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FREMOU I E:l 'VIRONMENTAL SfIRVICES, INC. Send P2}ment to: Phone: 00-559-3-,.. EPA ID#CAR000171017 P.O.Box 2875 Phone: 'M-448-3700. U.S.D.O.T.#1484667 INVOICE, # 9 5 Vacaville.Ca 95696-2875 Fax: 07-448-3499 D.T.S.C.#3544 wgrwhazwasteremoval.com CA#274461 Date SITE ADDRESS BILLING/MAILING ADDRESS Customer Rrannon Tie Customer Rmonon Tire StoCktor ?C' i -I 5510 1 E.P.A. # A L Q 0 n 96 " Phone Additional Contacts: PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION 7 • 14%• 21 • 30 • 45 • 60 • 90 • 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT CODE 22' ,'-- ;ice - ;' �, ��., reez,, CA 13:' 1.00g -- _ - To: 5500 3.,araajs 1''r?S,e JQIW_ ,Ov �-c r.,afn ina!ec ,:E"_'i ;.oli' Empty Drurns Provide = Remove = 1 A 1 1 A2 5g ❑ 1 Og ❑ 15g O 30g ❑ 55g O S P F Clor-D-Tect 04000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge r:-4,3,PPM .7:_ Transportation Charges/Additional ruck Time/Additional Labor/LAB Packing/Site Cleaning Clean: Y ,N Labels ✓ Oil f -1 , .. A/F UOF •'; .I_ Oily Debris /U` r A SERVICES REQUESTED BY I TAX y•!i(i We a � Acce t = � P. O.# TOTAL CHARGES: 1 0- GENERATORISCIERTIFICATION: a-_t .:e='c,e - •Tis=ars:o-^�er:ore tum and,ccuretely described above by proper shipping name and are classified,packed,marked,and ace'ea.a-c ce' = e=c=.s c --- - - - ,^ ^-- acco,dr^ore opoiicob:e state erd,otioncl government regulations. II 1 am a large quantity generator,I certify that I ave c oro;c- c c=e•:-e=_=e•-e._--e::,= ._'-.:'-.o>a;ererc'ec-c r-e eegree i hove determined to be economically practicable and that I have selected the practicable method "e= a s'==.e : _ : _ -e• _ - -_a ire oresen-t ono'::rare<hreot re numan health and the environment:OR.if I am a small quantity generator,I have made -_-- -e"=- - .- e o e _ _ _ _ _ -_ dos°e^c- _s.^e-'r^e-hod'ba o'is voiio5le to me and that I con afford. All used oil from the generator listed above ce" -=c= e= = h:e- z. - c^^n -c^d ce-sec o :-•c'ecycled o�OR a'ociGfy that is required to comply with Federal regulations applicable to the •es :<^c..^:r s_s=s^ec^cxc•ds Zssc=ic'ec w;;r•�;waste has beer disclosed. The customer agrees to pay reasonable costs and attorney fees inc_r•ed'^-Tis ro eci�^c ^`s oc,^et:a-.. 'ver_ .'^_;";,:ocses of Lnis obli anon sho4i oe in Solonc county. I declare under enol of e' that the forgo is true and correct. -�)IISPOSAL/RECYCLING FACILITY: -Collection Stati n Industrial Agriculturej Govemment Marine Other I Industrial Oil `�; -' ❑• .-.. .,.n};.,, .r;d� 1'):Sijaf1lu N,Etvtl !11T i h�-Alands Dr..East _ .. .. .. . _ .... iti: -. _ .....7Y��I-,._:_� /•. 7� „'h�?Frl'try'D��i:>B Prilit Name ie oi's Signature Drivers Signature State Law Requiresthat you keep this Recelptt/01111 of Lading on Mono less than 3 years. ZTT/RPOIn OKI SOAS AKH Af1010M 600:9V rLOLT XM OT:6T TTOZ/ZZ/80