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FRIEMOU EI - 11RONMEN IAL SORVICES, INC, <br /> Send Payment to: Phone.: 8 -559-3214 EPA ID#CAROOO 171017 <br /> 8 . ' 8 <br /> P.O.Box 2875 Phone: 7 7-"8-3700 U.S.D.O.T.#1484667 INVOICEA 2 0 2 %9 <br /> Vacmille,C2 95696-2875 Fax: 7 7-448-3499 D.T.S.C.#3544 7% <br /> www.ha--wasteirernoval-com Date <br /> CA 274461 J <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer . Customer si-arinoin ± I r� <br /> Avpr I r- R <br /> 10 <br /> L 3 Phone <br /> E.P.A. # —_ .4 <br /> Additional Contacts: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 4S <br /> W/C <br /> 60 WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> * 90 • 180 365 CODE <br /> ,`?(J <br /> j LTJ <br /> % <br /> Empty Drums Provide Remove I Al I A2 5g 0 1 Og C3 15g Q 30g El 55g L3 S P F <br /> Clor-D-Tect Q4000 Test Kit: Test El Pass C3 Fail Q Generator Knowledge .2-, PPM ;i <br /> Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean:," Y Labels oil A/F UC)F <br /> Oily Dpbris <br /> SERVICES REQUESTED BY <br /> TAX <br /> we <br /> AcceDt P. O—e TOTAL CHARGES: V <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping home and are cicssified,.locicked,marked,and <br /> labeled,and are in all respects in proper condition for tic3nsperl by highway according to applicable state and rofionol government regulations. If I am 0 large quantity generator,1 certify that I <br /> have a progron,in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically p,octicable and tho'I hove selected tyle 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 Iam a small quantity generolor,I have made <br /> a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. All used oil from the generator fisted above <br /> will be transported only to a facility permitted by the State of Califomia to produce used oil into recycled oil OR a facility that is required to comply with secleral regulations applicable to the <br /> management of used Oil. Ali relevant information regarding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and cffomey. <br /> fees incurred in the collection of this obligation. Venue for 2uMcses of this obligation shall 6e in Solana county. I declare under penalty of perjury that the forooing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: .�1f�LTd7i <br /> ificin Industrial I Agriculture1.�=emnnient I Marine Other I Industrial 1-77""ething <br /> Oil Oil <br /> �)yvxh z7rv­MOM <br /> 4z s. <br /> oaf' 7 <br /> 27 r % , 6ol <br /> Femi�), NY' R54CF, <br /> 3 ,n 54; au Mt;M. �Z <br /> v <br /> V <br /> G;4AeF&0r`S Signature <br /> DrIver's Signature I <br /> 0.!AY;MON that I have -d-an •havethe c(uthority to bind the above listed aentrator to the terms on the re S <br /> oft form. <br /> 990/ZT07l SIXI SDAS ANZI MAOXHN,4 66VE8Vt'LOLT YVA 9T:9T TTOZ/ZZ/90 <br />