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FREM , ' E VIRONMENTAL S#RVICES, INC. <br /> �cnd Pi•:: cni lo: P^one .00-459-3_ -4 EPA ID=CAR000I'1017 - <br /> P.U. Bot 2J-4 Phone: --"8-3-00 U.S.D.O.T,= 1484667 INVOICE # <br /> N aca%i11e. Ca 94696-:8 Fav 0--148-3199 D.T.S.C.=3544 Date •j �• 1 l <br /> ,A v,.� w•aem <br /> az ;tero,.al.com CA=274461 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer __ Customer R nnnn Tiro <br /> 4905 Claremont Avenue P.O. Box 1988 <br /> Stockton, CA 95207 / Stockton, CA 95201 <br /> E.P.A. stGAL 000 w www <br /> V Phone <br /> Additional Contacts: 209 77-9000 <br /> PRODUCT • ERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> • 1' 45 5 90 '8C 365 N'C i WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE i <br /> .� " 1 i?2 37% � 2JC Gallons <br /> Gallons <br /> nCA 223 1 1 <br /> N/A 71�„ 0 <br /> I <br /> I <br /> I <br /> ��( , �•�•-- �- ��-' J is L cI`i:SJ v !(___ <br /> F e = Remove 7A! i A2 5g ❑ 'C•g ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> C;o­D-'ec- Q4000' -e_- C -es- ❑ ass ❑ Fail ❑ Generator Knowledg PPM . Dr <br /> icki-ie!Additlonal Labor/ LAB Packing/Site Cleaning <br /> ll A 7 UOF 5 ,it Oily Debris `,�„r <br /> SERVICES REQUESTED BY i TAX k.00 <br /> 'we P. O. # <br /> TOTAL AL CHARGE :Acce � <br /> GENERATOR S CERTifICAr10N: -___ =e=__ -_ - =-oec knee oy orcper shipp;ng name and ore Clonfled,packed,marked.and <br /> -_ _.,,._ c=-e: _z-:: ., ,,..cl aovem-en'•eq�ialions. 'r i am a large quantity generator.I cerci. that I <br /> _= _ _______ _ ___ _ _ _ .___ _--__ - ecero-zcw,c c'ccc-e ano")at I hove selected the practicable method <br /> -- -- _ __ _-_ - _ - --- e_ _ e -e.. _T ^ea"yd•re e ,:.cn^•..e^!:OR.:f i em a small quantity generator.I hove mode <br /> .c'co e-c^e CC•`.cr =o=cfforC. All used oil from the generator listed above <br /> _ - - - - _-- _ _-_ _= a _ _ __.__= c ec= OR=be:rv.^or's recal•ed r complywith Federal regulations applicable to the <br /> bee^ OII <br /> <.c a eC. TunLe customer agrees to pay reasonable costs and attorney <br /> - - - - -- _ _ _ -_ S=r=c= cec:=re under nit of e that th or oin is true and correct. <br /> D!SP05A EC YC LING °ACIL:—”: Collect- Station - Industrial Agriculture Gov mment Marin Other Ind oil LUbrlcatlnfl <br /> Oil <br /> �' "D.O. i- C'I [ ]Clean Harbors San,lose LLC Bi Erwonmerdel <br /> [ 9 [ ]Clearwater Erndronmenl <br /> s" Sm h Aw 1021 gem es9a Road 401 W.Channel Road 2430 Almond Drive <br /> 2 NewarlS CA 4i5K 3 San e,CA 95133 4 .8enlcia,CA 945105 Silver Springs,CA 89429 <br /> 5 t rl :AD 982446874 5`10-7954400 CAD%08874 1.0,952 CAD 510-54 1-2128 CAL 775 577 9001 NW9823%483 <br /> Prin ame Generatol's Signature Drivel's ature <br /> I hereby certify that I have read and have the authority to bind the above listed generator to the terms on t e reverse side of this form <br /> 990/090 P ON1 SDAS MIH AaONHH3 66VCRVVLOLT XV3 OE :9T TTOZ/ZZ/80 <br />