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FREMOUW F' TVIRONMENTAL k*RVIC ES, INC;. <br /> Send Payment to: Phone: 800-559-j.,f4 EPA ID#CAR000 171017 <br /> P.O.Box 2875 Phone: 707-448-3700 U.S.D.O.T.# 1484667 INVOICE # 2 0 5 0 6 <br /> "acacille,Ca 95696-2875 Faz: 707-448-3499 D.T.S.C.#3544 Date <br /> www.hazwasteremoval.com CA#274461 <br /> SITE ADDRESS [� BILLING/MAILING ADDRESS <br /> Customer r'�i4�1��� t Customer sr:-z-,- ',rl <br /> ti•r:a r`'.I.]; ,1} • `I C} t.:.i.f i 3�1� 'u LI <br /> �.:;.;�>^;1' .•�'i:; `.•., ,,.r'` i. � '✓ ins.•. In, 1,;,�"'i :�iJ•_v' <br /> E.P.A. # �.� •` tt rte. i• ;,. V Phone <br /> Additional Contacts: <br /> i - <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 . 14 . 21 30 • 45 • 60 • 90 • 180 • 365 W/C WASTE MANIFEST NUMBER QUAN71TY UNITS PRICE AMOUNT <br /> CODE <br /> - - - . , <br /> _. .� .-9 'f1.:..o <br /> .�:�. t,. �'j,-4J .:w�.; a..� - �'11�- �_:�:ic•�C-;.'i�$��. J-' 0 U <br /> Empty Drums Provide Remove 1 A 1 1 A2 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect 64000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y`.' N Labels _ Oil A/F UOF =' — Oily Debris <br /> SERVICES REQUESTED BY SAX 9.uQ <br /> We � - <br /> Ac.. t P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: he eey aecicre"a'-he ca^.`e^'s a'+^is ca>bn^re^t cre fui'ly a^.d accurately described above by proper shipping name and are classified,pocked,marked,and <br /> labeled,anc are in a�,-escec7s:r,proper co^di=d 'Cr I•cnsea^ay rrgh-cv cccorainy to cpoliccble state and ncticnal government regulations. If I am a'�orge quantity generator.I certify that I <br /> have a program in place:o reauce;he vo�ume c^a�ox:d-of-,os-,e generared to rhe degree i nave determined to be economically practicable and that I have selected the practicable method <br /> of treatment,storage,a disposal cvnen-ty ovaticble to me whim minimized the present and future threat to human health and the environment;OR.if I am a small quantify generator.I have made <br /> a good faith effort to minimae my waste generation and select the best waste management melhod that is available to me and that I can afford. All used oil from the generator listed above <br /> will be transported only to o facility permitted by the Slate of California to produce used oil into recycled oil OR a facility that Is requirea to comply with Federal regulations applicable to the <br /> management of used oil. All relevant information regarding known or susDecled hazards associated with'his waste has been dsclased. The customer agrees to pay reasonable costs and attorney <br /> fees incurred in the collection of this obligation. Venuel for purposes of This obligation s r-OMe Salano county, I declare under penalty of pedury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station'Indust'- I Agriculture Government Marine Other Industrial Lubricating <br /> II Oil <br /> ^ .� <br /> ::q i911?isiCerai.:ti-Ml <br /> n 2! <br /> '• ::= ,^., - _ t, - r ._�C .-''•t:,q .%�s r r o Sky t�'J <br /> ,tin a -'-GenqWs Signature Drivers Signature e the out I to bind the obove.listed erator to the term on the reverse side of thi f rm. <br /> 990/STO[P1 ZINI SOAS ANH Af10NHHA 66VCSVVLOLT YVd LT:9T TTOZ/ZZ/80 <br />