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FRE M OL N E AVIRONMENTAL *RVICES, INC;. <br /> •cnd i'r. `.c -. - ?-.ore. -`�y ="3 EP-41D=e-�RODei-10i" ( V <br /> P.O. Rn\. -s"� P`are: =�t '- r�' L-.S.D.O.T.= 138466- INV CE # ii <br /> 35 <br /> N a.a;iilc. C a V=b'+n-'R FLx: -;1 ic_:eau D.T.S.0`35' a �` 6 <br /> CA=2-4461 Date <br /> SITE ADDRESS D..,,,,,�,�., -� BILLING/MAILING ADDDRR,E.SS....,.,. T �� <br /> Cus}omer _[�gMon Ute— _ _ Customer_tel LLi[�1L11LC- <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA R.207 Stockton, CA 95201 <br /> 000196 538 Phone <br /> Additional Contacts: 209 47-9000 <br /> ike <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> e 2. a 3C . 45 a 50 a 90 180 a 365 W; COD_C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> ` <br /> �c=R-QA Hazy oous Waste Liquid(Used Citi) CA 221 '007ST-1 3 ZJS 190 6AL <br /> do CRA m+azroous 'Waste Liquid Used Ant-Freeze CA 134 1.009 <br /> tics-n-^'.' naza-oous Waste uquia (Qiiy Water) CA 223 <br /> Dr anew lsec Gli ;Gasotine/ Diesey Fifters NIA 55.00 <br /> Nor,-RCRA.Hazardous Waste Said Ol Cort ed Debris.Sot CA 223 <br /> Oar's Washer Senrce CA 223 <br /> No=RCP,-' Hazardous Waste Liquid(Brake Fluid) CA 343 <br /> Vh9e FWrrrwbre Lgad. N.O.S.. 3. UN1993 PGli(G2soirne-Diesd) 4311DO18 <br /> I <br /> r �. ♦ r ._ _ r .. �L - 'G'•' - - _• •-L 17g v^` J SSg wl C P r <br /> --e. "e. -e.- :o 5 :j3enerc°or�:^owiedee PPM <br /> aE =ackir.giSi`e Cleaning <br /> L <br /> - `c - - �.:" U'-'r Oily Debris/a K <br /> SERViC: EOuFSTED 5Y I I O ( TAX .00 <br /> P. O. TOTAL CHARGES: <br /> zcr�e o. 'are classified.packed,morke <br /> - d.ond <br /> __ ::_:. _ _ _ - _ _ _ �::c - orr a farce cuan`ity generator.I certify that I <br /> _ = 5; n_ _ - ,- _ e ac tnor I have selected the practIcable method <br /> -' c, , <br /> - _ d <br /> -- -��-��..-- -- ^t C'. rr+a small quantify generator.I have ma <br /> -^ 'arc. A ::sed oilfrom the generator Isted above <br /> , __._s OR: yc r,-tea < ec, _o=ory.vrn'ederal regulotions applicable to the <br /> e c assn d'sc;=sec. The cusromer cgrees to pay recsonable costs and attorney <br /> .fie rde,cenairy o`oe'unr thot the forpoiing is true and correct. <br /> D: ..SA:/RECYCL:'w�AC'�'^: Coilec''.or.station 11MUstrial `Agricult,ra Govemment Marine Other Industrial I Lubd&ciffng <br /> on <br /> >R • ars i 1 r p+.!Yx _`Clean harbors San Jose LLG [ i B 9 Sky Er ronrnertaf [ i 21st C6ury EMI <br /> a <br /> ° '"�3ce Sm>fi Ave 1021 Berryeme Road 401 W.Chemet Road 2095 Newlands Dr.,Eam <br /> +e- 'S Ca 9d56u 3 San Jose.CA,95133 4 Benicia,CA 94510 5 Ferrdey,NV 89408 <br /> 5[siY CAC 9E244W4 Cr1D 99088241& e0e-4gI�M CAD X6494310 510541-2128 CAL 000301639 775575.2760 NVD 980 <br /> 895333 <br /> Print Na Generator's Signature Driver s Siggnalure <br /> h2mby certifythat 1 have read or 'be authoritybind the above listed generator to the terms on the reverse side Qf this form. <br /> 990/0011 OKI SOAS AKH AfIONHHA 66VEMLOLT XHd LZ:9T TTOZ/ZZ/90 <br />