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FREMOU E*VIRONMENIAL SRVIUES, lilt;. <br /> Send Pa%ment to: Phone: 8 -559- EPA ID-CAR000171017 <br /> P.O. Bo%28"5 Phone: -0 -i8-3700 U.S.D.O.T.#1484667 i INVOICE # <br /> acav ilia.Ca 9.9696-28"5 Fax: 70148-3499 D.T.S.C.#3544 <br /> wA-whan,asteremoval.com CA#274461 Date YCZ_ <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer Rriant on Tire Customer Rranrnrl Tire <br /> 'A 95201 <br /> E.P.A. # Phone Fax <br /> Phone Numbers: Office Cell <br /> Contact: ' r <br /> PRODUCT - SERVICE INFORMATION PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 180 365 WAC WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> r^ <br /> '.00 <br /> 75 <br /> 11 I:il <br /> :.n � � 1Q�. :"`t' :iC in ^� .-nil -i ..i•�. <br /> Empty Drims Provide 0 Remo e Q 5g ❑ 1O ❑ 15g ❑ 30g ❑ 55g❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ P ss ❑ Fail ❑ Generator Knowledge-9---PPM <br /> Transportation Charges/Additional TO Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: : Y_r.; Labels Olt= , _- A/F !; UOF ,9 - -- Oily Debris A <br /> SERVICES REQUESTED BY TAX 4'i1' <br /> We <br /> Accept P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERn•ICATION: _c - - _ -- - _ '^'s cc^s'g^^•a-'a•e`_'iy c-c cccu•cteiy described above by oroper shipping name and are classified,packed,marked,and <br /> ^ae ec = 'e c =---:= c=- `a .b^•:a• ^Y rc ppo•co_�e s`a'e ena notional government regulations. If I am a large quantity generator.I certify that I <br /> ^.o,e a c'cg': -c c_e'?'=._c ^s•c_-e r c'cY: - .•:cs-e pe^e-a-ec rc'r-e degree neve determined to be econamicclly oracticable and that I have selected the practicable method <br /> of treo*rre^.r.storcge. o'tz=: c_-er ,ava'co.e-c. .vn c,•rl^imizecithe oresert and future threaf fo human health and the environment:OR.if I am o small quantity generator,I have made <br /> a good fain effc�'o rr.:ni-.a-y Noste ge�ercr:cr.or-c elect the best waste monogemen,method that is available to me and that I can afford. All used oil from the generator listed above <br /> will be fransporea on:y'c a`aCi::`y perr.tteC b)•'ne$tot of Coiifamio to produce useo oil into recycled oil OR a facility that Is required to comply with Federal regulations oppricable to the <br /> management of;,sea ol'. A"re:eva^t I•+fo—otie-:egordi a down or suspected hozards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney <br /> ?ees incuned'n•t•e ce!�ec'a^of rhes cpri char,, we^ue fo pu, oses of this obli orlon shall be Ir Solano county. I declare under penaltyof perjury that the forgoing is hue and correct. <br /> DISPOSAL/RECYCLING FACILITY: Collection Station Industrial Agriculture Government Marine Other Industrial Lub lc ting <br /> EMI <br /> oil <br /> sewfanm'Dr.,rnsi <br /> eraiev \^J 9-9419 <br /> CIT19 Generators Signature Driver s Signature <br /> State'LRequires that you keep this Receipt/11111 of Lading on file no less than 3 years. <br /> To Re=A tivate or to:obtain on-EPA#-Customer may contact DTSC 0 t-a0n-AIA-A9A7 <br /> ZTT/5001() DNI SOAS ANH MfION21HA 66V£9VVL0LT XVd 69:9T TTOZ/ZZ/80 <br />