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FREMOUW EOVIRONMENTAL SORVICES, INC. <br /> 'wnsl Pay nicni Eo: Phone. 00-559-3274 EPA ID 4 CAR000 171017 INVOICE <br /> P.O. Box 2871 Phone: 07-448-3700 U.S,D.O.T.# 1484667 <br /> Vacaville, Ca 95696-2875 Fax: 07-448-3499 D.T.S.C.# 3544 Date <br /> www.hazwasterernoval.corn CA P 274461 <br /> BILLINGIMAItING 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 /> 60 90 180 365 T I Y N H S WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> 30 CODE <br /> Non-RCRA Hozardolis Waste Liqui (Used Oil) CA 221 <br /> Non-RCRA Hazardous Woste Liqui (Used Anti-Freeze) CA 134 <br /> Non-RCRA Hazardous Waste Liqui� (Oily Water) CA 223 <br /> No--RCRA -azcacs'Noste �or­ar7-aTed Deb.1s, $o i) CA 223 <br /> Non-RCRA Hazardous Waste Liqui (Latex Point) CA 291 <br /> Drained used oil /Gasoline / Dies I / Filters N-A� <br /> Combustible Liquid. N.O.S., NA 193 (used oil) 1U CA 221 <br /> -' <br /> Waste Point Related Moterick, 3 LIN 1263, PG 331­-D001 <br /> Waste aam7-ct!e :liauid. N.0.5 ,3,UN � 331�'?93, OG II (Gas ol;,)e-Diesel) <br /> 0, <br /> 18 <br /> Waste Aerosols, N-O.S. 2-1, UN 19 PG .331 <br /> 0001 <br /> Uy EMhffffb 401 W.Cl"Iffillil Buli CA 9510 M00030164 (510)541-2128 <br /> Empty Drums Provide D Re ove D 5g L] I Og C] 15g U 30g El 55g Ll S P F <br /> Clor-D-Tect Q4000 Test Kit: Test D Pass :1 Foil C3 Generator Knowledge Q PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Additional Equipment Supplies <br /> Hazardous Waste Labels <br /> Used.0il Disposal Fee <br /> Pyorgreen ErMronnww Swvjw*.04,N Rood 308 Davis,CA 95616 CAD%82446874 (510)7454400 TAX <br /> We VISA <br /> Accept P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: !hereby Oc !'ho;.1 innnen!ore'vy and cccurcie'y described above by proper s)-.ippinc name ono ore classified,packed,marked,and <br /> labeled,and ore in all respects if,groper cd�;d.';.' CWport by highway according to cpp;c able state and national government regulations. If I am a'urge quantly generator,I certify that I <br /> icity o' voste generated 10 the degree i hove determined!o be economically practicable and that I have selected the practicable method <br /> have a program n place!o reduce the volume and�: <br /> of treatment,storage,or disposal currently ovoilnhle which minimized the present and future threat lo human health and the environment;OR,if I am a small quantity generator,I have made <br /> a good foRh effort to minimize my waste generation and select the best waste management rnelnocl that is available to me and that I can afford. All used oil from the generotorlisled above <br /> will be transported only to a foctlily permitted by the State of California to proavce used oil into recycled oil OR a fccildy that is required 10 comply with Federal regulations applicable to the <br /> management of used oil. All relevant information regarding known ln(J <br /> o'suspecled hazards associated with this waste has been disclosed The cuslomer agrees to pay reasonable costs and attorney <br /> fees incurred in the collection of this obligation. Venue f ur ases..of lh�s obligoton shall be in So;oro co—1 . I declare under penalty a?pedury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Cafl ectton station Industrial Agriculture Govemirnent Marine Other I us!Oil Oirlal LubrIl I I I l <br /> Evergreen Oil,Inc. General Environmental Management,Inc. Veolio ES/[AD Ramos Environmental <br /> 6880 Smith Ave.,Newark,CA ?4560 3 1 I&SS White Rock Rd..Rancho Cordova,CA 95742 5736 West Jefferson,Phoenix,Al B5043 7 ISIS S.River Rd,W.S=amento,CA 9501 <br /> 510-795-4400 CAD 980887418 916-351.0980 CAD 980884183 600-368.90?5 AZU 000337360 916-371.5747 CAD 044003556 <br /> Commercial Filter Recycling Industrial CII Q Alto mani Londlill nBongo Oil tic <br /> 2 33210 Western Ave..Union City,CA 94587 4 1291 Laverne Ave.,Klamath Folli,01 97603 6 10640 Altamont Pass Rd.,livermote.CA 94560 8 22211 fango lt&'Follon,NV 89406 <br /> 510-487.9727. 541 994 9124 ORD 980980775 92S-455-7300 CAD 981382732 775-867-5082 NVR 000080655 <br /> Print Ndrne. Gen., ors SlgnatLae <br /> Drivers Signature <br /> State Law Requires that you keep this Receipl/Billf of Ladino on Ole no less than 3 vaort. <br /> 990/v00�1 UNI SSIAS ANH MAONHHA 66fESVVLOLT YVH VT :9T TT0Z/ZZ/80 <br />