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FREMOUW EIVIRONMENTAL ARVICES, INC. <br /> Scnil P.i mcnt to: Phone559-3274 EPA ID#CAR000171017 <br /> P.O. Box 2875 Phone: 7-448-3700 U.S,D.O.T.# 1484667 INVOICE # <br /> Vacay ille,Ca 95696-287 Fax: 07-448-3499 D.T.S.C.# 3544 <br /> www.hazwasteremoval.com CA# 274461 Date - <br /> BILLING/MAILING 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 /> 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 Liqu' (Used Anti-Freeze) CA 134 <br /> Non-RCRA Hazardous Waste Liqui (Oily Water) CA 223 <br /> Non-RCRA 50:1C IOi! on'cmirhated Debris,Soil) CA 223 <br /> Non-RCRA Hazardous Waste Liqui (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 , 3 UN 1263, PG 331 <br /> 0001 <br /> Waste Flammob!e Liouid,N.O.S.,3,UN 993, PG II (Gaso!ine-Diesel) 331"'018 <br /> 331 <br /> Waste Aerosols, N.O.S. 2.1, UN 195q PG 6001 <br /> Empty Drums Provide = Rertove 0 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 /> 9( J Eveyreen Envirore fttai Servicer("Road 308 Davis,CA 95618 CAD982448874 (510)795.440" TAX <br /> WeVim � P. O.# TOTAL CHARGES: <br /> Acce 1 mm.m <br /> GENERATOR'S CERTIFICATION: thereby declare Teal the contents of This consignment are fully and accurately described above by proper shipping name and are classified,pocked,marked,and <br /> labeled,and ore in all respects in proper condition for transport by highway according 10 applicable sidle and notion¢'government regulations. to I am a large quantity generator,I certify that I <br /> have o program in place to reduce the volume and toxicity of woste aenercled to the degree I hove determined to be economically practicable and that I hove selected the practicable method <br /> of fres tment,storage,or disposal Currently ovoilable to me which minimized the present and future threat to human health and the environment:OR.if I am a small quanlity generator,I have made <br /> d <br /> a goofaith effort to minimae my waste generation and select the best waste management method that is available to me erd that I can oHord. All used oil from the generator listed above <br /> will be transported only to a facility permllea by the$rote of California to produce used oil into recycled all OR a facility[hot is required to comply with Federal regulations applicable to the <br /> management of used oil. All relevant information recording known or suspected hazards associated with Ks waste hos been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurred in the collection of this obi atfon. Venue for purposes al this obli otion shall be.in Solono county. I declare under penolty of perjury that the for in is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collectlon Station industrial Agriculture Government Marine Other Industrial Oil <br /> rial Lubricating <br /> - - I <br /> Q Evergreen Oil.Inc. C'�_ General Environmental Manogemenl.Inc. f-1 Veolia ES)ERD f-� Rr mm�c Environmental 6880 Smith Ave.,Newark.CA 94560 _3 11855 White Rock Rd.,Rancho Cordova,CA 95742 5 5736 West leltefson.Phoenix.AZ 85045 7 1515 S.River Rd,W.Sacramento,CA 95691 <br /> 510.795.4400 CAD 980887418 916.351-0980 CAD 980884183 800368.9095 AZO 000337360 916371.5747 CAD0440D3S56 <br /> Q Commercial Filter Recycling InduslrialOU O AltamonlLandfill Q Bongo Oil 11C <br /> 2 33210 Western Ave.,Union City,CA 94587 4 1291 Laverne Ave..Rlama[h Falls.OR 97603 6 1064C Allanonl Pass Rd.,Livermore.CA 94550 8 22211 Bongo td.Fallon,NV 89406 <br /> 510-487.9227 $41-884-9124 ORD 980980775 925.455-7300 CAD 981382732 775-867-5082 NVR 000080655 <br /> Print Name Generators Signature Drivers Signature <br /> Slate Law Requires that you keep this Receipt/Bill or Ladino on file no less than 3 veers. <br /> 990/OT0[P1 OMI SOAS MIH M-nOKHHA 66V7 RVVLOLT XVd ST :9T TTOZ/ZZ/80 <br />