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FREMOU ' E' 'VIRON►VIENTAL SSRVICES, INC. <br /> Send Pa%men! to: Prone: 8 0-459- EPA ID=CAR00017101 7 5 6 6 3 <br /> P.O. Box 28 Phone: -'--44&-'700 U.S.D.O.T.= 1484667 INVOICE # <br /> VacaN ille.Ca 95696-28-4 Fav 70-448-1-199 D.T.S.C.#3544 ' <br /> w wwhazw•asteremoval.com CA#274461 Date r <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Brannon Tire _ Customer— Brannon Tire <br /> 4005 Claremo t Avenue P.O. Box 108$ <br /> Stockton, CA 5207 Stockton, CA 95201 <br /> E.P.A. a CAL 000 96 538 Phone <br /> Additional Contacts: 2000 ,177-9000 <br /> Mike <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 . '4 • 21 • 30 • 45 • 60 • 90 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> rt2Si@ _I"' vSEGCA 221 <br /> y <br /> - >TSS e :Se- nt:-Freeze, CA 134 1.001 <br /> V'tiaSie -,Gu a 10i:r VViaier; CA 223, <br /> _'72.nec Sem °u; JaSOiine,' DeS Filters Ll <br /> N/A. -7 ', flC'L1JS <br /> ?.c r-r;07, n3?a.'co-s vVasie Soad(0!i C rtaminated Denris, Soil) CA 223 <br /> �cJS r' aS :e.' Se CA 223 <br /> -- lqA -2za"1C.:S aSIC- uCu ,'1 ;Cr3! e �!d) CA 343+ <br /> i2:'i: _ .•'�3�G _:yu.;. �� .,.:. u'��c �C. ;Gasoiir.z-Dlesei� l3-JIDOitli <br /> - -A2 5g ZI 10g -:2 15g. Q 30g 0 55g O S P F <br /> Pasc :1 ;:Cl: :1 "'er.erai•or i;nowledge ; PPM <br /> Zi(7—ie-'A dirk".,, Lack-• LAB packing/Site Cleaning <br /> Ciean: Y tiJig - <br /> _atr Ai N �? i10F t Oily Debris �; Z <br /> SERVICES REQUESTED BY 'a/2 .UO <br /> 3 U r TAX <br /> We <br /> Acce t P. O.0 TOTAL CHARGES: <br /> GEN':2 o''S CERT!FiCATION: -c__.____ - - _ _ __ .-.:-__ _ _-_ - - •g'y eSC'I:`?a Cao• ^uy'proper chlpaing Home and are clOSsrfied,packed.marked.and <br /> :ab e^ a^a e - _- is -5'^^'Pr` t,^.-:C- -f I DT a large quantity t7cv__a-ay c _ _ _ - - - - _ g g q ty generator.I certify that I <br /> of treo!r^e- _ Z. _ _:3 - _: _ e _:e e c cilli c b e and that I have selected the practicable method <br /> '" F c e en ro me OR.d.a-,a small quantity generator.I have made <br /> a goad`ci:r or c .0 a r_ A;I usec oil Trom the generator listed above <br /> will be transported only t c-•.iT p _S c c. c c c e s OR .cc7 '9Q� ea Ia cCmp!y with Federal regulations applicable to the <br /> manay5ment u,�a A: z a c - < ;e-a a d;sck_Sed. -he customer ogress to pay reasonable costs and attorney <br /> fees ince—ed;r the ta'.__ r=. 3 __ ,, S- _ . _ dao CM.,de•aenalt of cer.ury that the forgoina is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: i olles3icaa }e7t n industiic l Agriculture Government I MarineOthef t^d gtdat �♦t^^ <br /> i 121st Cenkry EM! Cn' <br /> • i -wY 1,k T:YRe ca- '�401 W Channei Road <br /> ;r u 2095 Newlands Dr.•East <br /> -I '"``'_ _ '.v 4 8bncia CA 9452 5 Fondey,NV 13903 <br /> - - c--�'-.- _ _M. _ a r. r•1.`i r�a��- <br /> 5441-212K0' i r�W(Sjg -57&27M NVD 93M338 <br /> Plitlt Name Ge tees Signature Driver's Signature <br /> that I have readave the or'ority to bind the above IWed generator to the terms on the evrs sideo thi form. <br /> 990/LEOIA OUI SOAS ANH MROXHM 66VCRVVLOLT XVd EZ:9T TTOZ/ZZ/80 <br />