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FREMOU EYMONMENIAL VKV1( MN9 11rL;. <br /> Send Pa.mcnt to: Phone: 00-559- _ EPA ID#CAROOO171017 <br /> P.U.Bo.x 25-5 Phone: 07-148-3'00 U.S.D.O.T.#1484667 INVOICE # <br /> \•aca.ille. Ca 95696-28'4 Fax: 07-448-3499 D.T.S.C.#3544 <br /> ii -N,. CA#274461 Date �4 • +' = 4 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer '"�``i Customer <br /> E.P.A. # <br /> Phone <br /> Additional Contacts: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> • '= 2' 30 45 60 90 180 365 W;C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> i <br /> r. <br /> 1 <br /> Empty IDrurrs Provide = Remove — 'A, 1A2 5g U l Og U 15g U 30g U 55g U S P F <br /> Clot-D-Teat Q40CC-es` Ci:: Test U PassZ) Fal! U Generator Knowledge PPM <br /> Transportation.;Charges/Additier.al Truck Time/Additional Labor/LAB'Packing/Site Cleaning <br /> Clean: y N Labels- Oil A/F UOF ti Oily Debris <br /> SERVICES REQUESTED BY i TAX $ <br /> We <br /> Accept Yet• ® P. O. # TOTAL CHARGES: �j +r � <br /> GENERATOR'S CERTIFICATION: _s :_ _ _ :_ e -_ - ^.e are c_; cnd accurately described above by proper shipping name and are classified,packed.marked,and <br /> ocp•'cable state and noSonol government regulations. If I am a large quantity generator,I certify that I <br /> t-e zec-ee:-ave oetermined to be economically practicable and that I have selected the practicable methoc <br /> -- ce a ^r-n-',%;re threa?to human health and the environment;OR.if I am a small quantity generator.I have made <br /> -- - _ - - _ . ..__ _._._ =-c =es'+.ore r-a-o::e-en'me!hod tho;Is available to me and that I can afford. All used oil from the generator listed above <br /> to "c'sac =-: c -_ _ __ Cc ^r-,o^c a atuce Asad oil Entc recycled o9 OR a facility that Is required to comply with Federal regulations applicable to the <br /> narage-e"C:-±-= trc5---spec led hazards associated with thts waste has been disclosed. The customer agrees to pay reasonable costs and attome <br /> fees'-CL-ed in:,-e clec!`cn c`-^'s'x%^c"c-.yve-='c•o_reos_s c'!hi,obit ction shat be in Solana county. I edare under penalty of t trdsihe foraoing Is true and correct, y <br /> DISPOSAL/RECYCLING FACILITY; Collection Station Industrial Agriculture Govemmenttita�ine, Other Industrial I Lubricatlno <br /> Oil I on <br /> -arrwry EW. <br /> 'u:� --- ._ _. ... �: ... �.. i:'•.:d:';'r�a" � :r'�:}t�%3i X15 D?,::E4 <br /> tVt me Generators Signatmes signature <br /> 3tai Law Requires that you keep this Receipt/Bl8 of leer tip on Me no less than years <br /> .s <br /> ODII SOAS ANH A110WH'dA 66VC9VVL0LT XVd £T:9T TTOZ/ZZ/80 <br />