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FREMOU E - ' V1R0NMEN'1ALSfRV1UhS, nU. <br /> Send Pavirnent to: Phone: 8 559-3.L 14 EPA ED#CAROOO 171017 <br /> P.O. Boz 2875 Phone:: 7 7-448-3700 U.S.D.O.T.# 1484667 INVOICE # 2 J 2- 6- 4 <br /> Vacaville,Ca 95696-2875 Fax: 7 7448-3499 D.T.S.C.#3544 Jy <br /> www.hazwaAcremoval.com CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Drannion J ire Customer LSTa1-1rj0'n-- 1 ire <br /> E.P.A. # Phone <br /> Additional Contacts: <br /> PRODUCT - $ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 9 60 • 90 • 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Z <br /> c . <br /> Empty Drums Provide C::) Remove I Al I A2 5g 0 1 Og U 15g 0 30g Q 55g Q S P F <br /> Clor-D-Tect Q4000 Test Kit.- Test U Pass C] Fail 0 Generator Knowledge LJ PPM <br /> Transportation Charges/Additional Truck rime/Additional Labor/LAB Pocking/Site Cleaning <br /> —7— <br /> Clean: �'Y NI A/F Oily Debyis Labels -------'7o 7U 077 <br /> SERVICES REQUESTED BY I TA <br /> We P. O.# TOTAL CHARGES: <br /> AcceDt is= I <br /> GENERATOR'S CERTIFICATION: 'ne,ebydec!are'hw the ccntienis of this consignment ore furry and accurately described above by proper shipping name and are classified packed,marked,and <br /> labeled,and ore in all respects in proper condition forlronsoorl by highway according to applicable state and national government reguictions. if I am a large quantity generator,I certify that I <br /> have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method <br /> of treatment,storage,or disposal currently available to me which minimized the present and future threat to human health and the environment:OR.if I am a small quonfity generator,I have made <br /> a good faith effort to minimize my waste generation and select the best waste mcnogement method that is available to me and that I can afford. All used oil from the generator listed above <br /> will be transported only to 0 facility permitted by the State of California to produce used oil into recycled oil OR afacility that is required to comply with Federal regulations applicable to the <br /> management of used oil. All relevant information regarding known or suspected hazards a ted-ft tb <br /> this waste has been disclosed. The customer agrees to pay reasonole costs and attar ey <br /> fees incurred in the collection of this obligation. Venue for purposes of this obligation shall t lao county. I declare under penalty,of pedury that the forgoing is true and correct. <br /> DI =0rt <br /> AL/RECYCLING FACILITY: Collection Station (4n 1-1 Government Marine Other.] Industrial LubrlacrtiV <br /> —­.- _ :tr.121 .1 Agriculture QII Ol <br /> Fa:r�k-y,NV S-WR <br /> J <br /> 0-arn Generator's Signature <br /> Generators <br /> I s Signature <br /> ;10aft-read ova�the c thorijy to bind the above listed generat r to the terms <br /> verse side of this form, <br /> 990/TTO[Pl ON1 SDAS ANH MONHHA 66VESVVLOLT YVA ST :9T TTOZ/ZZ/90 <br />