|
FREMOUW EWIRONMENTAL S_ WICES, INC.
<br /> 'sund Pal nill ro: Phone- 800-559-3274 EPA ID 4 CAROOO 171017
<br /> P.O. 30.N 287: Phone: 701-448-3700 U.S.D.O.T. 8 1494667 INVOICE iV
<br /> lv'aca%ille,Ca 95696-2875 Fax: 707-448-3499 D.T.S-C. fl 3544 Date
<br /> wwwhazwasteremoval.com CA#274461
<br /> BILLING/MAILING ADDRESS
<br /> Customer Customer
<br /> Address Address
<br /> City State Zip City State zip
<br /> E.P.A. # Phone Fax
<br /> Phone Numbers: Office Fax Cell
<br /> Contact: E-mail:
<br /> PRODUCT SERVICE INFORMATION PROPER SHIPPING DESCRIPTION
<br /> 30 60 90 ISO 365 T T Y N7 H S WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT
<br /> - --CODE
<br /> Non-RCRA Hazardous Waste Liquic (Used Oil) CA 221
<br /> Non-RCRA Hazardous Waste Liqui (Used Anti-Freeze) CA 134
<br /> Non-RCRA Hazardous Waste Liquid (Oily Water) CA 223
<br /> ,o,)-RCR,A -cjzc,do,;sVf cs1e So 1d,"C Cor'crnlneed Dl Soii' CA 223
<br /> Non-RCRA Hazardous Waste Liquic (Latex Paint) CA 291
<br /> Drained used of /Gasoline / Dl i/Filters N-A
<br /> Combustible Liquid, N.O.S., NA 19 3 (used oil) IE CA 221
<br /> Waste Paint Related Materials. 3 UN 1263, PG 331,,-_1
<br /> 1 ,--DOOIJ
<br /> Waste Flammable Liquid,N.0.5-3,UIN, 1993,PG Il (1'_'aso!jne-Diesel) 331'
<br /> 01
<br /> Waste Aerosols, N-0-5.2.1, UN 1959 PG 331
<br /> 0001
<br /> Empty Drums Provide 0 Remove 5g U 10g ZI 55g 0 S P F
<br /> Clor-D-Tect Q4000 Test Kit: Test L] Pass L-1 Fail El Generator Knowledge-0 PPM
<br /> Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning
<br /> Additional Equipment Supplies
<br /> Hazardous Waste Labels
<br /> Used Oil Disposal Fee
<br /> TAX
<br /> We FP O. #
<br /> Accept TOTAL CHARGES:
<br /> GIN Ef1ATOR*5 CERUIFICATION hereby fully and occurclely described above by proper shipping name and are classified,pocked,-orked.and
<br /> labeled,and ore in or, -P-c!,1,arc'Der c':':0n ,a!"crmor'-�i r-cco,d,r.g'a applicable state and nolicncl government regulations it J am c large quantity amity
<br /> netator.1 certify that I
<br /> have a program in piece to reduce the volume and i Dxici!y of waste generated 10 the degree I have determined to be eConomicaly Practicable and that I have selected the practicable method
<br /> of treatment,storage,or disposal currently available to me whiClh minimized the present and future threat to human health and the environment;OR,if I am 0 small quantity generator,I have made
<br /> a good fall efforl to minimize my waste generation and select the best waste management method that is available to me end that I con afford. All used oil fTom the generator listed above
<br /> will be transported only to a facility permitted by the Valle of Colifornio to produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the
<br /> management of used oil. All relevant information regarding known or suspected hazards associated vvifin this waste no;been disclosed. The customer agrees to pay reasonable costs and attorney
<br /> fees incurred in the collection of this oblinalien. Venue for purposes of I his obligation shall be in Solana county, I declare under penalty of perjury that the forgoing is true and correct-
<br /> DISPOSAL/RECYCLING FACILITY: Colrectton Station I Inclutrial I Aoricuiture I Government Marine Other I Industrial Lubricating
<br /> Evergreen 00,Inc. General Environmental Management,Inc, yeallo ES/FRO I I of I oil
<br /> 4880 Smith Ave.,Newark.CA 94560 111155 White Rock Rd..Rancho Cordova.CA 95742 = tames Environmental
<br /> 3 S736 ill Jefferson.Phoenix,At 85043 7 ISIS S.River Rd,W.Sacramento,CA 95691
<br /> 510.796-4400 CAD 980887419 914.3S 1.0980 CAD 9SOM41&3 800.368-n?s A ZO D00337360 916-371.S747 CAD 044OD3SS6
<br /> Commercial fil Recycling r Industrial Oil O Altamont landfill = Bang o Oil LLC
<br /> 2 33210 Western Ave.,Union City,CA 94587 1291 Laverne Ave..Klamath Falk,OR 97103 6 10940 Allarnoril Pass Rd..Livermore.CA 94S50 8 r2211 Sortgo Rd..Fallon,1 89406
<br /> $10-457.9227 $41 Ill ORD 960980775 925-455-7300 CAD 981382732 775-867.5082 NVR DOl
<br /> Print Name Generatol Signature
<br /> Drivel tSigna4ure
<br /> State Low Requires that you keep this Receipt/Bill of Ladino on file no less than 3 vock.
<br /> Z T T/9 V 0 In ONIT SOAS ANE,11 Mflffli[Jad 66VMVL0LT YV,11 OT:VT TT07;/ZZ/90
<br />
|