|
FRE NIOLNVE WIRONTMENIAL SjbKVIULS, "U.
<br /> �vnd Pa.%rr,!-.- i. E PA�D=CAR000 2 8 6 IL 8
<br /> P.O- Box 28" S.D.O.T. '148466 INVOICE #
<br /> N 2cal illo. Ca Y-;696-28-; Fa-x. D.T.S.C. 3544 Date 11
<br /> v;,-x-w.h&z%x-asteren-.c,,al.com CA 0 2-1144 61
<br /> SITE ADDRESS BILLING/MAILING ADDRESS
<br /> Customer Bran n T're Customer BrannOn Tire
<br /> 4905 Claremont Avenue P.O. Box 1988
<br /> Stockton, CA 9,5207 Stockton, CA 95201
<br /> E.P.A. -h — CAL 000 196 538 Phone
<br /> Additional Contacts: 209 477-9000
<br /> Mike
<br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION
<br /> WASTE
<br /> 7 21 - 30 - 45 - 60 160 - 365 W C CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT
<br /> I
<br /> Non-RCRA Hazardous Waste Liquid (Used 01) CA 221
<br /> Non-RCRA Hazardous Waste Liquid Used Anti-Freeze) CA 134 1.00
<br /> Non-RCRA Hazardous Waste Liquid (Oily Water) CA 223
<br /> Drained Used Oil/Gasoline/ DiesEi FiltersN/A 55.00
<br /> Non-RCRA Hazardous Waste Soid(Od Cortw*iated Debris, Soil) ICA 223
<br /> Parts Washer Service CA 223
<br /> Non,-RCRA Hazardous Waste Liquid(Brake Fluid)
<br /> CA 3431
<br /> Waste Flartrrd*Lm*, N.0-&, 3, LIN1M, FIGH(Gas Diesel) 331M18�
<br /> Empty Dr-�rrs Provide Rerrove Al 'A2 5a ZI I Og J 15g 0 30g J 55g D 5 P F
<br /> Clor-D-Tec' u40/_''C-eS_ -es- :3 Pass J Fall J 'Generator Krow1edqe"2-'PPM ';wr�L�
<br /> ransportotio- C~arges!Acc";o Tr, Ck Tjme/
<br /> A,4diticnai Labor/ LAB Packing/Site Cleaning
<br /> Clear: A/F 2f T-UOF
<br /> 3o,,1 1Oily Debris Z
<br /> SERVICES REQUESTED BY TAX 19-00
<br /> A 1
<br /> We cceDt = IF Id P. O. # TOTAL CHARGES: UZ
<br /> GENERATOR'S CERTIFICATION: -e,eov ce--c— 'ne::o-:e- ::ZsgeC:'e'_:.ty CICczc,'c-ev CJeScrtoec cbD-e by oroper shipoing name and are classified.packed,marked,and
<br /> labeled,crd are in c!i resrez-5'-=,z:e-zc-- ;capC. Z:::Z0-Z ng'o 300,1cc.O!e T�C'_ ^07ibnol go,err-erl leguiolions. !'I am a large quantity generator,I certify that
<br /> have C program in o,cce'c rqc, C3'-C IC--9 n�::-oy�c 0,'e.'05'e gele'o-ed TC Ire cen-ee:'ClIc ac-e--eL to be ezo",r. e
<br /> ;cc!1y orcc�;cob!e and that I have sected the prccticoble mathoc
<br /> of treatment.storage,or disoos,'"c.rer-i,a,c�icbia-ane vif�Lh. -ec're preserf and`inure threcttoruman health and'he environment;OR.it i am a small quantity generator,I have made
<br /> a good 11"ith effort to rr;rirr.;ze—ry-ore qe,e,c';or=^:d se:ec'!-,e.,es,waste^C,oge're,-.'^Sthod trio':s cvuilcibe?a me and that!Car,afford. All used oil from the generator listed above
<br /> wig be transported only toe.`act' cer-ri!'ec o j '.y
<br /> mcr)oge .0 ' I e S'cte c�cc';C. c �.n!o re=,c�ec o�OR a foc;P '1501 is required fla compiv with Federal regulations applicable to the
<br /> rre�t 3:_;5CC C:. A�_ev�-- ec .,-1----c;7e as c,..,cis,lo,ed. The customer agrees to pay reasonable costs and attorney
<br /> lees;rcur,ed it :1 as!-
<br /> c:o lecl:o-.Cf C-. ve e 4—0 pqes geln 5 3-�, ct7 -:: ce_��ve under cerolry a!veru ry'A%tthe foraoina is trueand correct,
<br /> ent I M)6�019\ Other Lubricating
<br /> r)isI`OS_Af!�/lRECY(ZLING FACILITY: Coll on Station Industrial) Govemm on
<br /> -Od Inc -D. Evergmn Oil,Ire ]Clean Harbors San Jose LLC I Big ZCEN— 12191 Cv&jry EMI
<br /> 44561 Road 306 EM)SmM Ave r,
<br /> 1021 Beffyms Rosa 401 1.1f Road 2M5 Newtandq Dr.,East
<br /> I DM,GA 95616 2 Netraek,CA 94660 35 S CA 95M 4 Beri6a,CAW10 6 Fernley,
<br /> ey,W R
<br /> 510-7954400 CAD 98244SU4 '147954400 CAD99WA18 ( /I
<br /> --CAD 069WI0 510-541-2128 CA 6 t9 775.575-2760 M%OMM
<br /> C#pr
<br /> Print Name Generators Signature
<br /> I bgreby certify th9t I have read 304 have the authority to bind the!2Bove listed generator to the#11Lrr1K1Wreverse side of this form.
<br /> 990/9co[n ON1 SOAS MIH AMONRUA 61SH:MLOLT YVA ZZ:9T TTOZ/ZZ/90
<br />
|