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FREMOU Phone: g a E l Tl SVVICES9 INC. <br /> Send Payment to <br /> P.O.Boa 28'= Phone: 7-448-3700 1✓.S.D.O.T.#1484667 INVOICE #' % " <br /> 19 <br /> Vacaville.Ca 9-9696-287-4 Fax: 7(7-448-3499 D.T.S.C.#3544 _ `j <br /> w�w-w.hazwasteremoval.com CA#274461 Date iCi �' <br /> SITE ADDRESS _ _ BILLING/MAILING AD�ESS r n G <br /> Customer dranno i in,, Customer ra1�, r ` ire <br /> t <br /> �' ,;•' �i.\:�..;'.i �, •,.. , <br /> E.P.A. # <br /> CAL 000 'i 'b X38 V Phone <br /> Additional Contacts: _•h ` rC — <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 /> ca- <br /> Empty Drums Provide = Remove 1 A 1 1 A2 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Teat Q4000 Test Kit: Test ZI Pass ZI Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional ruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: `Y NLabels Oil = A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX <br /> we <br /> Accept P. O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION, described above by proper shipping name and ore classified,packed,marked,and <br /> !cbe'ec,c"c c•e ^ _:•s - ce• c-sc n-c:v-'e^'. - coo�icac.e-c'e c^d rational government regulalions. It I am a large quantity generator.I certify that I <br /> have a progrc'r'r r:Me% rec_a -e-= —e c^c-.:xci n`.+oi'e ge,.eraten'o'he degree:hove determined to be economically practicable and that I have selected the practicable method <br /> of treatmeni,storage.a.disoosc' ur. <br /> crerj cacCcb a rre wnich minimized The present cna future threat to human health and the environment;OR,if 1 am a small quantity generator,I have made <br /> a good faith effort to,rn nirnize+:v was-e genwo'tcr and select the nest waste"ncgemen,method fho•is available to me and that I can afford. All used oil from the generator listed above <br /> will be transported only to a foci:ity oerm tteo by tie State of California to produce used of into recycled oil OR a facility that Is required to comply with Federal regulations applicable to the <br /> management of used on. All relevow Fnformallon mgc taing 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 obligation. veno fo[.PwAaAeLoLU5 obligation shall be In Solana county. I declare under penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: ollection Station`, Industrial Agriculture Government Marine Other industrial Lubricating <br /> OR <br /> --�� -'�r .. _ . . .v. -,... .:�. ._ .03. t 3>:•iswlarkt�Gr.,ca,t <br /> e ti ? <br /> Generators Signature Driver's S1g(iature <br /> Stale Low Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br /> Tr%R Arfivntc—f,nhlnin nn CDA }k <br /> ZTT/6£O In OKI SOAS AuFI MIIOI RIM 66VM tLOLT XVd 80:PT TTOZ/ZZ/80 <br />