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FREMOUW E*VIRONMENTAL S*RVICES, INC. <br /> nll Pal inunt to: Phonc: 1800-559-3274 EPA ID#CAR000171017 <br /> P.O. Bos 2875 Phone: `07-448-3700 U.S.D.O.T. # 1484667 INVOICE # <br /> Vacaville Ca 95696-2875 Fax: 907-448-3499 D.TS.C.# 3544 <br /> ' D.T.S.C. Date - <br /> www.hazwasteremoval.com CA #274461 <br /> BILLING/MAILING ADDRESS <br /> Customer Customer <br /> Address Address <br /> City p St to Zip <br /> City State_ Zip <br /> E.P.A. # 1 F Ce ✓ 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 I H S WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Non-RCRA Hazardous Waste Liqui (Used Oil) CA 221 <br /> Non-RCRA Hazardous Waste Liqui (Used Anti-Freeze) CA 134 <br /> Non-RCRA Hazardous Waste Liqui (Oily Water) CA 223 <br /> tics-RC c4. Jac dous'1�'as`e Se id 1i onrc^-i-cied Debris,Soil) CA 223 <br /> Non-RCRA Hazardous Waste Liqui (Latex Paint) CA 291 <br /> Drained used oii /Gasoline / Dies I/ Filters N-A <br /> Combustible Liquid, N,O.S., NA 1943 (used oil) III CA 221 <br /> Waste Paint Related Materia , 3 UN 1263, PG 331 DOOI <br /> Waste Ficmr^.abie Liquid,N.O.S.,3,UV 993, PG H (Gasofne-Diesel) 331 018 <br /> Waste <br /> Waste Aerosols, N.O.S. 2.1, UN 195 PG 331 <br /> 0001 <br /> Empty Drums Provide D Re ve O 5g ❑ l Og ❑ 15g❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional ruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Additional Equipment Supplies <br /> Hazardous Waste Labels <br /> Used Oil Disposal Fee <br /> --a 1 1 Evaprsan EJ1MroslFr»FL1q p Road 308 D",CA 050/0 TAX <br /> AW <br /> Acca 1 tom : P. O. # TOTAL CHARGES: <br /> GEN ERATOR'S CERTIFICATION: :^archly Cec k:re'hal!.a Care,• of"-.'s consignment ere fully and cccure'ey described above by proper shipping name and are classified,packed,marked,and <br /> labeled,and are in all respects In grope•conal'ier fpr <br /> if <br /> b•;hic rn-:cy ccccrC--g is cpo!icab,e stele end ndianol government regulafiors. if I am a large quantity generator,I certify that I <br /> have a pregra.m in place!c reduce the vo!ume c^a 1 aici'v c'..vcsie genera ied to the degree I have determined to be ecaromicolty Practicable and that I have selected the practicable method <br /> of treatment,storage.or disposal currenly avcilable!Q me which minimized the present and future threat lo human health and the en—onmenF OR,if I om a small quantity generator,I hove made <br /> a good faith effort to minimae my waste genercticn c d selec!:he best wosie menccement rneihod Inc'is available to me and Ihot I can afford. All used oil from the generator listed above <br /> will be transported only to a Iccilify permilled b:tr.e 5!o'e cf Ce-ilom'a'e produce used aG into recrc;ed oil OR o facility that is required to comply with Federal regulations applicable to the <br /> manogement of used oil. All relevonl inrormalior reggrding kncv,n cr suspected hozords assocla+ed-th:cis vrpsle has been disclosed. The customer agrees to pay reasonable costs and ollorney <br /> fees incurred in the collection of this pbr alien. Venue for PurPoses of Ihis obli Ghon shall be in Solcno county. I declare under enpll of er'u !ho!the to pin is Irue and cortec 1. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial I Agriculture Government Marina Other nd ustrlal Lubricating <br /> I VII 011 <br /> Evergreen Oil,Inc. General Environmental Management,Inc. eolta ES/[RD <br /> 1 LJ nc. 0 Q Ramos Environmental <br /> 6880 Smith Ave.,Newark,CA 94560 8 11855 White Rock Rd.,Rancho Cordova.CA 95742 5 5736 Weil Jetlerson,Phoenix,At 85043 7 1515 5.River Rd,W.Sacramento.CA 95691 <br /> 510.79S.4400 CAD 980887418 916.351-0980 CAD 980884183 800.368.9095 AZO 00033 73 60 916.371-5747 CAD 04400.3556 <br /> Q Commercial Filter Recycling Industrial Oil O Altarnonl landfill 8ango Oil LLC <br /> 2 3321Ave.,Union City.CA 94587 4 1291 Laverne Ave..Klamath falls,OR 97603 6 10640 Ailanonl Fass Rd..Livermore,CA 94550 8 22211 Fango Rd..Fallon,NY 89406 <br /> 510-4E7.M47 7-9227 541.884-9124 ORD 180980775 925-455-7300 CAD 981382732 775-867-5082 NVR 000080655 <br /> i <br /> Pnnt Warne <br /> Generators Si®nature Drivers Signatu <br /> State Law Requires that You keen this Receiol/Bill of Ladino nn fit^nn I—16nn z v—, <br /> 990/LOO M OKI SOAS ANH MAMMA 66VE8YVL0LT YVA VT :9T TT0Z/ZZ/80 <br />