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FR.EMOU E"VIRONMEN rIAL 4RVICES9 ifliiii <br /> Send P2vinent to: Phone: 559-3,4 EPA DD#CAR000171017 �� /1 <br /> 4 <br /> P.O.Bos 2875 Phone: 7-448-3700 U.S.D.O.T.# 1484667 INVOI E # <br /> Vacaville,Ca 95696-2875 Fax: 7-448-3499 D.T.S.C.#3544 Date <br /> www-bazwastmmoval.com CA#274461 <br /> SITEADDRESSBILLING/MAILING ADDRESS <br /> Customer r ,.,. - Customer <br /> ii�%'r!ocI i t. �' t. T.1' ,, �1 <br /> moi. y,�r.�' 1 <br /> r <br /> E.P.A. # r r I: .:.,�: :�:rj Phone <br /> � . <br /> Additional Contacts: <br /> r <br /> PRODUCT ItERVICE 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 /> Z.- - - 55.00 <br /> `.. `• 7 �"-� '/ y / / `^i �r.J roc';::, <br /> Empty Drums Provide Remove 1 Al 1 A2 59 ❑ 10g ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect G4000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional ruck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> } <br /> Cleana Y N Labels t=� Oil 4s r�-:� �•. 'A/F ,' UOF=,:F �;x. Oily Debris <br /> SERVICES REQUESTED BY TAX 0.0o <br /> We <br /> Acce t W P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: I hereby declare that t contents of this consignment are fully and occu,ately described above by proper shipping name and are classified,packed,marked,and <br /> labeled.and are in all respects in proper condition 1 transport by highway according to applicable state and notionol government regulations. If I am a large quantity generator,I certify that I <br /> have a program in place to reduce the volume and t xicity of waste generated 10 the degree I have determined to be economically practicable and that I have selected the practicable methoc <br /> of treatment,storage,or disposal cvrrenily available to me which minimized the present and future threat to human health and the environment:OR,if I am a small quantity generator,I have mode <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 listed above <br /> will be transported only to a facility permitted by the State of California to produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the <br /> management of used oil. All relevant information regarding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> feigs incurred in the collection of this obli ation. Venue for purposes of this obligation shall be in Solana covnty. I declare under penalty of pejury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government L Marine I Other Industrial I Lubricating <br /> Oil I Q9 <br /> 1 'F fi7&^:� 1�...�n".:.^.cpEr':di'^ I:rtQKj �4•S^.:L^2:da 'i <br /> ? ,t>>w1an^�br.,cW; <br /> _ .,:.:Y ..C..:4. '.`,. :•t.- :is_ :Ji;' 7 ,.•_7te ihr',.`.�'rv'�'a�t.'�••: <br /> Geneirdtol's Signature Drivers Slynature <br /> ave fha authori to bind the.above li ted enerotor to the terms on B reverse side f this form. <br /> 990/£T01A ON1 SOAS i NH 61f10I HNA 66V£RVVLOLT XHd 9T:9T TTOZ/ZZ/RO <br />