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FREMOU E• TVIRONMENTAL ' '1ZVILES, INC, <br /> Send Payment to: Phone: 00-559-sz/4 EPA ID#CAR000171017 <br /> P.O.Boz 2875 Phone: 07-448-3700 U.S.D.O.T.#1484667 INVOICE # 2-J <br /> Vaca-dHe,Ca 95696-2875 Fax: 07-448-3499 D.T.S.C.#3544 <br /> www.hazwasta=oval.com CA#274461 Date <br /> SITE ADDRESSBILLING/MAILING A T ' <br /> Customer IannGi' !f Customer nnor' IIIF <br /> box 1988 <br /> -t it �J ��:..i' 'Jrt ��-'r�• / 5��,1t!".;�,1, �,7 , '95201 <br /> • n r• <br /> r; i <br /> E.P.A. # � L '=�'', 6 Phone <br /> Additional Contacts: <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> WASTE <br /> 7 • 14 • 21 • 30 • 45 • 60 • 90 • 180 • 365 W/C CODE MANIFEST NUMBER QUANTRY UNITS PRICE AMOUNT <br /> .CGt /'. .~. .. a...lj �t'.1 �;,i / Y <br /> A!, -A 134 1.00^ <br /> r" cif <br /> 55.00 <br /> �'t:.' -'S`:gid.+ `.ZL'u vim::.': •tr;:5`:'' ..::;'sl I�ra;,� ;. :+f J',. ,•. ., <br /> ' r <br /> Empty Drums Provide D Remove M 1 A 1 1A2 5g ❑ IOg❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ ass U Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional T1ruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: `Y N Labels Y Oil A/F UOF '^ _��' Oily Debris <br /> SERVICES REQUESTED BY <br /> We <br /> Acce t P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: I hereby deUcre'l-cth rents of'nis consignment are fury enc occure.'ely described above by proper shipping name and are classified,packed,marked,and <br /> labeled,and are in all rescects;n prooer co:.clitior for.aneoar'oy h!ghwoy according to applicable state and national government regOotions. it I am a large quantity generator.I certify that 1 <br /> have a program in place to reauce me volume arc to'city of wast <br /> me generated to the degree I nave determined to be economically practicable and that I have selected the procticobie method <br /> of treatment,storage•or disposal curren•y ovailablto <br /> e .e w, ich minimized the oresent anc future threat to human Health and the environment;OR.if I am a small quantity generator.I have made <br /> a good foitti effort to minimae my waste generation al,. select the best wosie monagement method thol is available to me and thal I can afford. All used oil from the generator listed above <br /> will be transoorled only to a facility permitted by the St to of corifomia to produce used olt into recycled all OR a facility that is required to comply with Federal regulations applicable to the <br /> monagement of used o8 <br /> tees incurred in the collection o!this ob anon. venue or ses of this obit otton 5h2tMign SOlono coup I declare under enol ' <br /> of a u that the foraoing is true and correct.DISP SAL/RECYCLING FACILITY: Collection Station > dU51 I AgrlCUlture Government I Marine Other industrlal I Lubricating <br /> vStrj.. tiM'!vr;h�,yr:vnr7o:iL;,,:. <br /> Oil <br /> Oil <br /> 4M.vl H.:aJ.'� _:r^ ! :al, .till,:r xMMenai± <br /> 4 far.:'-• f%+G +r h.'t: .a:iear2aor G,:cxsoivtwm' ZJ5New�0., <br /> 5t4�.}�•. ._S.a .';, °'... _. - �rau,;n:>.!.;�'Efii�' f 0�N_:ra, :? �: �"u i' �trsays,i�N <br /> (r' �— � �-=•:t_ iT:4�!'�tr'-c; 7Thm,27`1J parr <br /> l, 7 ll(JCr off p r r�!`•y ._;.- f.� <br /> G neratoes Signature vers Signature <br /> 1-hereh a rti that l`have read an a the authori to incl the a ave list d ner t r tDili o the f rms on th reverse side oft is form. <br /> 990/9T0[Pi ONI SOAS ANH A0010Hd 66tESfVLOLT IVA LT :9T TTOZ/ZZ/SO <br />