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FREMOU 0 ET <br /> 3_WED IRONMENTAL SWZVICES9 INC. <br /> Send Pa-.Intent to: Pbonc: 8 -559- EPA #CAROOO 171017 <br /> P.O. Box 28"5 Pbone: 70 U.S.D.O.T.*1484667 INVOICE # <br /> !0 <br /> Vacaville.Ca 95696-2875 Fax: 70 8-3499 D.T.S.C.#3544 <br /> wwwhazwasteremovalxom CA#274461 Date <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer f-2 n r <br /> rj�)n TIre Customer L`ij­zln:jar, I !re <br /> 4 <br /> 520 i <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 /> -A-i <br /> Empty Drums Provide Remoe O 5g 13 10g U 15g U 30g E3 55g LI S P F <br /> Clor-D-Tect Q4000 Test Kit: Test Q Pc ss El Fall E3 Generator Knowledge C3 PPM <br /> Transportation Charges/Additional Tn_ck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels Oil A/F <br /> TUOF Oily Debris <br /> SERVICES REQUESTED BY I TAXI I <br /> We <br /> AcceDt = WE 1-0 P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: -- ---:,--:s=0,57r�,y and OCC-jrWely described above by proper shipping name and are classified,packed,marked,and <br /> e.-::L c.-�;r,,cy::cccr6.rg-o apoticabie state and notional government regulations. If I am a large quantity generator,I certify that I <br /> ro'. v a' <br /> .r <br /> have 0 P,ogrctrrm 3:cs -•ea.;ce,,e ,c Lrne, ,asie generated to the degree;have determined to be economically practicable and that I have selected the practicable method <br /> of treatment,storage.a 1;ccsc' L.�erryo,c�abielo�. which minimized the present and future threat to human health and the environment:OR,if I am a small quantity generator,I have made <br /> 0 go dfoith effo—z ­:,;^'s;ze—,c_os,e geercJo­znc�s ec't-.,ie best-oste mcnagemert method that is available to me and that I can afford. All used oil from the generatorlisted above <br /> 0 1 1 <br /> will be nspc�"e�c- ,c 3 ce,-!'ec b,-'le S'at o'Cc`o,n;a lo croduce used oil into recycled oil OR a facility that is required to comply willlf FeAde(ol regulations applicable to the <br /> _01age e-,c,_sec regara; c r Suspected hazards associated with!his waste has been disclosed. The customer ay reasonable costs and attorney <br /> ' '-c--ec , ! t �no-,n a <br /> less. -e zz e::-*:,, s on;sgo*�c-.. Venje$a Lfaoses of this obligo on shall be in Soil no'counly. I declare under penalty of pZ%jrY that 1�ge'�"2%20inpi is true and correct. <br /> DISPOSAL/RECYCLING FACILITY: ollecYon Station Industrial Agriculture Govemment Marine I Other I oInduIrtllrial u_bdcallng 1 <br /> Oil <br /> ,,is,".'erikint kM] <br /> Or..Ea-311 <br /> 17-1.Y INE 9r 3i£ <br /> Print;Name Generator's Signa re <br /> Drive ks-Qn0ture <br /> State La ReciLlilres that you keep this ReCelpl/Blll of Lading an file no less than 3 yes. <br /> To Re.-A ivate or to obtain an EPA#-Customer mov r.nntnrt nT.,,r a i-Ann-/i A-AcA <br /> ZTT/900[n OKI SOAS ANH AfIONaNA 666CRVVLOLT YV3 69:CT TTOZ/ZZ/90 <br />