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FRE'NZOUW E- TVIRONMENTAL SORVICES, INC. <br /> pend Pi}rnent tt.: P'*-c+^e W-459-3:-.;= I:PA ID=CAROoO;'101 i 2 5 3 6 9 <br /> P.O. Box '_S Phone: ' !- g -00 U.S.D.O.T.= 1484667 INVOICE # <br /> VacaN ille. Ca 9 696-28 Fax: _)--4,13-33-199 D.T.S.C,#3544 <br /> %;-vv .bazwasteremo,al.com CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Brannon Tire_ Customer_ Brannon IJre <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA 9 207 Stockton, CA 95201 <br /> E.P.A. st CAL 000 1 6 538 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 Liquid(Used Oil) CA 221 7Zbo. c�JJK Sjj G- N c- <br /> Non-RCRA Hazardous Waste Liquid Used Anti-Freeze CA 134 1.00 <br /> Non-RCRA Hazardous Waste Liquid(Oily Water) I CA 223 I <br /> Drained Used Oil /Gasoline/Diesel Fifters N/A 55.00 <br /> Non-RCRA Hazardous Waste Soid(Oi Contamided Debris, Sal) CA 223 <br /> Parts Washer Service CA 223 <br /> Non-RCRA Hazardous Waste Liquid(Brake Fluid) CA 343 <br /> Waste Flammable LKW, N.0-S . 3, UN199 , PGII(Gasoln)e-Diesel) 31/0018 <br /> I � <br /> Empty _ :7.,;ce = Re—c;e — ;A 42 5g J Qo :1 15g :D ?Oa D 55g D S P F <br /> Clor- -'ec'GrtY -es` C "e D Po« _-3 �c" �e-,erotor Knowledge ❑ PPM <br /> -'C!SDG~ C� ge;;.gcdi°Ic^c ck ^ e/Adoi+ior:c.: cdori _AB 'ac ing/Sita Cleaning <br /> CIecr: Y N I--els 1l0, 1A/ <br /> I UO j I Oily Debris Z <br /> SERVICES REQUESTED BY 101,21yt„ D i TAX •QO <br /> ACCe t YL j F. O.it TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: _ - _ - -- - - - C,:bec d�cve ov crooa:shccir norne and ore classified,packed,marked,and <br /> 1abeIed. c a _ _ g <br /> G ___ ? � i em D large quan'ij gene•ntor.I certify that I <br /> _' _ =�e o•ac,cable a-o that!have selected the practicable method <br /> ' - - - - ''=a•r- ,e- o-r^e-^!:OR. ' r^.'ca small quantity generator,I have made <br /> c e a- -c--."cra Al;used oil from the generator listed above <br /> V _ _ - e c:'OK, oc: v a ;-e Jed to coma y vvi!h Fecera!regu!ofions applicable l0 the <br /> ` -• - _ :v.as,e r:os neer,dlsciosed. 'ne cusremer agrees to pay reasonable costs and attorney <br /> lees nc.; aC - -- __ ;c V �-_ eC cre.;-der oene3v of oe'ury shot the for goingis true and correct. <br /> DISPO rREC�C�i,CFa.CILI:YJ 4 co:ectlon1*atrer. I, I ..LatnciV Agriculture Government MOrtne Otfier Industrial Lub <br /> ( rgreen N t><-DBv>s l j Everc reen Or!,,nc. <br /> �,Road� [ j Clean Harbors Sen Jose LLC ( ]Big Slry Ernnronmental [ ]21x1 Cer!AuylEMl I <br /> 6980 Smrlh Ave. 1021 6emom Road 401 W.Channel Road <br /> Dave,CA 9561E 2095 N,NVB 08 Ea91 <br /> 2 Newarlt CA 94560 Sen Jose,CA 35133 4 Benicia,CA 94510 5 Fernley,NV 89409 <br /> 5AA10AA-7195-r44/00' CAD 962446974 510.7954400 CAD SOW41 1-0962 CAD 069494310 510.541-2128 CAL 000301639 775.575.2760 NJD 980895338 <br /> 89533 8 <br /> Pfint Name Generato s S nature <br /> 1 hereby certify that I have read arid have the authorityind the above listed generator to the tADe <br /> lt nature <br /> reverse side of this form <br /> 990/ZbOlpI ONI SOAS ADIH A10T1HM 66fMVLOLT XVd SZ :9T TTOZ/ZZ/80 <br />