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FREMOU �" V1KV1V1Vl�lr lAL ► -';KVlI.;��, llrl.,. <br /> Send Payment to: Phone: 559-,-/4 EPA ID#CAR00017101*7 .I �, ,1 <br /> P.O.Boz 2875 Phone: . 7-448-3700 U.S.D.O.T.#1484667 INVOICE # �. Fi' <br /> Vaca-.-We,Ca 95696-2875 Fax: 7 7-448-3499 D.T.S.C.#3544 "' ? <br /> wwwbazwasteremoval.com CA#274461 Date <br /> SRE ADDRESS BILLING/MAILING ADQRESS <br /> Customer Brannon i ii'a Customer Brannon I la s <br /> r.. c <br /> .�tr�:�t`;}r i .i'r: .+i�,•:j, �sl.�.,��1\it'i ii �..�.�> J4.� <br /> r r•.♦ <br /> ,ter._ OI lr; yE; ., <br /> E.P.A. # ``' Phone <br /> Additional Contacts: <br /> PRODUCT - iERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 • 60 • 90 • 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Empty Drums Provide Remove LJ IAl 1A2 5g O 1 O ❑ 15g 0 30g G 55g O S P F <br /> Clor-D-Tect Q4000 Test Kit: Test ❑ Pass❑ Fail D Generator KnovAedge,fd`"PPM -a <br /> Transportation Charges/Additional Iruck Time/Additional Labor/LAB Pacidng/Site Cleaning <br /> Clean: 7.` N Labels Oil = A/F =r' UOF , Oily Debris <br /> SERVICES REQUESTED BY %-, �:. ,f I TAX <br /> A ce t .iiltri � " = I P. O.# TOTAL CHARGES: ri ,tlL� <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classKed.packed,marked,and <br /> labeled,and are in all respects in proper condition for ransport by highway according to applicable state and national government regulations. In am a large quantity gene'ator,I certify that I <br /> have a program in place to reduce the volume and t :city of waste generated to the degree I have determined to be economically practicable and that)have selected the practicable method <br /> of treatment.storage,or disposal currently available I me which minimized 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 and select the best vydste management method that is available to me and that I can afford. All used oil from the generator listed above <br /> will be transported only to a facility permitted by the Sate of Calfomio tb produce used oil into recycled of OR a facility that is requ'red to comply with Federal regulations applicable to the <br /> managemen'6f used oil. Al relevant information reg.ding known or' pected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurr din the collection of this obli otion. Venu for u os of this ob aion shall be in Solana coup . I cedare under enal of •u that the for oin is true and correct, <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Indusfrlal Agriculture Govemment Mariner Industrial Lub icoting <br /> st5ot R+ ;1. r, ". _..e::ravr,•.c,. t <br /> j 4131 uwwry <br /> Sort.9:C :iy: ,�i'xt:,+ , •1.^!1 ti' .t13'F rnl F.-grj ! e 7f•,f NBrlf6f d3[1r.,Fd`fi <br /> ,s ,:'.c' a> -..,` _ •..r .. ,.. %:nC33,: SrtS is r. `•t 5 'r <br /> W;40. fit'' it4i. �yy�l(�)-1� <br /> T)�. ^ry ^. ) . Yi-. .l- •'` ` �m �.'4L r t' :r.•1."` _}•,L iVlD•ZTA0.X+q <br /> �. civ '.'•:C �.'lti �- �,:v. 'S la'L` 'f.i i_1_� ''^S '' J 0 27F,' <br /> erators Signature <br /> Driver's Slggn Lure <br /> Lbtr certify that 1 have read and have the authority to bind the above listed generator to the terms on ia, reverse side of this form, <br /> 990/6TO P1 OMI SDAS AIT AAfIONHHA 66VY SVVLOGT YVVA ST :9T TTOZ/ZZ/80 <br />