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FREMOU ilmF T1RONMENTAL . <br /> - ­IIAVICES, IN U, <br /> ,%ySend Payment to: Phone: 00- EPA M#CAROOO 171017 9 -1 <br /> P.O. Box 2875 Phone: 7-448-3700 U.S-D.O.T.#1484667 INVOICE # 6 4 1 <br /> VacavWe,Ca 95696-2875 Fax: 7-448-3499 D.T.S.C.#3544 <br /> wwwhazwaste=oval.com CA#274461 Date <br /> SITE ADDRESS BILLING/MAKING ADDRESS <br /> Customer Rrarlin "I i r_- Customer Dre <br /> StS955201 too-k.ton- 15201" 'ndloor') <br /> E.P.A. # Phone <br /> Additional Contacts: <br /> PRODUCT . SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 • 180 • 365 WAC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> 5. 0 <br /> -4 <br /> P"3;: Gasymv-)t6se;0 Li 1b <br /> Empty Drums Provide Remove 1�3 1 A I I A2 5g L3 I Og LJ 159 E3 30g U 55g U S P F <br /> Clor-D-Tect Q4000 Test Kit: Test C3 �ass 0 Fail U Generator Knowledge.-WIPPM V. <br /> Transportation Charges/Addition <br /> _777 7 al Iruck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: N Labels Oil A/F 2;,- UOF�= ; <br /> Oily Delorli 'Or. <br /> SERVICES REQUESTED BY <br /> We <br /> P. 0.# TOTAL CHARGES- <br /> GENERATOR'S CERTIFICATION: I hereby declare ithot th contents of this consignment ore fully and accu fely described ob=by proper shipping name and are classified,packed,marked.and <br /> labeled,and are in al'respects in proper con 0 or onsport by highway according 10 appricabie state,and notional government regulations. if I am a large quantity generator,I certify that 1 <br /> is e customer agrees to p <br /> _io" flaction shall be In <br /> have a program in oiace to reduce the volume 0 and <br /> c . it*y of waste generated to the degree I hove determined to be economically practicable and that I have selected the practicable method <br /> of treatment.storage,or disposo(curreritty,available tc me which minimized the present and future threat to qurron health and the environment:OR.if I am a small quantity generator,I hove made <br /> a good with effort to minimize my waste generation a cl select the best waste management method that is available to me and that I con afford. All used oil from the generator listed above <br /> will be transported only to a facility permitted by the 5 ate 0 a ormu to produce used oil Into recycled 00 OR a facililty that is required to comply with Federal regulations applicable to the 1. <br /> management of used oilAll l information reg ding or suspected hazards associated with this waste has been disclosed. The cu ay reasonable costs and otl6mey <br /> !ees,ncu,ed,,,the collection of this obligation. Venuefor pt of this ob true and correct <br /> Solana county. I declare under nal of periury that the femoing is <br /> LubrIcating <br /> CAectian Staticin rine/I �OtherI Industrial I <br /> DISPOSAL/RECYCLING FACILITY: ticin industrial I Agriculture GoyWr1j;�ent Ma <br /> I '"f Oil <br /> -YEM <br /> �-W;i sl-'y r; 21sl 3enliil <br /> Aw 1;0 F:1%(-1 RM: wvl h *11 M KraAW49 Dr�'EW <br /> Da;o 3� g5ra!16b. Read <br /> CAD 3�2 <br /> 10 e-;35 40)0 CAI:' <br /> Z <br /> jm­ <br /> Generators Signature <br /> 26edAnarture <br /> I the authority to bind the abgve listed genGrallor to the berms_Qn the reverse side of this form. <br /> 990/ozolpi DNI SDAS ANH A00NHHA 66VV86VLOLT YVA 8T :9T TTOZ/ZZ/RO <br />