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FREMOU ' E- -VIRONMENTAL `-RVICES, INC. <br /> Send Pay meet ro P=ane: K 0-c�9-:_ a EPA ID=CAR000171017 24723 <br /> P.O. Box. 28-4 P~c-re: ---Ws_3700 L.S.D.O.T. = 1484667 INVOICE # <br /> VacaNiIle. (a 95696-28 Fax: "-115,-_199 D.T.S.C. 3544 .- <br /> Date <br /> ww.hazwasteremoval.com CA#274461 <br /> w- <br /> SITE ADDRESSBILLING/MAILING A E55 <br /> Customer Brannon Tire _ Customer_ rannon Tire <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA 95207 Stockton, CA 95201 <br /> E.P.A. -4 CAL-000 1�96 538 Phone <br /> Additional Contacts: 20977-9000 <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 !-iqui (Used OII) CA 221 Cp-+qCC ae L) (TK (Ob <br /> Non-RCRA Hazardous Waste 1—Iqul (Used Anti-Freeze) CA 1341 1.00 <br /> Non-RCRA Hazardous Waste Dqui (Oily Water) 1 CA 223 <br /> 5.00 <br /> urained Used Oil/Gasoline/ Di Filters 5 <br /> Nor-RCRA Hazardous Waste Sobd(01; aminated Debris, Soil) CA 223 <br /> a ;s Washer e'Vlce CA 223 <br /> Non—RCNon-RCRA Hazardous Waste Liquid (Brake Fluid) CA 343 <br /> Waste Glartlmable'_4x, N C S . 3, UN1993, PGII (GasoW-, Diesel) ;331/0018 <br /> Cr :a'. ✓ vv — Vie" A A25u � '0� 1 1 Sg J 20g :1 55g Q S P F <br /> Cior-D-Tec- Q43C-,Tes- (ii. -es- ass ZI Fail E GenercIor Knowledge PPM <br /> Transption Cho,ges;Aaaitlonai rjck T-irrEVAddifioncl Labor/ LAB Pocking/Site Cleaning <br /> Clecn: N I Label I ��� /= UOF Oily Debris I. <br /> SERVICES REQUESTED BY C y TAX <br /> We <br /> A cep' "a � P. O # TOTAL CHARGES: <br /> GENERATORS CERTIFICAS!ON' _.c. ___=a - "j._- - __ _-- _- _ _ __..e.a'F:-.beC ccc,e ov o-coe.'<h;Cpirg narle Cnd are classified.packed.marked,and <br /> - _ _ -- _ -- _ _. _ - _-_ - _ a :c.e rite^ eoula+:o^s. d I am c orge gior fity generator.I certify that I <br /> have_-C='oy'c"'T=C-- _ e :_ .;_ __ - - _ .. - _c ='-e__ _ c•e _ ce a-r,^,o^�aal,y arac'Icot,e on--that!have selected the practicable methoc <br /> ° r r ' c- - .Z:.c ::Z:z- - _le-- _c a �He c e-, -re emvc--Tent OR if I cm a smo!i quanlity generator,I have made <br /> a good fd•h f. e e _ - ___ _ - 7.e -c' ,o-1c.,e--o^-e rd not,con a-'cra Al;used oil from the generato•listed above <br /> Ml be Far.oc , .. ec y OR C ca'ty mc':s reojireci to com !r with F <br /> p. acarol regulations applicable to the <br /> metas--3d!C l c A SC a- ..•-�--- +.•Ger been d sclosed. Tne cis?Omer agrees to pay reasonable costs and attorney <br /> fees ccu^ed - _ - _ _ :,e :oto o cc., oec.c.e u-oer c)eno!tN of perjury'hat the forgoing is true and correct. <br /> J OSAL/RECYCLING FACILFY: Collection Station industrial Agriculture Government Marine Other lndustrtal Lubricating <br /> OII oil <br /> e1M j 4 151 u8nury trA <br /> 44561 Roel t�SmIEI Ave 1021 9ern,,ma Road 401 W.Channel Road 20%NwwfBnd8 Dr.,East <br /> veva,CA 2 Newark CA. 46@3 3 San Jose,CA 95131 4 Benicia,CA 94510 5 Fem ,N' <br /> 518 982446872 F'27g5 ser)p CAD 3801187418 40441-M CAD 059494310 510.5!1-2128 CA 17011301639 775 <br /> 27En NVD J09M <br /> Pdnt Name Gen tot's Slgnoture Driver s <br /> I hereby certify that I have read and have the authority fo bind the above listed generator 90 the terms on the reverse side of this farm <br /> 990/OV0[p1 3XI SOAS ANH MIIONHHA 66VE8VVLOLT XVd VZ :9T TTOZ/ZZ/80 <br />