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FRE�ZOLT ' E TVIRONMETTAL .RVICES, INC. <br /> Scnd P5)mcn: :n: ?' EPaID-CAR0001710i7 <br /> P.O. sox 28 Prcne: ' ' t€ "00 ti.S.D.O.T.= 1484667 INVO C #1 25999 <br /> Fap 44l€ ,•�99 D. . . . <br /> TSC _=3544 6 <br /> ��aca�ille, Ca 9.696-_8"� <br /> uuu'.hazu'asrereMo%al.c0m CA 0 274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Rmnnnn Tire Customer <br /> 4905 Claremor t Avenue P.O. Box 1988 <br /> Stockton, CA 9 207 Stockton, CA 95201 <br /> E.P.A. yCAL 000 196 538 Phone <br /> Additional Contacts: 209 77-9000 <br /> 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 /> CODE <br /> Non-RCRA Hazardous Waste Liqui Used Oil / CA 221 bn qe90d <br /> Non-RCRA Hazardous Waste Liquil itU,-jadAnj Freeze) CA 1341I <br /> Non-RCRA Hazardous Waste Li ui (QiWater CA 223 <br /> Drained Used Oil/Gaso ine/Di Fitters I WA <br /> N CA 223 <br /> Parts Washer Service CA 223 1 <br /> Non-RCRA Hazardous Waste Liquid(Brake Fluid) CA 343 <br /> Waste Flarmnabie LKW, N.O.S., 3, UN1993 PGII Gasoir-ileDiesel 31/D016' <br /> I <br /> Er-o'y e _ cerr cve A,2 5c J 7:�c -1 15g ZI ',^g U 55g S P P <br /> Clor-D--ec 0��' _ as. mac? GPrerO`O'Knowledge PPM IC <br /> Trcnspora':o� Crc ae�;p.�c;lic - ck -- ,e'Acditicro Lcbcr/ LAB °ackir.giSite Cleaning <br /> fc:� <br /> V I U0. 3 Qr-Z Oily Debris Z OSERVICES REQUESTED 4 1 4 81 I TAX 9.00 <br /> Acce - . I P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: _ - -- _ - <br /> . - - _ - - --- -_- - ,`ems_~.=e'r',�-_;,rp�aec,csh <br /> ioPsp•n.o na•^e and are closs�e ,Packed,marked,an <br /> dcbe=c.o - <br /> hcvec a^-:y- o-o large quontity generator.I certify that I <br /> of re + er <br /> -c_-_ _ - e _.c- e =e ara^iCa ty CCcbe ono i'not I have selected F P- ': . d the practicable method <br /> o gcoc -_ - _ __ _ _ _ OP ,f cn a small quantity generator,I hove made <br /> "ill.,e is-saa = - __ '-`•� � - Mea-a c ar 'oro. Ai ,sec oJ'rpm the generator listed above <br /> c.,c=�-s`- ac c OR a empv with Federal regulations applicable to the <br /> :ees nC '•ea _ _ -e c�s;cmer agrees to Pay reasonable costs and attorney <br /> -'"" '" '� �`- -=o ---•- ...;nae.aer ai cer„ ,hat rhe for a is true and correct. <br /> DI POSAL/RE..Y;LHNG FACIA. v Cogection�t� lon I_dustrici I Agric�)l+ure- Government I Marine Other I Indusfdal Lu br coling <br /> 1 def 1 Oi Inc-D— I Eqr9reen 04,kx ( )Chan Herhas San Joee LLC ( )Dig Sky EmironmeaW <br /> 44551 Rcad 308 IM Smith Ave 1021 Be ossa Road [ 121st Cen4uyEMl <br /> 1 <br /> Dam,CA 95616 rr 401 W.Channel Road 2095 Newtat>ds Dr.,EPA <br /> 2 %w5r1 CA g4550 3 San Jose.CA 95133 4 eenicia,CA 94510 <br /> 514795-4400 CAD 9824/6874 514795-W C.AD980887418 1 10 510541-2128 17QQ�1839 <br /> 5 Fernley,NV 5575• NVV 9808953386V;� <br /> 1l ��:"� Al".may � r <br /> Print Name Generators Signature g <br /> I hero certify that I have read and have iFJe authority to bind the above fisted generator to the terms ronithne reverse side o this form. <br /> 990/8£0 OMI SOAS ANN Mf10XHHd 666£8TVLOLT XVA £Z:91 TTOZ/ZZ/SO <br />