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FREMOU F TVIRONMENTAL *RVICES, INC. Send Pacment to: Phone: 00-559-3174 EPA ID 4 CAR000171017 P.O.Bos 2874 Phone: .07-448-3700 li.S.D.O.T.# 1484667 INVOICE # ;�• � L Vacaville. Ca 95696-28"5 Fax: 0'-448-3499 D.T.S.C.#3544 aww.hazwasteremoval.com CA#274461 Date f SITE ADDRESS BILLING/MAILING ADDRESS Customer - Customer „.•- E.P-A. 4 Phone Additional Contacts: PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION 7 14 21 30 45 • 60 • 90 . 180 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT CODE Empty Drums Provide Remove ':A 1 1 A2 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F Clor-D Tec.Q400C Test Kit-. Test❑ Pass Z) Foil L) Generator Knowledge l3 PPM Transportation Charges/Additional ruck Time/Additional Labor/ LAB Packing/Site Cleaning Clean: Y , N Labels Oil - A/F UOF1 Oily Debris SERVICES REQUESTED BY TAX We _ .Ac ce t P. 0. TOTAL CHARGES: GENERATOR'S CERTIFICATION: pDec are'^.ot .e cc^xe-•;o'-ri_c�-,;�,_,-•,,-.e ce tcGy crd occcra•e•v described above by proper shipping name and are classified.packed,marked,and a bete C,a'c:;a a -es ae:'i -ccae'�C �''`a^tC -•Crsp Of° ccccrd^y^to a oliccble s`.a'e c':J national govemment regulations- If I am o large quantity generator,I certify that I hove c r•oy,c.•n:r.c cce•c rec ce -e c m_^ a asc-• a;•e gere`a ed'c'ne oea,ee;hc.e de-erm+ned to be economiceny precticabie and that I have selected the practicable method of treatment,storoge.o,dsposol cu,.en:�•ovci.ab;e ro-e wr:n min;•n Ezed the p•esent and fu-ure three,^o`!urr.on health and the environment;OR,it I am a small quantity generator.I have made a good faith eBor,to minimize my waste generation and seiec!the best waste management method that is avaiiabie to me and that I can afford. All used oil from the generator listed above will be trarsported only to o facility permitted by the State of !*he to produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the management of used oil. AI'relevant information regarding known or suspected hazards ossociated with this waste has been disclosed. The customer agrees to pay reasonable costs and attomey fees incurred in the collection,of this obligation. Venue for purposes of this obligation shall be in Solano county, I declare under penalty of pedury that the foMoing is true and correct. DISPOSAL/RECYCLING FACILITY: Col ggry�atioq Industria! Agriculture Government Marine Other Industrial . ... . - . _. - ._ ;:?may.; •:�+ �,..- s - .:�:.,. .�.. y X, PHht Name Generator's Signature Driver s Signature h 14 I hereby certify that I have read an have the authority to bind the above listed generator to the terms on the reverse side of this form- 990/6ZOIA I ON1 SOAS ANH MAOIHHA 66VCSVVLOLT YVA IZ :9T TTOZ/ZZ/80