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EREA10L ' E_ WIRONMENTAL ,*RVICES, INC. <br /> Send Pa,nig nt to: P=r ne: n-�59 EPA ID=CAR000171011 27311 <br /> P.O.Bo.28 P or-c: - -148_31"00 U.S.D.O.T.# 1484667 INVOICE # <br /> Vacaville,Ca 94696-2875 Fax; ' --448-3499 D.T.S.C.#3544 <br /> ww.hazw•asteremoval.com CA#274461 Date _G, MIT) <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Brannon Tire _ Customer— Brannon Tire <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA 9 207 Stockton, CA 95201 <br /> E.P.A. g CAL 0001 16538 Phone <br /> Additional contacts: 209 4 7-9000 <br /> Mike <br /> PRODUCT - JERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 • 14 . 21 • 30 . 45 . 60 • 90 180 • 365 WIC j WACODESTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> :c--RCS, --azw-cous Waste :qui ;used Oii; , CA 221 »k Zj Ga!/o N L <br /> Hazaracus Waste ';qui (usea Ana-Freeze) ;CA 134 1.00 <br /> -aZe'OOus 4aslc :gut (viiy 'J1r'aier CA 223 i <br /> :-a nec :.1SeC -'%Di' GaS0iiile/ Diesel Miters NIA 55.00 <br /> 'nor.- C'P!. -qazarams yhsf ,e Solid(Oil Coni amirated Debris, Soil) CA 223 <br /> Pais !WaSrer Service CA 223 <br /> `w-RCRA i-fazarocus WasteLiquid(Brake Fluid) CA 343 <br /> Nas?e Fiarnmabie Ljw..�. O S.: 3. L;N'993 PG11 (Gasoline-Diesel) 3311DO18 j <br /> I <br /> Empty Po., cve A A2 Sg .] ng ., 15c ZI _10g55g D S P F <br /> Generator Knowiedge U PPM pp„ <br /> c^ * C- css c tic"C cki^?e;.4dditjc.nc Labor/i.�.8 Packing/Site Cleaning <br /> Ciec_ _� ,e t V- C: Y t l l�(�l v i - �- 3 UOF 0,-- Z Oily Debris t .d F Z <br /> SERVICES REQUESTED BY IL& A,V i�/ 3' V 11 TAX .v0 <br /> We �1► P. O. # TOTAL CHARGES: D - <br /> GENERATOR'S CERTIFICATION: -------- a, - ccc•,e= proper shipp;ng name and are classified,pac d,marked,and <br /> :GbeeC - .-71C'1S. a I an,C IC' a Uanii <br /> have o pragrcr r a ace y = .J __- _ - _ _ 9 9 a ty generator.I certify that I <br /> y o'oc`cab,e ant the•I hove selected the practicable method <br /> or hea!^a^r,sic cce.- sa _ :-- - r o-•neni:OR,i`;or a small quantity generator.I have made <br /> a good foie-e r o - - - Li:^cirrra A' _se.:aii from the generator listed above <br /> wilc be•ransM i OR a'=17v a s-equ;red,c comp,.,!In-rederol regulations applicable to the <br /> monageTe o. ,ec p a -ys a - n no ween c scbsea The cu5omer agrees to pay reasonable cosh and attorney <br /> teas incurred in the cola ho o ^5 oa iia en i_ a p_ e;e,c CC c _n sr ai bE .,So anc cc c . .deciare under penal of thof the forgoing is true and correct. <br /> DI POSAJ_/RECYCufNG FACILITY: Calle !e^Station Industrial Agriculture Government Marine Other Indusil LubrlcaHnp <br /> [ Evergreen OV Inc-Da isOil <br /> [ I Eve -seri Or,,Irr I j Clean Harbors San Jose LLG [ )Big Sky Enmirimantal [ 121st CenluryEMI <br /> 44501 Road 33E S,dth A%* 1021 Bwrry sa Road 401►S.Channel Road <br /> Dais,C:, 9561 � IiS CA 9466D - 2Q95 New4andy Dr.,East <br /> 2 New o San Jose, 95133 4 Benicia CA 94510 5 Fernley,IVH ds'Dr <br /> c'C7` ;4rn gz2�SE7a 511 CAD <br /> r7t P s.Op�4' c LAD - 510541-2128 CAL 000301639 TI 5-2 MO 980895338 <br /> 1 ' \ C s <br /> Pftnt Name Generat s Signature <br /> I hereby Gerfrifv that av -d - e the outharilyto bind the ab ve line for tot Driver'nr Ke <br /> a thisfor <br /> m. <br /> 990/9}70lpI OUI SOAS ANN MROWMA 66VCRVVLOLT XVd 9Z:9T TTOZ/ZZ/80 <br />