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FRE���OL- r E- 'VIRONr J1 - TAIL RVICES, INC. <br /> �'rnd P.�N r^:'-: To: ?::. t r "� r PA iD=C.'A0001-'101, <br /> P.O. Bo, ,s- .. - - -��l L.S.D•��.T.= ;4�1bb- iNvorcE.# 25020 <br /> Vaca%ill,�.Ca 95696,-_.S Fax: `I---"S---;9q L,.T.S.C. <br /> w,vu.naz�;as:eremo�aL:�m CA=274461 Date le•1 U iCJ <br /> SITE ADDRESS BILLiNG'MAILING A RESS <br /> Customer Brannon Tire Customer Brannon Tire <br /> 4905 Cfaremoni Avenue P.O. Box 1988 <br /> Stockton, CA 9207 Stockton, CA 95201 <br /> CAL 0001 6 538 <br /> _ <br /> E.P.A. = _; 6_•_ _ Phone <br /> Additional Contacts: 209 77-9000 <br /> ike <br /> PRODUCT - ERNICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 . i 4 . 21 • 30 • 4S • 60 • 40 • 180 • 365 w/ CODE C 1 WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> _ ; <br /> wU � Q33dOWaste ;qul.- " L (Used Oil) j CA 221 l ori 64 L_ N � <br /> 'vcr-=cC A <br /> "azardous Waste Liqui (Used Anti-Freeze) i CA 134 , 1.00g <br /> Non-RCR.A Hazardous Waste Liqui (Oily Water) 1CA 223 <br /> Ji-aimed Used !l I Gas Ine les Iters <br /> hon-RCRA Hazardous Waste Soiid(Oi!Co aminated Debris, Soil) ,CA 223 <br /> I <br /> 2r is Nasner Service I CA 223 � <br /> No.--- .: G L�.azarccus caste Uqui rake Fluid) ;CA 343 <br /> ~Neste Flamfnaaie Ltgtk 'i 0 S.: 3, UN199 , PGIi (Gasoline-Diesel) 31/D018 <br /> 'A2 5gZI 'Ogg 15g 30g 55gO S P F <br /> - � Z! Generator Knowledg PPM � <br /> J <br /> Trcnso-0rtc+?c C;e-ges,'a.cdis;c lnuck T!-r e/Additional L cbor/ LAB Packing/Site Cleaning <br /> Ctecr Y c;e; 0�; �O :�� is A/F UOF 3/ .L5 Oil Debris V <br /> SERVICES REQUESTED BY ' �,1 Z y L�✓�— <br /> we t d t'`'tCit � � �J,J.4 t_J <br /> Acce t P. O. #t TOTAL CHARGES: �� <br /> GENERATOR'S CERT:;CA-:ON: - -_- - - <br /> - _- _ <br /> aornp name and ore classified,pocked,marked.and <br /> ^a•:e c -`- _ _ --- _=._. - e_ •a"o^s. am:o:orge quantity generator,l certify that l <br /> ==e._ ^ y c e one that I have selected the practicable method <br /> a goc r as e s_- __ '_ _- _ e a c e e rent OR if I am o small quantity generator,I have made <br /> will b ir_ o_.e.. •_3• -�;c__ - - - - i •- ..e a e 3 rcr _c-„1„-d. Al:-used oil from the generator nsted above <br /> maroge—en c'_sec c -- - _ _ _ "_'"_: - e =i 0R `.^.C.Ii^�'na'is required to comoa with Federal regulations applicable to the <br /> tees nc� ed' --- ---- - - - -_ o'e ^u ware ccs beer,disclosed, ;he ccstomer ogre <br /> es to pay reasonable costs and attorney <br /> e- - - - = _rr. decore order penalty of ae u that the for an is}rue and correct. <br /> DISPO L/RECYCLING FACILITY: - Coll ion Station IndusirialJ I Agriculture Government rin Other IndO�n al Lubon flnfl <br /> r ,-2:-. iii n: ?:.^.: <br /> Ev eer. L"r 1 lean. era^ <br /> :56!P.eaG3^_9S -0waSe Ll, t gJ rwonrne <br /> -TRh F:v% :D2�Bern ease R031 e <br /> k <br /> d01 iy runnel R 9d �New land9 Dr.,Easl <br /> cse,;�1?5i72 <br /> s ;•;l 4 6eniia,GA 94 0 5 Fernley,NV 89403 <br /> �':, -. •�='-�•---'•y' , r1aCG rt03�J8E7413 1•Q42 Cl+.DCY53194.310 5 1-2128 <br /> 771,1.575-2760 %,D 98089M <br /> Zi <br /> Print Name I eratces Signakue <br /> I he oby cer.14V that I have read anvet h ri o 6'n a li ed eat t th e e s Sl ne eeersa side of this form. <br /> 990/TV0Pi ONI SOAS ADIH MAOXHUH 66Y£8VtL0LT Xtrd VZ:9T TTOZ/ZZ/80 <br />