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Send P2>mFrREMOU: s o_iE�VIRONMENEPA ED 0* 1TAL 017 k*RVICES, INC. <br /> P.O. Box 28-5 Phone: -, 448-3700 U.S.D.O.T.#1484667 INVOICE # 17205 <br /> acai ille.Ca 95696-2875Fax: '70"-448-3499 D.T.S.C.#3544 Date <br /> w%i�A%hazw•asteremoval.com CA#274461 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer er' r).n Tire, Customer Ammon Tire <br /> lug, :;iaremo, t NvenlUe <br /> tocr•:tor: ;!? 9,i 1 5201 <br /> E.P.A. # ti.A' j 00 I y� Phone <br /> Additional Contacts: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 • 142• 1 30 • 45 • 60 . 90 • 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Empty Drums lrovide = Remove 1 A 1 1 A2 5g U T Og ❑ 15g O 30g D 55g ❑ S P F <br /> Clor-D-Tect Q4000 lest Kit: Test Z) : ass :3 Fail :3 Generator Knowledge U_.PPM ; <br /> Transportation Charges/Additional ruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: . Y N Labels Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX 9(10 <br /> We <br /> A ce t ® P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -e•ea.cec=re-o- cc•--e-'s c''-.is ve'.,'y Dnd accuro'eN described above by proper shipping name and are classified,packed,marked,and <br /> labeled,and are In a5 resaecrS'c arc--sr cc^a'-:---'c• ::.Saert av n:g%,,:cy ccco•dins`--anciicable state orc national government regulations. If I am a large quantify generator.I certify that I <br /> have a program Ir p'cce'c-ea:ce s v --—e-.-a­_cic7.Tv or was e y ero'ed'c:he degree i re <br /> have determined to be economically practicable and that I have selected the practicable method <br /> of freotmenr.storage.ar e'sodsc c_ r .• <br /> e ,cc: .e c _ n'cn--r,, <br /> pre,.:zed'ne ser.'enc tutu 'hreot to Kumon health and the environment;OR,if I am o small quantity generator,I have made <br /> o good faith et'crt'o-7:ct ze—.V etave ge.ercr:cr c- cse,ec-the aesi.veste mcnogemert method that is available to me and that I can afford. AN used all from the generator listed above <br /> will be transported only'c a facie y perm5hea oy rre S' fe of C-_''fcmtc to--reduce sed ca into recyc:ed oil OR a facility that Is required to comply with Federal regulations applicable to the <br /> management of used oi-. A';relevan'irtcr,-a:ia- e_c.ding 2^o+v^cr- spec-ec hczords esscda'ec Ki'-.'-is waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurred in the CJiieC ar ofprion sna,be n Soiono county. I declare under penalty of pedury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Colla on Station Industria) Agriculture Govemrnent I Marines thef Industrial Lubricating <br /> OI Oil <br /> „s1Gr-iituryEY4 <br /> -. .- -- --• ... _ .. .. .. 'h'rf�2'-.,, i%�K r.ihv,'ianV�3 iJr.Eavl <br /> Print dIT>e Generator's Signature De SI nature <br /> State Low Requires that you keep this Re Ipt/Bill of Lading on Ole no less than 3 years• <br /> ZTT/0601() ONI SOAS ANH MIIONHHA 66VCRVVLOLT XVd 60:6T TTOZ/ZZ/80 <br />