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FREMOUW IWVIRONMENTAL __�,'RVICES, INC. <br /> Send Pa ment to: Phone: 900-559-3:'4 EPA M F CAR000171017 <br /> P.O. Bos 28'5 Phone 70--448-3'00 G.S.D.O.T.# 1484667 INVOIC # 3 842 <br /> Vacaville.Ca 95696-'-8'S Fay:: '10'•-448-3499 D.T.S.C.=3544 Date 72 ��� <br /> u� <br /> ww.hazwasteremoval.com CA##274461 � <br /> SITE ADDRESS Brannon Ire BILLING/MAILING A nno I Ire <br /> Customer Customer <br /> Claremont4905 venue ox 1988 <br /> Stockton, CA 5207 Stockton, CA 95201 <br /> CAL 000 96 538 <br /> E.P.A. = Phone <br /> Additional Contacts: Mike <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 /> Non-RuFA Hazardousi 17 1.00 <br /> Non-KUKA Haz5RBFse <br /> e I`IWRTk0e 3, UN-1993, Pull (ISM3MLIliew) <br /> Empty Drvms ProviCe = Remov 1 A 1 1 A2 5g ❑ 1 Og ❑ 15g ❑ 309 Q 55g ❑ S P F <br /> Clor-D-Tect Q4000 Tess Yit: test ❑ Pass ❑ Fail ❑ Generator Knowledge. PPM Circ , <br /> Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clea Y N Labels Oil A/F 14 UOF % 'L v F 1 Oily Deb ' Op <br /> SERVICES REQUESTED BY 1_71j, � TAX <br /> We <br /> _ O� <br /> Acce t P. O. # TOTAL CHARGES: <br /> GENERATORS CERTIFICATION: - y _ e o.orooe'shi <br /> _ _ _ �scr. ppfnq name and are classified,pocked,marked,and <br /> �.abeiec.arc cec occ•� <br /> Neve c p'ag•c- _ _ __ _ _ _ _ _ - ___c _cc a c- ��-• e.�Ter•regula!ions. ,am a large quortity generator,I certify that I <br /> of treatmen!.sro,Cge^x=socsc�^ - - - - _ .._' '- -` - `c e ca'-"-`�c'arae_-cnc-�ceby graclicabie anc ihct have selected the practicable method <br /> `- e •• c "'� =c'r � 'e o'- .-^hec,,�a-d e nviro^Hent,O.R.iF I am a sural quontify Generator,I have mode <br /> o good.C, e`a�!o r-. rr .r garerc•-a a e ••-•. ^o�c- -•.-m v :ab o oro ._c.I ccn o!`o-d. All used oil from the generotor listed above <br /> will be trensponec or,'y o a oc perm,•ec o - e_'c r .c c <br /> management c used o A r e_� a•^• r `-s`--c° c. =..OR c focr.y:na; s reo: ,ec to comply with Federal regulations applicable to the <br /> fees rrccveC.n-ne codeci:a^a"�s c^rear'cc. ve�e`e•o_�rno,es c`�SFob ecs a^����;�oocr c:ac,o coon-JI�aeclerewnde Is elooRd. The ecustomer <br /> tagrees <br /> the o Pay <br /> trueandreasonable <br /> costs and attomey <br /> SAL/ Y Iaa FACILITY: - n du I A ric ,e v ent Marine O IndasMa! 4+bdc:�.^.; <br /> 1 Road 3D8 T.6,Atie 1021 E3e R <br /> D� Road <br /> 9508 2 9MBrit CA � rYwsa Road 461 W.channel Road 2096 NwMands Dr.,East <br /> 3 San Jos4q,CA 96133Benda,CA <br /> 514795-MW rAD982416874 16795-4400 CADSIM7418 409-"1-09G2CAD059d94310 4 514541-2128 CAL LL 0003015395 Fernley, 89408 <br /> 775575.2277 6D NVD 980895339 <br /> Print Name y �•\A <br /> Generators Signature Drivers Si nature <br /> I herebycertifythat I haver n have the authoritv to bind the nhnva Uct.A..e..e..&—&_ L.-. �__ <br /> 990/££0lpl DNI SOAS ANN AMONHHA 66VCRVVLOLT XV3 ZZ:9T TTOZ/ZZ/80 <br />