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FREMOU E' ' VIRONNIENIAL VKV1k'h:5, Ink, <br /> Send Pavrnent to: Phone: 00-559-3-4 EPA M#CAROOO 171017 INVOICE # 2 910 <br /> OC <br /> P.O.Box 2875 Phone: 07-448-3700 U.S.D.O.T.# 1484667 <br /> Vacaville,Ca 95696-2875 Fax: 07-448-3499 D.T.S.C.#3544 CA#274461 <br /> www.hazwasteremoval.com Date <br /> BILLING/MAILING ADP <br /> SHE ADDRESS irQ <br /> F Irp 64 <br /> 4 p—ri, ', ffalir-10", �I— <br /> Customer I Ic Customer <br /> E.P.A. # Phone <br /> Additional Contacts. <br /> PRODUCT -ISERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 • 9� • 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Empty Drims Provide a Remove� IAI 1A2 5g C3 I Og Q 15g U 30g 0 55g 0 S P F <br /> Clor-D-Tect Q4000 Test Kit: TestL1 1PassU fall C3 Generator Knowledge LY PPM <br /> Transportation Charges/Additionsi Truck Time/Additional Labor/ LAB Pocking/Site Cleaning <br /> 1 <br /> Clean: Y N I Labels -'—I I Oil 'JA/F TU OF `oily Debris <br /> 7- <br /> SERVICES REQUESTED BY TAX 7-7s <br /> We <br /> AcceDt P. O. # TOTAL CHAR <br /> GENERATOR'S CERTIFICATION: 1 hereby declare that the contents at this consignment are fully Ord accurately descr4bed above by proper shipping name and are classified.pocked,marked,and <br /> labeled.and ore in oil respects in proper condition fqr transport ny highway ocrording to applicable state and national government regulations. If I am a large quantity generator.I certify that I <br /> have a program in place to reduce the volume and Itoxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practic6ble mathoc <br /> of treatment,storage,or disposal currently avoilable'to me which minimized the present and future threat to humon health and the environment:OR,if I am a small quantify generator,I have made <br /> 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 a[]from the generator listed above <br /> will be transported any to a facility permitted by the State of California to produce used oil into recycled oil OR a fccifily that is required to comply with Federal regulons applicable to the <br /> management of used oil. All relevant information regarding known of suspected hazards associated with this waste has beer disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees incurred in the collection of this ninfinnfinn v—11e for pujposes of this obligation shall be in Solana county. I declare under penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: 'Collection Statlon IndustrialAgriCulture �oyemnent. Marine I )ther <br /> Industrial ILubricatng <br /> I Oil Oil <br /> I -Vb"a;D(. '-n�: <br /> s <br /> Generator's Signature <br /> iave.recid n1,r,,d have the authoritv to bind the obove listed enerotor to the ter s o the reverse i e of this form. <br /> 990/m A ON11 SDAS ANH A30WHXL4 66V£RVVLOLT YVA 6T:9T TTOZ/ZZ/SO <br />