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FREMOU E)WIRONMENTAL SWtVICES9 INC* <br /> Send Pa%rnent to: Phone: 800-559-32W EPA D3#CAR000171017 , <br /> P.O. Boz 28.5 Phone: 701-448-3700 U.S.D.O.T.#1484667 INVOICE # <br /> Vaca%-ille.Ca 95696-28'5 Fax: '70'1-448-3499 D.T.S.C.#3544 <br /> www.haza-asteremoval-com CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer 0"� " iF�. Customer :• ri",-N + i tri <br /> rt <br /> ,.icy:r'f^ �; _�.,E^ :.l 1.=✓t.. ,l�. 4!!"1 :% _0 s <br /> E.P.A. # " ,:} :' . - - Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 • 21 30 • 45 • 60 • 90 • 180 . 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Empty Drums Provide Remove 5g ❑ 1 Og❑ 15g❑ 30g ❑ 55g❑ S P F <br /> Clor-D-Tect 04000 Test Kit: Test❑ Pass ❑ Fail ❑ Generator Knowledge ❑ PPM - <br /> Transpertcticrr Cherges/Additional Trick Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F - UOF j: ' 011y Debris <br /> SERVICES-REQUESTED BY TAX 8.Ot? <br /> AccerA P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -e-en.de.d•e'^d"^e e^•e":="-s cc-t;gr-mer?c•e`::�iy end occurote:,y described above by proper shipping name and are classified,packed,marked,and <br /> c__ _ e-d_= tee•cc-c''c^.'c• g^.:,a,accorda n 'c epo:icob!e s!ote and national government regulations. If I am a large quantity generator,I certify that I <br /> '-e —=c-c _< s a_e^e c+ec'o'^ degreehove determined to be economically practicable and that I have selected the practicable method <br /> - - = - _ -=:- _---- ' -- :•" — -ec'^e zrese-:cnd'u'ure!nrec!tc numon.health and the environment:OR.if I am a small quantity generator,I have mode <br /> _ :.cs•e ge^e•c• r ;e ec V•-e cesr-•:cs*e•nencge—en,method thcr:s ovo!labie tome and thof icon afford. All used oil from the generator listed above <br /> -- e ^• - - -duce .n-a recvcled oil OR a facility!het is required to comply with Federal regulations applicable to the <br /> A -;<-c =r. scec'e^^a±cres csscc`c'ed with'n s waste has been disclosed. The customer ogrees to pay reasonable cosh and attorney <br /> 'ees _-ec -'^e='e::-c-^ is ab"^d'd^ :c--::e' • uses cf te:s ebl: ct.on s^ail be in Solano=onty. I declare under enolty of p"ury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: �Qollection Station Industrial Agriculture Government Marin® Other Mustdcl u OlaNng <br /> Oil <br /> uenlur:E rAl <br /> i:.:v;nlRb'it.East <br /> .__....- _. .. - .. .. _. -... .. err. {.`/!:.!; f'�Li,•°�r�4{J <br /> RMT ame Generator's Signature <br /> Drivel's Signature <br /> State Law Requires that you keep thls Receipt/6111 of Lading on file no less than 3 years, <br /> T6-Re-Activate or to obtain ani EPA'#-Customer may contact DTSC.Q 1-Ron-A i 9-A9e9 <br /> ZTT/£00[n OKI SOAS ANH AfIONHHA 66V£8fibL0LT XVA 99:9T TTOZ/ZZ/90 <br />