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FREMOUW E WIRONMENTAL S6.RVICES, 1AC, <br /> Send Pa%meat to: Phone: 800-559-3z r4 EPA ID#CAR000171017 ,.a p� <br /> P.O. Bos 2875 Phone: 701-448-3700 U.S.D.O.T.# 1484667 INVOICE # 2 0)4 8. <br /> Vacaville,Ca 95696-2875 Fax: 07-448-3499 D.T.S.C.#3544 ' <br /> w-w-w.hazwaAff=oval-com CA#274461 Date <br /> SITE ADDRESS r� BALING/MAILING ADRRESS <br /> Customerti F• Customer =,^ .,I,'1 , <br /> .. '.1" .t. i� r•` r .'� �'. r-,;L'� 14,.1`-.�i•.� <br /> E.P.A. # � i '� ' ''!r `k Phone <br /> Additional Contacts: <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 • 14 • 21 • 30 • 45 • 60 • 90 • 180 • 365 W/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> -00 <br /> - _ . . _:.... 15.00 <br /> - G:3 A31Sr <br /> Empty Drums Provide Remove lAl lA2 5g❑ 10g❑ 15g❑ 30g❑ 55g❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test 7 ass❑ Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional ck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels 011 A/F UOF -'` Oily Debris <br /> SERVICES REQUESTED BY - r 1fAX <br /> ec ✓ ' '�' i ' s.. <br /> we <br /> Acca t P. O.# TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: i hereby deciore that'h contents of tt;s consignment ore fully and occurctely described above by proper shipping name and are classified,packed.marked,and <br /> labeled.and are in all respects fr;Groper condit.or tar,ensoort a%,^ighway oacording to applicable Vote and national government regulations. If I am a large quantity generator.I certify that I <br /> have o program p{cCe o roc ce'^e va d-c to'city of'we=re generated'o the cegree'rave determined to be economically practicable and that I have selected the practicable method <br /> of treatment,storage,or cisposo:curren�y ova oa;e'o 'wn:ch rnirnmaed the present and future threat to human health and the environment:OR,if I am a small quantity generator,I have made <br /> a good faith effort to minimae my waste generation a.. select'he 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 St to of California to produce used oil Into recycled ad OR a facility that is required to comply with Federal regulations applicable to the <br /> management of used oil. All relevant information regal ing known or suspected hazarckossocioted with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> feez Incurred in the co <br /> of this obl oton. venue or ores of this obr alion shall be olono county. l declare under penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILrrY: Collection Station <lridustriQl Agriculture Government Marine Other Industrial Lubricating <br /> i ��. .,... e. .. .:, I; .;atr 11 Oil <br /> �t,1 (tfilts aa. .. ..�:. .. ..':. _ -- .• �, .. ,:;�r.�a:. `:r No- t?c Exit <br /> �..� V.�✓'T"a'\i'iG li,. �'{ ._�' ..'I Yn^= ., _ -3Vi11uy.i wlN <br /> r i'�,:a. ti�d ..r.i- '.i r' t�':`.�1;'=��' :i r. -��•5::..�5� j�, :1 - <br /> - <br /> / her mature . DrNer s si na ure <br /> t <br /> g <br /> `' i3Fi►1hdt 'hbtyerrrrnd and have the authori to bind the above listed generator to the terms on the reverse side of this form <br /> 990/VTOI$1 DNI SDAS ANH MAONHEA 66VERVVLOLT Y'd 9T :9T TTOZ/ZZ/RO <br />