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FREMOU E' TVIRONMEN IAL S6KV IULN9 IiN L;. Send Pa%ment to: Phone: 00-5;9-3x. 4 EPA ID#CAR000171017 INVOICE # P.O.Bos 28 Phone_ •0.-448 _"00 U.S.D.O.T.4 1484667 Vacaville.Ca 95696-287= Fax: 07-448-3499 D,T.S.C.#3644 Date i y. w��w•hazwasteremoval.com CA#274461 SITE ADDRESS BILLING/MAILING ADDRESS y Customer .:�l If,O; • er.. Customer E.P.A. # Phone Additional Contacts: PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION 7 14 21 • 30 45 60 • 90 180 • 365 W/C WASTECODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT Empty Drums Provide Remov 1 A 1 A2 5g ❑ l Og El 15g ❑ 30g ❑ 55g ❑ S P F Clor-D-Tett Q40U0 Test Kit: Test10 Pass ❑ Fail ❑ Generator Knowledge ❑ PPM Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning Clean: Y N Labels Oil A/FUOF Oily Debris _ SERVICES REQUESTED BBBYY .. TAX We Acte t P. O. # TOTAL CHARGES: GENERATOR'S CERTIFICATION: :re•eby declare that he contents of tnis consignment are!ugly cnd accurately described 000ve by proper shipping name and are classified,packed,marked,and labeled,and a;e in oB respec!s it proper con f r transport by highway according to applicable state cnd national government regulations. !f i am a large quantity generator,I certify that I hove a progrom in piace to eouce the vciurne and toxicity of waste generated to rhe eeg ee'have determined to be economically practicable and that I have selected the practicable methoc of treatment.storage,ad'spcsa'cutre^.-!v ovci7able'o ,e which mirirmized the present ano`uture threat to humor,health and the environment;OR.if I am o small quantity generator.I hove made a good:pith ef'ort to^i-rni_e my wcsre generorio. cr.d se!ecc t-e best waste mor,cge nest method that is cvailable to me cnd that Icon afford All used oil from the generator listed above will be transpor'ed eniy to o iacity permiffed by theS-ate o'Co@Iorn:g to produce used oil rote recycled oil OR a facility that is required to comply with Federal regulations applicable to the management ct used oil. Ai! etevcht infonncticn regarding(no,"or suspected hazards cssocicted with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney fees incurred in the colectlor of'h's obli aVon.. Venue fo., a ores of this obligation shall be in Solana conn , I declare under penalty of Perjury that the forgoing is true and correct. PIS POSAL/RECYC LING FACILrrY: %Collection Station Industrial :Agriculture Government MarineOther Industrial Lubrl"ting Oil / GerXeraol's Slgnafure\ v Ignature ~ 1 fierekiy certify that I have read and have tFie authority to bind the above listed generator to the tenth's on the reverse side of this form 990/LZOin OMI SOAS ANY[ Af101HEA 66VCSVVLOLT YVA OZ:9T T10Z/ZZ/80