Laserfiche WebLink
F EMOUE.' • V1KO.NME1Nr1AL VKVIUEkN, INL;e <br /> Send Payment to: Phone: 00-559-3y r4 EPA ID#CAR000171017 <br /> P.O. Box 2875 Phone: 07-448-3700 U:S-D.O.T.#1484667 INVOICE #G 2 0 4 4 <br /> Vaca,ille,Ca 95696-2875 Fax: 07-448-3499 D.T.S.C.#3544 �. <br /> www.hazwasteremoval.com CA#274461 Date `�t`• C i <br /> SITE ADDRESS -^ 111lUNG/MAILING AD <br /> r?�ll'iL1Ci lid <� �I; <br /> Customer " Customer <br /> 4905 1 box 1.988 <br /> L ti.. jnr <br /> E.P.A. # Phone <br /> k'• <br /> Additional Contacts: <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 . 21 30 . 45 60 • 90 180 365 WIC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> }-tom.. <br /> ,�. .- -,ci' __'•_ I' - -.. .. � ..� ... .. _. =,..tet'. .. ,'r i.i)1�' <br /> + i" Z. _'ji ... .� Y�c ,t _.�.I U �..ity 'sy�i'�r vF 22` <br /> 'f 'I_ ..may-l�•Jh YY <br /> n <br /> :'`YaG:•: - r-;bl:de_.{. Cit •� . �.`{ `O•,' 'r1'if�'Oti"�:/!���.1"• .ri�.ij i <br /> Empty Drums Provide ED Remove I A I IA2 5g ❑ IOg O 15g❑ 30g O 55g O S P F <br /> Clor-D-Tect Q4000 Test Kit: Test O ass❑ Fail ❑ Generator Knowfedge,.•lJ- PPM - >; <br /> Transportation Charges/Additionalruck Time/Addiflonal Labor/LAB Packing/Site Cleaning <br /> Clean: :"'Y,-' N Labels Oil 1=_ Oily Debris y4, ;svt,L <br /> SERVICES REQUESTED BY <br /> we TAX <br /> • <br /> A ce t OF a P. O.# TOTAL CHARGES: b:D G N�IIC <br /> GENlRATOR'S CERtIRCATION: ^e,eb v dec o•e:^a• n Car!91-C of«tis torsion rent are fully and accurately described above by proper shipping name and are classified,packed,marked,and <br /> labeled.and are in alt resnecrs Sn trope,condi eon far•cnspon oy nignvrey according to opp5coble state and notional government regula lions. If I am a large quantity generator,I certify that I <br /> have a program in place to reduce the volume and to'city of wosre generated to the degree I hove determined to be economically practicable and thot I have selected the practicable method <br /> of treatment,storage,or disposal currertly available to 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 on select the best waste 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 St to of California to produce used ON Into recycled oil OR o focifity that is required to comply wlih Federal regulations applicable to the <br /> management of used oil. M relevant information rega ing known or'suspected hazards associated wtlh this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurredkrlhe collect on of this obli ation. Venue for u os -of this obligation shall be in Sola o coon I decbre under enol of u that the for oin is hue and correct. <br /> DIS P_ URECYCLING FACILITY: Coll�ctlon Station Ind�shieIr culture Government Martr�,- they Industrial Lubrlcating <br /> s 4L4ii f'38A "t/ ;h Cn:a:.r,a _r,.... ..: .. } II oil <br /> 1 Or^a 3591;; +rr:hanr�l�• r, ;nirab;,t��r <br /> _ n'W. t. i ,Eta' <br /> •�" '•,•r�,'w:F7;.'� 9e,:�:a ':i s%5'„i v ! � E t9,^��y fA ?31��' <br /> 3":4'75 . .. v_ ••:��.. _ •-r•` •>`• f _ <br /> u' , si 1✓' � r'_ f f' ,f <br /> 4.1 <br /> Ge eratof's i dv s S nature <br /> - hmre the put ori t bi d the bove listed ener for to the le fns ofYthe reverse side 9f this form. <br /> 990/TZ0[P1 ONI SOAS A_NH A00WHEA 666ESVVLOLI IVA 6T :9T TTOZ/ZZ/SO <br />