <br /> ZTT/9£0[n ONI SOAS ANH MROIQHHJ 66VCRVVLOLT XVd 90:6T 110Z/ZZ/90 <br />