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FRE VIOU ' E' •VIRONMENTAL Sf RVICES, INC. <br /> Send Pai ment to: Phcne: z 0-:59•_ EPA DD=CAR00017101? <br /> P.O,Bos 2874 Phone: ' 448-3"00 li.S.D.O.T. 1484667 INVOICE # 24150 <br /> S•aca�ille-Ca 95696-28-74 Fax: 707 IA8-3499 D.T.S.C. 3544 <br /> www.haz7wasteremoval.com CA#274461 Date 1 <br /> SITE ADDRESS Brannon Tire BILLING/MAILING Aannon Ire <br /> Customer Customer <br /> 4905 aremon venue ox 1988 <br /> Stockton, CA 95207 Stockton, CA 95201 <br /> CAL 000196 538 <br /> E.P.A. # Phone <br /> 209 411-9 WOU <br /> Additional Contacts: Ike <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 - 14 21 - 30 - 45 - 60 - 90 • 180 - 365 WAC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOPI . NT <br /> OCICioQC%3�-� 1 O C� N L �C <br /> 1.00 <br /> Non Hazardous YETe—SW <br /> Fiat ts wasm lei So vice ILA <br /> Waste <br /> Empty Drums Provide = Remove 1 A ;A2 5g ❑ I Og ❑ 15g ❑ 30g ❑ 55g Q S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ Pass ❑ Faii ❑ Generator Knowledge D PPM <br /> Transpo)lWion Charges/Additional Truck Time/ dditi nal Labor/ LAB P king/Site Cleaning <br /> Clean: LY N Labels O.I (,' 2 A/F UOF ( (V!L L Oily Deb nnl <br /> SERVICES REQUESTED BY �1 I4 <br /> fl If M TAX <br /> we <br /> Acce t = ® P. O. # TOTAL HAR ES: <br /> GENERATOR'S CERTIFICATION: '^e�etc aecc�e cn'e-,-_o;!,is con;ic-,r..e�:c,e, ,,•e.�described above by proper shipping. <br /> labeled.Ord are in en,esoec!> p c r cnc ;rc c ame and are classified,packed,marked,and <br /> nave a ro ram in Icce is�edcce - "" c'rx aoa c.b-'e;'a•e c e'iarG go':emm:ent�egula"o- If om a large quantity generator,I certify that I <br /> P 9 P e ...c.max_ _ :c,a ae ea.etl*..".e dey•ee -c.a ae!er- nec to oe econcrricalr <br /> of treatmeet.stora - precl�cab a and that I have selected the practicable method <br /> ge.or disposal curer-y o cdoCle'a me which minimized!r.e o ese anc'.u•e rrec',c rumcn heai'r.and the environment;OR.if I am a small quantity generator,I have made <br /> o good faith effort to m.inlrr"Ze my woste genera'ion one se!ec-Tne oes :•as!e r cnaye er r="rad--c• s c.,o;lcb'je!o In and chat car atiord. All used oil from the generator listed above <br /> will be'ronspo ed only to a fa ;T pe ,sec by r Ste-e o'4orn c•a o�eauce usec71173•ec c OR o`ate Gty!hat is required to comply with Federal regulations applicable to the <br /> management of usec; A. -c,+ or a rcn e ord rc gown or suspec* d cezord5 so :c' d h nIs,cste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> fees ncunetl -ne co-le,..o - venue; '-=ses of:hs co; c!�cn S`clil be it Sol.. o,co , <br /> declare under enols of per'v Ihof thMoin hue and cortect. <br /> G FACILITY: 1 tiSreFQgni Marin tIndustrial lubricating <br /> -4W%l Road 3,)3 Sm1i Ave. oil <br /> i Dem CA yE6ic Sw Jose, <br /> CA Road 401 W.Channel Road 2195 New4andv Dr.,East <br /> 510.7T,44(0 ` � ' 3 Sen Jose,CA 9513 i 4 Benicia,CA 94510 5 F NV 89408 <br /> CAC I 514,M 4400 W 980887418 40"1-M CAD 0339494310 510541-2128 CAL 0=189 <br /> 62760 WD 980895338 <br /> (;6 �l� <br /> Print Norrie <br /> IheGenerators Signature� gg <br /> ry certify that 1 have read dnd have the authority to bind the above listed generator to the termDilvs the evemEs sides nF Ftiie F^rm <br /> 990/bEO(Pi JN1 SOAS ANH KaONREA 66VERVtLOLT YVA ZZ:9T TTOZ/ZZ/80 <br />