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FREMOUW EO V IKU N MEIN JAL V 1uhnq int'. <br /> Send Pa%ment to: Phone: 8,00-559- EPA ID#CAR000171017 <br /> P.O. Box 28"5 Phone: -0"-448 "00 li.S.D.O:T,# 1484667 INVOICE # <br /> Vaca%ille. Ca 95696-287 Fax: 07-448-3499 D.T.S.C.#3544 <br /> "r <br /> ,xuu.haz-,Aasteremo,6al.com CA#274461 Date i <br /> SITE ADDRESS <br /> BILLING/MAILING ADDRESS•: <br /> _ -' <br /> Customer Customer '`" '`7 <br /> E.P.A. # Phone <br /> Additional Contacts: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 • 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> 1 <br /> Empty Drurr.s P,ovde = Remove 1 A ;A2 5g ❑ l Og ❑ 15g 0 30g ❑ 55g 0 S P F <br /> Clor-D-Tett Q40CC Tes' Kit: Test ❑ Pass Z) Fail O Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y NLabels Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX <br /> We P. O. # TOTAL CHARGES: <br /> Acte t <br /> GENERATOR'S CERTIFICATION: __. _..___ of:'e c_ _ _c..-s'lgn^ent are fully crd accurc-e!v described above by proper shipping name and are classified,packed,marked,and <br /> 'cbeiec.c _: :__�;: -__c a _c _ _�_-I"-c-"_ _. - d:nc to opo'iccb!e stote and national government regulations. If I am o Jorge quantity generator,I certify that I <br /> hCG e -� c�_-= _ .__ _ �E ee-e•a'ecy--o+:tee ceg,ee:nave de-err fired to be economically practicable and that I have selected the practicable methoc <br /> o''rec:-e sx'cc c". ac.c __'•o c oa- ".-.c-r-- -,_ec"e re,en:and t.•ure:fired rc Kumon health ontl the environment:OR,if I am a small quantity generator,I have made <br /> a gocc'c'•-e°'cr�n —�e—. .:cs� e-:erc-c^.�c se-9c-—e aes-;.cslA-c-�oce.err metnca the?is ovcilobie to me and that car afford. All used of from the generator listed above <br /> e•"cr•pa�ea c- r a -c o =_sec o no recycled oioft a tecility that is required to compN with Federal regulations applicable to the <br /> ma age^a-t o'.sec a e,=-- an- eg�.rr <.c r spe .e r`as _cssoa aced with`his waste has been disclosed. The customer agrees to pay reasonable costs and ottomey <br /> tees m„urred ir•ne cc l_...,,-D`11,coli^c.c ll be r Solano county. I declare under penalty of periury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Govemment Marine Other Industrial Lubricaiing <br /> Oil OfI <br /> t - - <br /> n7fltoes Nnotured <br /> State Law Requires hbt this Receipt/bil of Lading on file no less than years. <br /> 990/8001PI DNI SDAS ANN MIlOI HHA 66VERVVLOLT XVd 9T:9T TT0Z/ZZ/80 <br />