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FRE-MOU EYIRONTENTAL S6RVICES, INC. <br /> P�cne: �9 EPA M=CAR000t7101, <br /> P•TT. Rn� a'� ° cne: 0 -uk "0n Us.D.o.T." 1484667 INVOICE # <br /> 1 acal ilio. Ca 95696-28-5 .45-3499 D.T.S,C. +3544 i l� <br /> CA=274461 Date <br /> SE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Bran on e Customer Brannon Tire <br /> 4905 Claremo t Avenue P.O. Box 1988 <br /> Stockton. CA 5207 Stockton, CA 95201 <br /> E-P.A jit <br /> CAL 000196 538 ✓ Phone <br /> Additional Contacts: 20977-9000 <br /> ike <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> • 3' AS 6G aG '8G 365 W C ! WASTE I MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> -- -- _ __ f/tel Gallons ice] <br /> Gallons g <br /> .= - _ - -':,.��":,�..., ►roe.- _ Jci:. .'it- 'ems=G. �r. .3y 1.00 <br /> --:E _ ,,,.', rV3t2', CA 223 Gallons <br /> yE7 U �r�. NLC- <br /> -e : Wiese 3 , <br /> -A 223 <br /> -A223 l <br /> CA 343 <br /> G s Inei '111LtuI0 <br /> C 1-1110c- <br /> Remove -.A 'A2 5g ZI 109 Zl 159 0 30g ❑ 55g O S P F <br /> "e= :;d'j-f "es' C -es' Z) ass :I Fail Z) Generator Krowledgek PPM <br /> jcq X) <br /> a�,sperCt;c^ C-a-;es;ACdaicral -uck,Irne/Additional Labor/LAB Packing/Site Cleaning <br /> C ec� Y ti abel= :^I A/'►.� UOF Y 1 <br /> �. Oil Debris �. <br /> SERVICES REQUESTED BY (i ,,� O ( TAX <br /> ve • P. O. # TOTAL CHARGES: <br /> Accept <br /> GENERA? $CES!'.PCA-0N _ - _ _:e o:oroper snippins Home and ore classified,pocked,marked,and <br /> = _-_ „-❑ go,e er •egu c!'crs. !` am a large quantity generator,I certify that I <br /> Ce ez--0-iCCliy crcct'cable and'hof I hove selec•ed the practicable method <br /> •.e=• ""- - -"-- -- - - - = _ -`-"-_----- '• _e3e-'_ - - r•ec•- _ -^-neonn ofd;he environment;OR.if I am a small quantity generator.I have made <br /> =g=o=`= 'e`'=-u= ---_- _ _ - = c =se.ec•^e=_ ?=s,e = - ^vim­ :e to r^e arc cho' Den afford. A!!used dl from the generator fisted above <br /> M!I,cce- S:y rno'1s requrec to complywith Federal regulations applicable to the <br /> mon _ -- _ _ _ _ __ •_e- _ -s'?- c ec=�OR c ,-_. <br /> -- - - -•• -'s_____ec _ c ec:r .-s wcs-e tcs neer disclosed. the customer agrees to pay reasonable costs and attorney <br /> ee -ec - ^e� _ _ _ _ _ _ _ - - _ aec,ore under enalt of perjurythat the fora a true and correct. <br /> DISPOSAL/RECYCLING FACILITY: v - Ion Station IndustriolV VAgricultureemment Marine Other Indusltrlal Lu <br /> 24- <br /> fi <br /> Clearwater Ermronmental lAgml <br /> Road 24'JJ Almond Drive <br /> 2aI.6,C A 94510 5 Silver Springs,CA 89429 <br /> 5 5??9[t0t NVD 982354483 <br /> Firlint Name - -" <br /> ators Signature Drivers SIgnature <br /> I he th I _ d ih e a to th a th rev id o i <br /> 990/Z9011 DNI SOAS AMR A00WHNA 66VCRVVLOLT XVd T£:9T TTOZ/ZZ/80 <br />