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FREMOU E4 IRONMENTAL �RVICES, INC. <br /> Send Pat orient to: Phone: 8 0-559 _.4 EPA ID#CAR000171017 <br /> P.O. Bo-, _28-5 Phone: 7 7-448-3700 U.S.D.O.T.#1484667 INVOICE # 1 ? <br /> Vaca%ille.Ca 95696-38'5 Fax: ' -7-448-3499 D.T.S.C.#3544 <br /> ww w.hazwasteremoval.com CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer C Customer Hranri�! Tire <br /> 4905Claremo t Avenue P.O, Bax 1988 k}} <br /> ot <br /> 95201 <br /> E.P.A. # <br /> SAL- 00V 1 6 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 /> 1.00 2 <br /> ».00 <br /> G_ s u8S0"nE-�IC�C" ' 1rC'0i8 <br /> Empty Drums Provide Remove L# 1 A 1 1 A2 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tett Q4000 Test Kit: Test❑ Plass❑ Fail ❑ Generator Knowledge O PPM <br /> Transportation Charges/Additional T ck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F UOF - Oily Debris <br /> SERVICES REQUESTED BY TAX 1 9.00 <br /> we ® <br /> Acte t P. O. # TOTAL CHARGES: <br /> GENERATORY CERTIFICATION; `e'eCv Ce.^.'ara-!+.,;"r•e E`sr""'s a'1^!;consgr•-,ert ore.`ully and accuro!ely described above by proper shipping name and are classified,pocked,marked,and <br /> Iebelet.crit are i-o::resnec^'-r.c-_e-cc-a'iaa',;r r r:;pcc b.-ghwcv cccording so applicable state and national government regulations. If I am a large quantity generator.I certify that I <br /> have a program in olcce io reouce the vo!ume and tax dty of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method <br /> of treatme Ft,sioroge.or disposel ccce�"v cvo?ee!e Or,r na-rich minimized the present and future threat to human health and the environment:OR,if I am a small quantity generator.I hove made <br /> a Qood'o" _ _ , e-c-s-:- ,e 2c'•^e nev.:cs,e ^ncger^ -caihod`hct s ova:loble fo me and that I can afford. All used oil from the generator Rsted above <br /> be'ransac.ec c,,.. ^% -••e=n.•-e S- re c`Cc.•orrro!e prcc, ce-jsea o:inrc recyc ea oil oR o facility that is required to comply With Federal regulations applicable to the <br /> c <br /> menaeme—a e e-c••- -c-: •ec^ !mob zn r or sys56ctec rnza•ds cssnoctec with anis waste hos been disclosed. The customer agrees to pay reasonable cosh and attorney <br /> eer^ -ear -_- - c - -_- c•.c. ,e po�O'fh°;OD` otica scar:be in Soane tour.. I declare under penalty of perjurytrIcit the foraoing is true and correct. <br /> DISOSAL/RECYCLING FACILITY: C011ectlon Station Industrial Agriculture Govemment fytidrif�a Other Indust <br /> Lubricating <br /> I oil <br /> P <br /> _ - i tsl ueniury cMl <br /> W:^6 Nowiarwb Or_[2d <br /> Generator's Signature \\ rive 5lgnature <br /> State L Requires that you keep this Receipt/BIB of lading on file no less th0 ears. <br /> - Tn PA- Hivn+n nr to nhfntn nn FPa it-f-nhnmor <br /> ZTT/Tb01E 00 SOAS ANH A[IONHHA 66VCRVVLOLT XVA 60:6T TTOZ/ZZ/90 <br />