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FREM•OU F TVIRONMENTAL F#RVICES, INC. <br /> Send Pad hent to: Phone: 00-559-ji 14 EPA ID#C.ai"171017 <br /> P.O.Bos 2875 Phone: 07148-3700 U.S.D.O.T.#"1484667 INVOICE # �� 0 J 9 <br /> Vacaville,Ca 95696-2875 Fax: 07-448-3499 D.T.S,C.#3544 <br /> www.hazw&su=oval.com CA#274461 Date `` i'' <br /> SITE ADDRESS BILLING/MAILING ADDRESS T•- <br /> Customer Sr of riot f � 3re Customer t51'a"nnoln i 1j1,18 <br /> •4�S1"h1,.(;1. i1..t.A ii�'e' <br /> Iiv l0�1, C3 ';11111 �To 0.')r,, '-A 95201 <br /> E.P.A. # -rAL :C-v i2 ;;36 Phone <br /> Additional Contacts: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 • 21 . 30 • 45 • 60 • 90 • 180 • 365 W/C WASTE CODE MANIFEST NUMBER QUANTIFY UNITS PRICE AMOUNT <br /> EX <br /> •:�. - _ _. "`_ �: •+�• :J., _'_�. 1.c::'; ., �. � __. '+� ��.�ti c"•'' �=hU T-a:r C^iji �.i1C"L 3 L i--'C� <br /> �tC -_=:1 <�n3C'.t: Y''f?- +� 1C'I"Cn. - !3Mr-.ateI DeiJis: 011 t::a Lli <br /> • ! _:, .. '�'..,.,. _ .�. .1 _fin.: �..1��r� t�•f;.�+.' <br /> Z. <br /> Empty Drums Provide 0 Remove 1 A 1 1 A2 5g ❑ 109❑ 159 O 309 ❑ 55g❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test L3 ass❑ Fail O Generator Knowledge•-1°J"-PPM <br /> Transportation Charges/Additionalruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: 'Y N Labels OilA/F UOF. <br /> _ - <br /> :'r; �� Oily Debris � <br /> SERVICES REQUESTED BY TAX 3.10 <br /> We <br /> Acce t P.O.# TOTAL CHARGES: <br /> GENERATOR'S CEIttIflGAT10N: <br /> 'Hereby declare'�at to contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and <br /> labeled.and are in all respects in proper condition:o• anspon a �i hwo accordingto applicable state and national government regulations. If I am o large quantity y' g y Bo 9 g v generator,I certify that I <br /> have o program rn place to reduce the volume and to'ciN of wase generated fo the degree I have determined to be econom ca ly practicable and that I have selected the practicable method <br /> of treatment,storage,or disposal curren'y available to me wnich minimized the present and future threat to human health and the envuonment:OR,if I am d?nall quantify generator,I have mode <br /> a good faith effort to minimize my waste generation o select the best waste management method that a available to me and that I can afford. AR used'ol from the generator fisted above <br /> will be tronsponed only to a facfRty permitted by the State of California to produce used oa into recycled oll OR a bre to filet h required to comply with federal regulations applicable to the <br /> management of used oY. Au relevant Information lege ding known or suspected hazards associated with the waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incuned in the collection of th s alar anon. Venue for purposes thisobitnotion shall be In Solana county. I deciore under penaltyof e'u that the for oin is true and correct. <br /> DISPO L/RECYCLWG FACILITY: Coll rion Station Industrial Agriculture Goye;rnment Martnd Oth�ir industrial Lubricating <br /> ( <br /> (V Ira.Ira.-rJa'r_ '•y r O oil <br /> d� �•i�� -,_ i:..":.ih:n F.,y('r.t,:�t4r;y.l t;^„ 1 6iry <br /> cs5 :r ; . _ -«;x,?rren.Koatt i0t i,.r.'.•r inner aeai j ' tkwlen - <br /> ;_r' .'..i{1 ;.!.� >{};'•. _ .r..' =:f.-`, t j i rpY� 11r Swi-'il)B <br /> 7?�-57 i' 1M11 ted+ <br /> nerators Signature 4 <br /> i4k Drivers ture <br /> f l hav lea .an av fh u o ' to Ind the above listed menerator to the terms on e reverse side of this form. <br /> 990/LTO[P► 011I SDAS AXH iW110XHH3 66VE3VVLOLT Y"VH LT :9T TT0Z/ZZ/80 <br />