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FREMO UNV E TN-IR0TMENTAL .RVICES, INC <br /> . <br /> � n'C ?a N :r.: . - - EP-A.J A <br /> P.O. Box *-_ U.S.D.o.T.- :491667 INVOICE # 26688 <br /> D.T.S.C. = 3�,. l <br /> uxA AAvhaz-�xas:erenoval.com Ca r 274-46i Date <br /> ■■a.r..e.�Re�� <br /> SITE ADDRE55 BILLING/MAILING AgQRESS <br /> Customer Brannon Tire Cysto er ran <br /> non Tire <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA 95207 Stockton, CA 95201 <br /> E.P.A. 1 CAL 000196 538 Phone <br /> -Z <br /> Additional Contacts: 209 4 7-9000 <br /> ike <br /> PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 . 21 . 30 • 45 • 60 • 40 • 180 • 365 W;C WASTE MAN!FEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Non-RCRA Hazardous Waste Liqui (Used Oil) CA 221 ?3g I <br /> Non-RCRA Hazardous Waste Liqui (Used Anti-Freeze) CA 134 i I 1.00 g <br /> Non-RCRA Hazardous Waste Liqui (Oily Water) CA 223 <br /> Drained Used Oil /Gasoline/Diesel Filters WA 55.00 <br /> i 1 <br /> Nor-RCRA Hazardous Waste Soid(0il Contaminated Debris, Soil) CA 223 <br /> Parts Washer Servioe C 223 <br /> I <br /> Non-RCRA Hazardous Waste Liqui (Brake Fluid) CA 343 <br /> Waste Flwrnabie ( ) <br /> Ladd, N.O.S., 3, UN199 , PGII GasnYne-Diesel 1/0018 <br /> i <br /> '.t.2 '"g J '5c :1 30g ZI 55g D S P F <br /> _ 2 -_ ,A -es < -e: Cc« cc. ;ere•o'or Krowledge �PM <br /> Tren5portctc- C7,crge5f°.:.ca;cr-c;'--, CK I neiA�ditl'cnal Lcbor/ LAB Packing/Site Cleaning <br /> Clecr: Y N i_cbe,50°I / I P./= OOF pf Oily Debris Cr <br /> SERVICES REQUESTED BY ' 11 IO , TAX <br /> we <br /> = �i ` <br /> Accept P. O. TOTAL CHARGES: <br /> GENERAcCR_S CEPT.'E�CA°:.0 r:- ___ o _ _ -_ .._ - _ _�,.,,_,_ e•st'.^C'^^ ^-.e and r <br /> _ _ :.. _ - _-_- _ _ _ 5-o.. ere classified.pocked.marked,and <br /> c:e-Z':Z'-— __ - - - _ _ - -- - - - - - - .. -- - 8' :eg a:ors. !f i am o'arge quantity generator.I certify that I <br /> a`-•moo•— _ _,__ _ __ _-- _ - _ _ _ -_— -- =___-- -ce"-•arcc`ceble anal the'I hove selected the practicable method <br /> a gcca'a.. c- — _ _-a-_-__ - _ _ --_ _' _ _ _ `= = neo' c '•"e envtre.^:nent:OR.it I err a small quanti y generator,1 have made <br /> will be ra soar-ec or:,, - - - -__ - - ' _ - ---= a a-c-'-c^c*^ar 1 Cor c'�arc. Atr.used oil from the generator listed above <br /> ma cye^er o e e+ i OR .a ."v .c 6•eou:lea to comply with Federal regulations applicable to the <br /> hcs been disclosec. -he customer agrees to pay reasonable costs and attorney <br /> fee ea; C31e,. ''^. - - - _` - Sc -. <br /> ' - '" _ �declare ander Denoty os Perjury that the foraoing is true and correct, <br /> DI SAL/RECYCLING FACILITY: Cgflection Sfc tign I dusfrial Agriculture Government Marine Other Indusstlrial bOit tlna <br /> 44561eon Dd Irc_-Davis [ ]EvOrgmen 09,ax [ )Cie Hart, San Jose LLC [ )Big Sky EnvironrnonW [ ]21x1 Centay <br /> 1 Road 306 58W Smit Ave 102 e a Road <br /> 1 Davis,CA 95616 2 Ne C,4 g4 rrym 401 W.Channel Road 2035 Newlands Dr.,Eest <br /> 5147%-4e0p CAD S624WA 3 Sart J e,CA 96133 4 Benicia,CA 94510 5 Femley,W 85408 <br /> 51 7954400 GAD 97418 408141 -0962 CAD 0584,41310 510541-2128 CAL )639L775,F75.2760 Mo 9808%338 <br /> I <br /> Print Name erato cure <br /> I herebycerci that I have read n have the a t ori bind the above listed enerator to the term$onees lthne rev rse side of this form. <br /> 990/vtoln OAII SOAS ANN Aa0KHMA 66VMtiL0LT XVd 9Z:91 TTOZ/ZZ/80 <br />