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FREMOUW F NIRON 1V11:N1AL !#KVluh;5, Int'. Send Pa%went to: Phone: 800-559-, i4 EPA ID#CAR000171017 P.O. Box 2875 Phone: 707448-3700 U.S.D.O.T.# 1484667 INVOICE # 212 0 6 Vacaville.Ca 95696-2875 Fax: 707-448-3499 D.T,S.C.#3544 Date � ^^ www.haawasteremoval,com I C 274461 BILLING/MSITE ADDRESS t� '3r,i AILING ADD77-7rp Customer / Customer .UL1V '.Jl�,.�l.•It:�I IL i veli t:-,U, 1��.'.�l'F.L1r.)�� tl.:�•. li�,� *.�:i�fd�,��i \m'f`r '3520'. I =.t: E.P.A. # J VZ— Phone Additional Contacts: PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION 7 14 21 30 4$ 60 90 • 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT CODE I` Empty Drums Provide Remove 1 A 1 1 A2 5g ❑ 1 Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F Clor-D-Tect p4000 Test Kit: Test ❑ Pass ❑ Fail ❑ Generator Knowledge;,,@ PPM Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning Clean: Y-' N Labels / Oil A/F = UOF Oily De "f SERVICES REQUESTED BY ria. ,. _,. TAX We Acce t P. O.# TOTAL CHARGES: GENERATOR'S CERTIFICATION: I hereby declare that t e contents a,tnis consignnert are fully end occurctely described above by proper shipping name and are classified.packed.marked,and labeled.and are in all respects in proper condition fol transport by nighwoy according to applicable store and national government regulations. If I am o large quantity generator,I certify'hot I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable methoe of treatment,storage,or disposol currently available to me which minimized the present and future threat to human health and the environment:OR,if I am a small quantity generator,f have rri 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 fisted above will be fronsported'only to a facility permitted by the Pate of Corifornia to produce used oil into recycled oil OR a facility that is required to compVwith Federal regulations applicable to the management of"used oil. All relevant information regarding known or suspeat6d hazards associated with this waste has been disclosed. The cus orper agrees to pay reasonable costs and affomey fees incurred in the co.lecton of fh's obligation. Ven for purposes of this- blictolion shall be in Solana county. I declare under penalty of per'ury that the forgoian is true and correct. l5P S. REsC ql-! G FACILITY: ollection Station In u�tri Lure ve a e Ot e,, Industrial Lubricating QI. .,A011 u. 4?. : .� h C.Am011,F-Mi ou .ice ttsatsnb Gr.,cast ,., r.A� ..-":t_' - r .� Y>-..-.... .�._. .✓A�� iY."— .:Y."'>'�Jw:_Yrj I lr.i v i t _.. r I. }.Il.%./��...0 r..r Ji�r T,ritl JC.\i:U V.: f'f1t Narfile3 ! Generator's Signature I here ave read and have the authaefly to bind fhe above listed generator to the t r e reverse side of this form, 990/8T01A ONI SOAS ANH MONHNA 666E8VVLOLT XVd 8T:9T 1T0Z/9Z/80