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FREMOU E4TVIRONMENTAL S�VICES9 INC. <br /> Send Pa%ment in: Phone: 8010-559-2 EPA ID#CAR000171017 <br /> P.O. Box 28'- Phone: '0%-348-3700 U.S.D.O.T.#1484667 INVOICF # �.i1. 9 <br /> Vacaville.Ca 95696-2875 Fax: 70 -448-3499 D.T.S.C.#3544 Date I � t <br /> www.hazwasteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer c Customer Brannon lire <br /> d ';5 r ! rer,lr)n ,�ien�lu� ,f 988 <br /> • J' ?Ct 20 <br /> d- :' ' <br /> SIcn,�tor. CA <br /> / <br /> E.P.A. # <br /> `t` ►� ' , V Phone <br /> Additional Contacts: <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 /> - • '�! �- fir' IL I C 0 <br /> - <br /> - 00 J <br /> Empty Drums Provide = Remove W,, 1 A2 5g ❑ 10g ❑ 15g ❑ 30g ❑ 55g O S P F <br /> Clor-D-Teat Q4000 Test Kit: Test Z) 3ass:3 Frail ❑ Generator Knowledge EF- PPM <br /> Transportation Charges/Additional ruck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y Labels Oils :y-- AIF (�•,: UOF ,;_., rJ f, Oily Debris <br /> SERVICES REQUESTED BY TAX 9.001 <br /> A ce t . ® P. O. # TOTAL CHARGES: , <br /> GENERATOR'S CERTIFICATION: -_ __ - -_ -- : e cna cccurctery described above by proper shipping name and are cJassifietl,packed.marked,and <br /> ace ec :-ccs c _c__ rc oep,ice5ie s'ote a.^.d national government regulations. if!am a large quantity generator,I certify that I <br /> hove c b•cgrn- r cce '-e:c_-e cr,• >c••c'.cs:e gerwo'ec 7o the degree:nave determined to be economically practicable and that I have selected the practicable method <br /> e'7eat,Ter".s•c-cge.cr aiscosc -e----a-c,=b:e 'he present and fusure'hreet to human health and the environment;OR.if I am a small quantity generator.I have mode <br /> c gate fcftr a%r7'0^: _e-- .:cs'e gene o'ic-a a seiec'.-e best wcs'e r cncger-err rrelnod that;s available to me and that I car afford. All used oil from the generator listed above <br /> will be transported oniy Tc c'ecL�y oer n;!teo c•:Tre S ate o'Cc!Te ric to pmcL ce used a:!into recycled:)ii oR o IacOity*,hot is required to comply with Federal regulations applicable to the <br /> monogemen a'_sed c A're evcnr'n`crno'e-•etr !c'^g<r.--,n c-suspectee ticioros Qac:etea-IM'hs waste hos been disclosed. The customer agrees to pay reasonable cosh and attorney <br /> fees inc..rrea it•ne cc'ec-ic-c`rr.s ood c'ie-. ver 'c'n,,;Dcses o`rh!s ob@nettor•shat ce in So ono county. I declare under penalty of p0urY that the for oin a true and correct. <br /> DISPOSAL/RECYCLING FACILITY: n Industrial Agriculture Government Marine Oiher Industrial Ub c <br /> 01 II <br /> nes-=•a-. XY)Nowianrs Dr. FEas( <br /> - - - - .. __ � _ - t. 4 12xta.t� �•'• TS5]61%97 �A/C.SX�6355.�""� <br /> Frim.,lathe Generators Sibndtur�'+4L Drivers signature,1`f; <br /> State LOW Requires that you keep this R&elpt/BRI of Lading on Rle no less than 3 years. V <br /> Tin,R ArtivntP nr fn nhtnin nn FPA A_r i iclnmar m— r.f...•t nTcr•m T onn Z to 1n.n <br /> ZTT/8£00 OUI SOAS ANH AfION21HA 66V£SVVL0LT YVd 80:VT ITOZ/ZZ/80 <br />