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FREMOUW EWIRONMENTAL S: ZVICES, INC. <br /> lwn4l Pa mint tu: Phone: 8DO-559-3274 EPA ID#CAR000 171017 <br /> P.O. Box 2874 Phone: 707-448-3700 U.S.D.O.T. # 1484667 INVOICE # <br /> Fatal ille,Ca 9696-2875 Fax: 707-448-3499 D.T.S.C.#3544 Date <br /> www.hazwasteremoval.com CA#274461 <br /> BILLING/MAILING ADDRESS <br /> Customer Customer <br /> 1 <br /> Address Address <br /> City St to 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 90 180 365 T T Y N H S WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Non-RCRA Hazardous Waste Liquid (Used Oi') CA 221 <br /> Non-RCRA Hazardous Waste Liqui (Used Anti-Freeze) CA 134 <br /> Non-RCRA Hazardous Waste Liquid (Oily Water) CA 223 <br /> N. -R--RA `czcrdo:;s`A'aste Sc]d IC'i or*=incted Deb6s,Scii; CA 223 <br /> Non-RCRA Hazardous Waste Liquid (Latex Paint) CA 291 <br /> Drained used oil /Gasoline / Diesel / Filters N-A <br /> Combustible Liquid, N.O.S., NA 1993 (used oil) III CA 221 <br /> Waste Paint Related Materia s, 3 UN 1263, PG 331 0001 <br /> Waste Flammoble!iouid,N.O.S.,3,UN 993,°G H !Gasoline-Diesel) 331 Dote <br /> Waste Aerosols, N.O.S. 2.1, UN 1950 PG 331 <br /> 77 <br /> 0001 <br /> Empty Drums Provide O Remove 0 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tett Q4000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge ❑ 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 ` <br /> Accept P. O. # TOTAL CHARGES: <br /> .v.� <br /> GENERAT IM CERTIFICATION: t hereby declare-hct ire co,ten!s o,r-is consi.nmew ore fuiy or,cr accurotey described above by proper shipping name and are classified,packed,marked,and <br /> labeled.ono are in al:eespects m proper condition fdr•ronsoort by hiyhvrov according to applicable stole and notional government regulations. If I am a large quantity generator,I certify Ihal I <br /> have o program in place to reduce the volume and iitoxicity c'waste generated to the degree I hove determined to be economicalty practicable and that I hove selected the practicable method <br /> of treotmenl,storage,or disposal currently available to me v,hich minimized the present and future threat io human health and the environment;OR,it I am a small quantity generator,I have made <br /> a good faith effort to minimize my waste generolion Ipnd select the best waste moncgemenl method that is available to me and that I can afford. All used oil from the generator listed above <br /> will be transported only to a facility permitted by the,State of California!o 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 mown or suspected ho2ords associated with this wosle has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> Feas incurred in the collection of to is oblialio n. Ven a for purposes of This obligation shall be in Solono town! . I declare under penalty of pet wry that the forgoing is true and correct. <br /> DISF OSAL/RECYCLING FACILITY: C0116ctron Station I Industrial I AgricultureGovernment Marina Other Industrlat Lubrlcoting <br /> I Oil Oil <br /> Q Evergreen Oil,Inc. = General Emrlionmenlal Management,Inc. Q Veolia ES/FRO Ramos vlr Rd <br /> 1 bfSBO Smith Ave.,Newark.CA 94560 3 11855 While Rock Rd.,Rancho Cordova.CA 95142 5 5738 West lefleison.Phoenlz.A2 85043 7 1515 S.RiverEnvironmental <br /> Rd,,W.W.Sacramento,CA 95691 <br /> 510-795.4400 CAD 980887418 916.351.0980 CAD 980884183 800.388.9095 AZ0000337360 916.371.5747 CAD 044003556 <br /> Q Commercial Filter Recycling Industrial Oil = Altamont Landfill Q Bongo Oil LLC <br /> 2 33210 Western Ave.,Union City.CA 94587 q 1291 Laverne Ave.,IUamath Falls,OR 97603 6 10840 AUanonl Pass Rd,Livermore.CA 94550 9 22211 Longo Rd..Fallon,NV 89406 <br /> $10-487-9227 541-884-9124 _ ORD_9809D0775- 925455-7300 CAD 981382732 775-867-5082 NVR 000080655 <br /> r{ — <br /> ;:'t'IpM hTame Generator's 5 ature Diivers SigIriatbre <br /> Stag law Requires that you keep this Receipt/Bill of Ladino on file no less than 3 years.x <br /> ZTT/96012 DNI SOAS ANH MIIOIVHH1l 666£RbtLOLT XVd OT:VT TTOZ/ZZ/80 <br />