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FESend Pa�mT TO MOPhO e: o_;E*VEPA ED CAROOO IRONMEN1TAL S�VICES9 INC. <br /> P.O. Box 2875 Phone:'707-448-3700 U.S.D.O.T.#1484667 INVOICE/# <br /> X"acaville.Ca 95696-2875 Fax: 7(7-448-3499 D.T.S.C.#3544 Date J <br /> wRi-w.hazwasteremoval.com CA#274461 <br /> SITE ADDRESSBILLING/MAILING AD ESS <br /> Customer 6rannon IIre Customer railnon Iire <br /> 19�� C;►aremon` �1�!eni.Ie ' 0 Bax • 9�8 <br /> r / <br /> 950 i <br /> E.P.A. # — Phone <br /> Additional Contacts: <br /> PRODUCT - ERVICE 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 /> ,' . <br /> Empty Drums Provide V Remove 1 A 1 1 A2 5g❑ 1 Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tett Q4000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge-Q;-.PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N labels Oil A/F UOF ' Oily Debris <br /> SERVICES REQUESTED BY TAX 9,00 <br /> Acte t ® P. O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and <br /> labeled,and ore in all respects in proper condi!ior fe.transport by highway according to applicable state and national government regulations. It I am a large quantity generator,I certify that I <br /> hove o progrom in place'o reduce*he voiur..e end! xicity of waste genercted to the degree I have determined to be economically practicable and that I have selected the practicable method <br /> of treatment,storage.or disoosof c;.!rren!iy cvoi-cb:e t D me wnich m'nim!zed the oreseni cnd future threat to human health and the environment:OR,if I am a small quantity generator,I have made <br /> a good faith effort torrir.lm'ze-^v woste genera`br c^.c sere:'he best wcs'e mancge^en',rethod thc'is available to me and that I can afford. All used oil from the generator listed above <br /> will be tronsoorted only'c a`o&IN oe—,,-ec by"e -c:e c'CC:::c•-ic-c precuce:sec c?oifo recyctea al OR o faciGly!hat is required to comply with Federal regulations applicable to the <br /> management of used cS. A!I re:evort r'prrna'ier reg rdirg krc,,,n o•suspected cazerds essoc`oted xi!h'.waste has been disclosed. The customer agrees to pay reasonable costs and attomey <br /> fees incurred in the couecaior,of•res obi: atior. vew !er o,:rooses c' nis Obligation shay be it Soiono county. I declare under penaltyo1 perjury that the for oin Is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Coll�.}IessStahoA Industrial' Agricuiture Government Marine Other Industrial Lubrlc <br /> ,•`i� .. .,- - e.._ .. ,_ Wit' .. <br /> s r c 1-:i Gers+xy 61A1 <br /> f,Newlancls Dr,East <br /> v. ti nlef ry` 041% <br /> 7P,5;5.2, MrTJ��(1f4rii <br /> It" <br /> i. <br /> Frim Mame Generatoes Signature Drivel's Signature <br /> State Law Requires that you keep this Recelpt/Bill of Lading on file no less than 3 years. <br /> Tn Q . Artivnfo nr fn nhfrdn—CDA w r•, +....,.,...,—---1__,r....-— . ,.,,,, ,... —— <br /> ZTT/ZVO[E OKI SOAS ANH Aflffa A 66b£8bVL0LT XVJ 60:6T TTOZ/ZZ/80 <br />