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I <br /> FREMOU EVIRONMENTAL S*RVICES, INC. <br /> Send Pa%ment to; Phone: 90 -5:59-3 EPA DD 0 CAROOO 171017 <br /> P.O. Box 28--% Phone: '70-448-3700 U.S.D.O.T.#1484667 INVOICE # <br /> Vacaville. Ca 99696-29-4 Fax-- 70 -448-3499 D.T.S.C.#3544 <br /> %A-A-"-.h&zwasteremoval.cotn CA#274461 Date <br /> SITE ADDRESSBILUNG/MAIUNG ADI <br /> Customer Customer 1,k)!r o F 1, l re <br /> 3o -'�496 <br /> `IE''.'!. -x, 4 <br /> Q4 <br /> E.P.A. # A Phone Fox <br /> Phone Numbers: Office Cell <br /> Contact: t` <br /> PRODUCT - S --.RVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> 7 14 21 • 30 45 60 90 180 • 365 W/C CODE <br /> 1 7' <br /> Empty Drums Provide D Rel 5g Q 1 Og Cl 15g Q 30g El 55g C3 S P F <br /> 1--lor-D-7ec'Q4000 Test Kit: Test j Pss U Foil Z3 Generator Knowledge 0 PPM <br /> Transportation Charges/Additional T ck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY ITAXI I <br /> We <br /> Accept P. O.# TOTAL CHARGES: I <br /> GENERATOR'S CIERT'IFICAno7o-=EC:=,e Cfe'.-,v and cccjraleiy aescebed above by proper shipping name and are clomined,packed,marked,and <br /> Coe e-_ 21 z::,e C-Zce,zz:- 5cn, ecceOPplicabie S-a!e and notional government regulations. It I arm a large quantity generator,I certify that I <br /> ge-e'c";C!---le degree-have da*e.--rineci to be economically practicable and that I have selected the practicable method <br /> cr zec?ne orese�4 <br /> S-C-Zze z zCZ:--Z--e C.C�CC e'L - ri'n' Cnd future tr1re-CT To human health and the environment:OR.0 1 am a small quantity generator,I have made <br /> :we ge-e-c-o-c-= exec-7^e zes'.'Oste-'rlcncgeme-�method Tho'is available tome and that Icon afford.All used oil from the generator fisted above <br /> a gooc�C:t e"" Z� <br /> t:e rc -c"',cer7 S*c;" Cc c C orcCuce usec o into recycled oil OR a facility f hot is required to comply with Federal regulations applicable to the <br /> c'-se�- �; *e,e.o---,c,.----:c-'eg--=: i; <br /> .eei T this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> or. "en�q'C.D-rp�- h <br /> -a C= cr�gc-; poses�%f!h:s obiciation shoJI be in county. I declare under penalty of pejury that the for is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government marine Other Industrial Lubrolciating <br /> all <br /> AF e. <br /> vA; <br /> lot"V f.,7 <br /> '14y"rs" <br /> Generator S Signature <br /> Driver's Signature <br /> Staflil 4equires that you keep this Receipt/111111 of Lading on file no less than 3 years. <br /> Td.Re,A tivate or to obtain an EPA#-Custornermov contact DTSC(6)I-AMAIR-A9,19 <br /> ZTT/V001n OKI SOAS ANH MAMMA 66VC9f'VL0LT XVcI 69:9T TTOZ/ZZ/90 <br />