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FREMOU T E• "VIRONMENTAL SORVICES, INC. `und P3.%n':n: !r: Phone: _nn_:iq_:_ 1 EPA ID=CAR00017101',' P.U. Box 23-5 Phone: --448-3-00 ti.S.D.O.T.# 1484667 INVOICE # Vacat iflc_Ca 95696-28'4 Far: " '448-31499 D.T.S.C.#3544 w��-a.aazwasteremo�al.com CA#274461 Date SITE Ai SS — BILLING/MAILING ADDRESS Customer -' Customer 1_'!'! it}I ! de E.P-A. At Phone Additional Contacts: PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION 7 '4 2' 30 45 60 90 180 365 W'C CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT t Remove ;A A? 5g ❑ 109 ❑ 15g 7 30g ❑ SSg ❑ S P F C "e;' ❑ ass i!j cc: ❑ Generator Knowledge PPM �Q ra^spor�ction C-aroes%.Aaai�ic^a! *ick Time/Additional Labor/LAB Packing/Site Cleaning Clscr:. Y N j-cbe s v- 0:; rl� c.�•zv.v A/F UOF Oily Debris SERVICES REQUESTED BY 4 TAX we Acce i P. O. # TOTAL CHARGES: 9.9 GENERATOR'S CERn FICATION: -_ _c. _____ -_ - _:- e __ cc - __ _ --- _, -_=-ces onove by proper snipping name and are classified.packed,marked,and cc= _ ____ __=.e __- _ o gc'e• em+*eguloflons. It I em o large quantity generator,I certify that I _ - L - - --o c- •-airy prect'cab!e cnd shot I have selected the practicable method _ eseL e"-eo'-c n--=-reon,and!tee envi onrner•t;OR,if I am a small quantity generator.1 have made _ - -25—. _:-e ae-er=•_- -- •-e ces —c-ore er= cI o aro r+e crc•mar.•co^afford, til used oil from the generator listed above -__ _- _c = - _�_• o z_ _ c- _ce-sea o _ y_ec c;.oR. oc.lirw r a :S required to comply with Federal regulations applicable to 1he - c.v;h -s wcs•e cos beer disclosed. The customer agrees to pay reasonable costs and at'omey -a --` - - - - _ _ ,.r:-:. _ are ender penal of e'u that the forgoing is true and correct. DI POSAL/RECYCLING FACILITY: Collection Station Industrial `Agriculture Govemment Martne Other Industrial LubOn ing Plan Name G •eiotor'sSignature ver herebythath - the o ri to m e v I' o to th v e i e of thi 990/6901a1 OUI SOAS AKH MRONHHA 66VCSVVLOLT YVA 0£:9T TTOZ/ZZ/80