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01FREMOUW E IRONMENIAL S ' V1C;ES9 INC;. �cnd P3-,menr to; Pbonc: 80 -559-3 EPA ID=C_4R000171017 P.O. Box 28-5 Phone: '?0'448-3700 U.S.D,O.T,#1484667 INVOICE # Vacaville.Ca 95696-28'5 Fax: '707-448-3499 D.T.S.C.#3544 Date � y ww- w-w.hazasteremoval.com CA#274461 SITE ADDRESS BILLING/MAILING ADDRESS _ Customer Customer '.I a,, �oi ire D. E.P.A. # ,l ' -i Phone Fax - - Phone Numbers: Office Cell Contact: PRODUCT - ERVICE INFORMATION PROPER SHIPPING DESCRIPTION 7 • 14 21 30 45 60 90 180 • 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT CODE Empt,•D:;•ns P-ovide 0 Remove 5g ❑ l Og ❑ 15g ❑ 30g ❑ 55g ❑ S P F Cior-D- ect Q4000 Tess Ki.. Tes. ❑ floss ❑ Fail ❑ Generator Knowledge 0 PPM.','.;:; Transportation Charges/Additional 1ruck Time/Additional Labor/LAB Packing/Site Cleaning Clean: Y N Labels Oil A/F UOF Oily Debris SERVICES REQUESTED BY TAX We A ce t !Ww I P. O. # TOTAL CHARGES: GENERATOR'S CERTIFICATION: -ere .cmc";"e•-o• D center's c'—s corsignmen`ore f:.^y=no eccuratery described above by proper shipping name and are classified.p`—6d.marked,and Iobelec,enc ore�.r.a-rescec's i^crcae•ccro:!ion rc• ransoon by nighwoy according to applicable state and national government regulations. If I am o large quantity generator,I certity that I ave a crogrem;-ctece'c•ee_ce ^e:o: *'e arc tc xidty of waste generafed to the degree I have determined to be economically practicable and that l have selected the practicable method of treatment.storage.or cisocsG c enCw c?cote+ •^e which minimizec the present and future threat to human health and the environment:OR,it I am o small quantity generator,I have made a good faith effoC to r•n'.'^:±e m',wcste generation cind select the best waste management method that is available to me and that I can afford. All used all from the generator listed above will be trorsponeo cn y fa a fccaity permitted by the S late of California to produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the monagemer•cf used on- Ail retevort information reg rating known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable cosh and attorney fees incurred n the col ec7ion of this obli etion. Venu for purposes of this obligation shah be in Solano county. I declare under penalty of pZury that the forgoing Is true and correct. DISPOSAL/RECYCLING FACILITY: `;'Collection Station Industrial AgricultureGoverment Marine Other Industrial dcating II oil Pi41t,.17RtQ Generotof s S16noture Driver's ljhature State cw Requires That you keep this Receipt/BRI of lading on Isle no less than 3-years. To RE-Activate or to obtain an EPA#-l'ustnmar mnv rnninrf nrcr n,_fnn_A i A_Aoeo ZTT/Z001M ONI SOAS ANH MaORRHA 66b£8bVLOLT XH,d 85:£T TTOZ/ZZ/80