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FREMOU E� TVIRONMENTAL WRVICES, INC. <br /> Send Pty went ro: Phone: 00-559-3274 EPA M#r CAR000171017 <br /> P.O.Box 2875 Phone: 071348-3700 U.S.D.O.T.# 1484667 INVOICE # <br /> �'acaNille.Ca 95696-2875 Fax.: 07-448-3499 D.T.S.C.#3544 - <br /> www.hazwasteremoval.com CA#274461 Dateow <br /> SITE ApDRESSBILLING/MAILING ADDRESS <br /> Customer <br /> -e�" . '. - Customer <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 W/C WASTE ' MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> I <br /> I <br /> Empty Drums P•ovide Remove 1 All i A2 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> C!or-D-sect Q<)30-es'Kit: -es 7 Pass ❑ Faii ❑ Generator Knowledge ❑ PPM: <br /> Trc^seorctior: Cl�orgesiAdditbna Truck Time/Additioncl Labor/ LAB Packing/Site Cleaning <br /> Clear.: N Lcbels Oil A/F U0FOily Debris <br /> SERVICES REQUESTED BY TAX ' <br /> we <br /> Acce ® P. 0. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: csr;�c�,^-e-ce t-;'y crc eccu'c7eiy descnoec above by proper snipping name and are classified,pocked.marked,and <br /> !cbe:ad.crc c._ -„ -.a_c•, ____ L_-.. - _,cc-'o,- <br /> . ' ccordtr-•-ccc ccble s:c•e cne ro`ono,gcvemment reguiat;.ens. E!!a'n a large quantity generator,I certify that I <br /> ^.eve c ,y.rar- =oc ^•ec,ce— •c-. -o _ -. c _ _ :--_ _ n <br /> -he ce_•ce _ce aa-srr+irsc to be economically prcc`coble and thot I have selected the practicable methoc <br /> e =- c --e- •c` o' " e e c.'C hurar`!'eoBh on.-tre environment:OR.if I am c small quantity generator,I have made <br /> a a o, c"a-'cr -"•" a gen- a.•a"a 'a'e a C, c, eg_ -rel ?s ovoilabie'o me and that I can afford. All used oil from the generator listed above <br /> will be tror,sponec ony:o c-oc5'cernored by 1he S`a*e c.Qct?forn,c to c-ocace used oi!inro•ecycled of oR a fociiity that is required to comply with Federal regulations applicable to the <br /> menogerert o!-sac c'. Aa e ori:nro motanr arb:r•g known a•suspected heze os ossocictea wltb rhiswasie has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> 'roes!ncured:r,qhe cJ Ie r r°tCs obli�e'icn. Ven a u! ores c this obli otion sholl be in Solano coun! . I declare under penalty • <br /> of a v that the forgoing is true and correct. <br /> DIS?OSAL/RECYCLING FACILITY: 'Collection Station Industrial Agriculture Government Marine Omer Industrial Lubricating <br /> oil OII <br /> �iU.c, `ti iriG'r''*.orrr:' "}; -' .. •� +�Y... a _ir+r3!r ..,..-r.iNV rJs T. <br /> t NQ Generators Slgnr�' Drivers i ature <br /> I hereby certify that I have read and have the authority to bind the above listed generator to the terms on-the reverse side of this form. <br /> 990/8Z0l1 ONI SOAS ANH A1flOWHNA 666£8VVL0LT X-VA 0Z:9T TTOZ/ZZ/80 <br />