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,e ocnu rayrncrn rv. <br /> 2355 Road 192, Delano CA 93215 <br /> ® r r <br /> Ph : 209-863-0888 Fax : 209-863-0887 <br /> EPA#CAL000367042 ID#46-0727047 <br /> .Job Site : LIC.AND INSURED TRANSPORTER#3468 MCP#CA 130615 <br /> GENERATOR <br /> Site EPA ID# 2 70 Invoice No. M ¢ <br /> Contact Person <br /> r <br /> Company Bill To :Namm�^—� t , <br /> Address Name <br /> City, State,Zip Address <br /> Site Phone ; _ ( — c City, State,Zip <br /> Date �/ Customer PO Interval Net 30/C.O.D./Cash/Check Driv Truck/Name <br /> ( ti �7 <br /> PRODUCT waste code CA Manifest# Quantity Units Price Amount <br /> Non-RCRA Hazardous Waste Liquid(Used Oil) 4 '' <br /> Non-RCRA Hazardous Waste Liquid(Oil&Water) 223 �j r P c= Gal ! o <br /> Non-RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 133 Gar <br /> Non-RCRA Hazardous Waste Solids Contaminated Drum(s) <br /> Non-RCRA Hazardous Waste Solids Contaminated with Used Oil Dws(s) <br /> Drained Used Oil Filter Drum(s) � I51 <br /> Empty Drum(s) <br /> Fad <br /> Transportation&Truck Time&Washout <br /> HR <br /> Hazardous Testing <br /> We pay❑ Customer Pays <br /> Unless otherwise specified on this onsolidated Manifest Receipt(Invoice)Terms:Accounts due on the 10th of the month following Total <br /> month of purchase.Past due accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1.5%per month,which is the / �' 6 <br /> ANNUAL PERCENTAGE RATE OF I8%. v' <br /> I hereby certify that I have not mixed this waste with any other waste that the total halides are less than 1000 PPM,and that the waste does not contain <br /> any PCB's.I further agree to accept the additional charges r-legal disposal If this,waste is over 1 OOUEM,total halides,or contai s any PCB's <br /> GENERATORor <br /> AUTHORIZED: /,,) t"I''d DRIVER SIGNATURE: , <br /> TERMS:INVOICES OVERDO DAYS ARE SUBJECT TO A 1.5%SERVICE CHARGE CUSTOMER AGREED TO PAY ALL Lt GAL FEES OF COURT <br /> ACTION BECOMES,NECESSARY TO COLLECTTHIS INVOICE. <br /> Kem Oil here by advises the above Generator that Generators shipment of used oil may be transported to a facility that is required to comply with federal <br /> regulations applicable to management of used oil.But that is not required to comply with the more stringent requirements applicable to hazardous waste <br /> management facilities.Kem Oil Filter Recycling is authorized to file a request for EPA#from DTSC.California facilities that handle or process used oil are <br /> required to meet those more stringent requirements,and some out_of-state facilities that process used oil&also meet those requirements,engineering <br /> certifications of tank integrity,and financial assurances for closure an accidental releases.It is lavfiul to send used oil to outof-state facilities that comply <br /> only with federal used oil management standards and not those more stringent requirements By signing the invoice the generator certifies thatthe generator <br /> has established a program to reduce the volume or quantity and toxicity of the hazardous waste to the degree, as determined by generator, to be <br /> economically practicable.By both parties signing this invoice itwill serve as an agreement that Kem Oil will submit confirmations for(certain waste streams) <br /> to the generatorthat theirwaste has been transported to a licenced treatment or tmnsferfacility. <br /> Riverbankr NAME NAME <br /> 530Claus Rd,Bldil g 11 ADDRESS ADDRESS <br /> Riverbank,CA 95387 CITY CITY <br /> Ph:209-863-0888 Fax:209-863-0987 STATE,ZIP STATE,ZIP <br /> EPA#CAL0001 90816 PHONE PHONE <br /> EPA ID EPA ID <br />