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FREMOU E_ WIRONMENTAL WRVICES, INCe <br /> Send Pa}merit to: Phone: 8 -559-3274 EPA ID=CAR000171017 <br /> P.O. Bo-,28'?; Phone: ' '-448-3700 li.S.D.O.T.4' 1484667 INVOICE # 23727 <br /> Vacaville.Ca 95696-2875 Fax: -07-448-3499 D.T.S.C.#3544 Date nil K) <br /> www.hazwasteremoval.com CA#274461 <br /> SITE ADDRESSBILLING/MAILING ADDRESS <br /> Customer Brannon i ire Customer tSrennon I-ire <br /> P.O. Box 1988 <br /> OCK(In'', <br /> L.r�L- Vuu Phone <br /> E.P.A. # _ <br /> Additional Contacts: <br /> 1iliKC <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 160 • 365 W;rC WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Empty Drums Provice = Remove i Al i A2 5g ❑ l Og❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D Tect Q40.i es'Ki-: 'es` ❑ Pass ❑ Fc:: ❑ Generator Knowledge ❑ PPM <br /> Trcnsportatior:C^urges/Add t'.on Truck irne/Additional Labor/ LAB P eking/Site Cleaning <br /> Clear Y N 'Labels Oil A/F UOF c,f — Oily Debris \ • • p�P r2- <br /> SERVICES <br /> SERVICES REQUESTED BY 401;q TAX <br /> We P. O. # TOTAL CHARGES: C <br /> Acce t <br /> GENERATOR'S CERTIFICATION: -e•ec- .e.:.•- - --.c ---_c _ _ c_'._�c__=C-1:1e.1.95c4oec:=C a cv o'Oper shipc;ng norne and ate classified,packed,marked,and <br /> ^beieo.- _ _c_ ccc e s_ c _ _ _n-e- regvto?; r:s. o!orge quantity generator.I certify that I <br /> rave c = =c c - .--_- - - _ -- <br /> -Y= _ ___ __ee•ee _oa_,c -_ re ec.3, cele prec':- selected a practicable^ Babe and Ina!I have select th is le mefhoc <br /> _ ____ -r.. _ -_ _ -_. . -hec:")c _environment;OR.;'I on^a smo'I quantity generator,I have made <br /> c yacc'd:-a c. c — = c -- _ - --_ .=-"e c - _- c ob.e'o n-c,c-hat!can afford. All used oil from the generator listed above <br /> v.i+;be•e-scccea r. - ._ - — _a c. __ c__ �_ c c____c__.___ _ = ec c OR c'ec::y •',required to comp!•.•vrfh°ederol regulations applicable to the <br /> �x�cs beer disclosed. The customer agrees to poy reasonable costs and attorney <br /> 'Po-es c'. sra.ceV r,So one co_n deoore under enai of e' that the fo o n a true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Statlonv Industrial Agriculture Govemment Marine Other Industrial LubrlcaNng <br /> ou <br /> OR <br /> 2Av <br /> P m nerator's Sigrwture r ure <br /> that 1 have d hav the ri tc bin a ab listed n or to the term eMverse side of this form. <br /> 990/Z£OF(31 DNI SOAS ANB MaORRHA 66VEMLOLT YVA TZ:9T TTOZ/ZZ/80 <br />