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FREMOUN t E WIRON MENTAL *RVICES9 INC. <br /> pend P.iy TCnt 1,: Fhor.e: G-��4 -'- r-P.-k ID=CAROOO17101' 25486 <br /> P.O. Brix 28 P`_eae: "- 3„-�-OC U.S.D.O-T.”- 148466" INVOICE # <br /> Vaca%ille. Ca 95646-2` raX: -+.-- ? =Qo D.T.S.C,_--5 Ae. 0 <br /> n-w.hazN asteremoval.cem CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer_ Brannon The ___ Customer Brannon Tire <br /> 4905 Claremon Avenue P.O. Box 1988 <br /> Stockton, CA 9 207 Stockton, CA 95201 <br /> E P A 3 CAL 000 196 538 _ Phone <br /> Additional Contacts: 209 77-9000 <br /> Mike <br /> PRODUCT - SERVICE INFORMA.TION 'PROPER SHIPPING DESCRIPTION <br /> 7 • '4 • 21 - 30 . 45 • 60 a 90 • 180 • 365 W c CODE MANIFEST NUMBER (QUANTITY UNITS PRICE AMOUNT <br /> ' <br /> l <br /> Draped Used Ori/Gasotk+e/Diesel Fens N/A p�SL��i g� <br /> Nor�-RCRA Hazardous Waste SW(Ori Coria wIated Debris..Soi ;CA 223 <br /> E+.c�' ?et/aabie Matenai ',Latex Paint) N/A <br /> Waste Pawl Refaced Materials: 3, UN1263, II P 31/DOC1 <br /> Waste FLwTrraW LKpLK R&S.(Gas ", 3,L1N1993,I 34N D018 <br /> Non-RCRA Hwardous YVaste Liquid(Brake Fkid) 'CA 343 <br /> CombLlstlble Ligl_d, N.O.S., NA1993, III (H ed 041) 141/F002 <br /> vc�P. a.�. ar rties:e:nuc;Cr; A 343 <br /> cve = 'A' 'A2 5a 7 Gg ❑ 15a ❑ 30g ❑ 55g ❑ S P F <br /> -e_ ❑ ?ass ❑ cci ❑ Generator Knowledge ❑ PPM <br /> TMa�sac-c`a �a gs.;Acs`aria:Tr_!ck_irreiAaditiona; Labor/ LAB Pockina/Site Cleaning <br /> Clear: A/v UOF Oily Debris <br /> SERVICES REQUESTED BY ' ( Z µ, L4 p F TAX <br /> We Acca t P. O. # TOTAL CHARGES: <br /> GENERATORS CERTIF!CA71CN. -_ -- _3-__ e,-_ _ _ -- - __ _.___ .._. -9 �„ ?ov oro�)e_t ippirg name and are classified.packed.marked,and <br /> cc = - =-_ _ _== - ___ _- = - _ _-= _ - - _ _--_- _=c _ 00v 3n e-_regc,c ions. ?'or-)a targe quonfity generator,I certify that I <br /> - - ___ -e --_` :c oe"rch'groc-icobie^ne Ihot!have selected the procficoble methoc <br /> e,,,:onr ent:OR f!om a small quantity generator.I have mooe <br /> c aocc e„- __-=_-- = - - =- -__ _-'-_--_ _ ha' "ofd. A, used cii from the generator listed above <br /> ”'°I oe -"=o= - - __ -- _ - - -'" -- _ _ _:___== -:_-_ - _ _•_ c -'OR a 'red to comoly with Federal regulations applicab'e to the <br /> --- --as oee^asc osed. Tne customer cgrees to pay reasonable costs and attorney <br /> fees incurred '^e ca:ec-c-_ - •;E _ rhs „G-� _ _ _c �. deccre,;ride pend!ly of perjuj that'he forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Govemment Marine Other Industrial Lubricating <br /> I 1 Gear Hwbc*San Jose LLC ; I Evm"en N Im-DAVIS I I YBion Paird Re n Inc oil I <br /> �9 Bi8�9favc�mul I IGEMMRanchoCordareRSC ErnS1s <br /> 1021 Ben7ma Road "Mi Road 309 4481 VA*rs Sae d 01 W.card R-1 11855 Whit Ibck Pond <br /> I San Jae.CA 9513_' 2 Dem.CA 95616 3 McClehn, 4 Bei CA 94510 5 Rancho Cordae,CA 96742 <br /> 406-M1L862 CADM_wW10 510.7954400 CAD982446874 9169 1 CAL000336106 510-511-2128 CAL 000301639 916351-0980 CAD990884183 <br /> m Generators Signature <br /> �vaiqnCture <br /> 1 herebycert' that I have a thea thori to bind fh ve listed generator to the terms on the reverse side of this form. <br /> 990/£b001 DNI SOAS ANd MAONHHH 66VVRVVLOLT YVd 2Z:9T TTOZ/ZZ/80 <br />