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FREATOUNV E VIRONMENTAL SC,RVICES, INC. <br /> 5tndPa r,�-.. , ' c-... ` -�-= �P-AID=C.A -1--7 0;- � (A� � � � <br /> - <br /> P.O. Box 28 r ...., _{:.,__i . - ^ �.S.D.O. _ 148a<5 INVOICE # <br /> aca%ille, Ca 9=696 8 - 3.N. D.T.S. .;:t 3514 <br /> au�.hazu ante*emrn al.cea CA='274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Rrannnn Tire _ _ Customer — Brannon Tirca <br /> 4905 Claremoi it Avenue P.O. Box 1988 <br /> Stockton, CA S 5207 Stockton, CA 95201 <br /> E.P.A. k C 538 Phone <br /> Additional Contacts: 209477-9000 <br /> Mike <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 - '4 - 21 - 30 - 45 - 60 - 90 - 180 - 365 `N!C I '/TASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Non-RCRA Hazardous Waste Lig d Used Oil , CA 221110 0 I°L� %-,�[. F <br /> Non-RCRA Hazardous Waste Lig d Used Anti Freeze CA 1341 _ 100. <br /> Non-RCRA Hazardous Waste li d Oi Water CA 223 <br /> Drained Used Oil/Gasoline/Di Filters NIA 55.00 <br /> Nor-RCRA Hazardous Waste Sold Od ww-ated Debm CA 223 <br /> Parts Washer Service CA 223 <br /> Non-RCRA Hazardous Waste Ligdd(Brake Fluid) i CA 343 <br /> Waste Fharrciabie LiqL4 N.O.S.,3, UN1993, PGH Gasoix- esel 1/D0181 <br /> E-. .ply Dr-"'s a:-:) ce - Re-r.ov = 'A 1 A2 Sg 7 1 Og 7 15g ❑ 30g ❑ 55g ❑ S P F <br /> Cio' D -= Y4Y -es -es - Gerera.or Knowledge ❑ PMGrvd <br /> C': Pass mac:' + P <br /> ?ransoor'ctior•, C-:c-gesircc`Ti nc ;^-ck Tame/Aaditicna' Labor/ LAB Packing/Site Cleaning <br /> Clecn: 'Y " ; cbe Oil F/,;' A!F �/4 UOF 1/-,e G'Z Oily Debris <br /> SERVICES REQUESTED BY TAX 9.00 <br /> We ---TPO. TOTAL CHARGES: <br /> Acca t # <br /> GENERATOR'S CERTIFICATION: -,c-c cccrc,er desc^:bec ebcve by eroper shlppin name and are classified,packed,marked,and <br /> ebe'ec,=-c - -- - - - c ,ecn co g <br /> 1.c.,e c Y,o; V c V _`_- __: - - - e= o�c'gover"^enr reg 'xiens. .r i o a large quantity generator.I certify that I <br /> ='c -ems ce econernkah raricable ano that I have selected the practicable method <br /> crcoe,c'C baso'c_ ,. :csc - - _, yr 'zed-` _,._-_ ..._ .,,re-n•ea••c nomcn,necith cnd'he environment;OR,it i om a small quantity generator,I have made <br /> ,goo `cicr, .or•c— e-.; y c- -e a :c;'eL. o :S ova'ab a'o me oral that 1 ccn afford. Ail used oil from the generator listed above <br /> will b ircnsportea only c a ddfy _-e b S' C':'o ^c co a�seo 1.nto recyc�eo oii oR a rocility that is required to comply with Federal regulations applicable to the <br /> man gement ct used o: Ai vo- .a. -.crd ro ^ov ..z_rd-._ssoac ec w•-, osre h <br /> t--r,<w as been disclosed. 'tie customer agrees fees curved in the cGlgCii :.ot'hS ot;iac'ia '>.'e ce'c� cr cs�s o'•-':<oc:! ctiC^;ra'ce Ir.So;ano cc��n�. !declare under anal of eriu that the forgoings pay <br /> huesondblorrecsFs and attorney <br /> Di OSAL/RECYCLI G FA ILIT`!: Collection Station Industrial Agriculture Govemment Marine Other Industrial <br /> al lubOtating <br /> 10 �� ( J en�Inc ( j Clean Harbors San Jose LLC 1 J Big Sky Ervironmetdal [ ]21st Centuy EMI <br /> 44561 R SmM Ave. 1021 Benyma Road 401 K Channel Road <br /> 1 Dave, 9% 2 CA 945M 3 Sen Jose,CA 95133 4 Benicia,CA 94510 5 F�j y mpg E� <br /> 510 9B2 4 10.7915-4401 CAD 980887418 408-4412 CAD 059* 10 510-541-2128 CAL CM301639 775.r75.�0 Nyp M <br /> fV\Vr <br /> Plant Nanie Gen atces Signature <br /> �s Slgnature <br /> I hereb hat I hav read nd have the authorityto bind the above listed generator to the r on the reverse side of this form. <br /> 990/9£Ola1 ONI SOAS ANZI MaOj HHA 6617£8bt'L0LT YVA £Z:9T TTOZ/ZZ/SO <br />