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BILL TO: KHANS AL JTO <br />720 E, LODI <br />1-001 CA 9 Y240 <br />Phone <br />209-367-9870 MATHEVV <br />AMERICAN VALLEY <br />WASTE OIL, INC. <br />P- O- 13ox 340 • Delhi, CA 95315 <br />PH_ 1-800-732-4645 • FAX 209-668-3880 <br />EPA. CAL000827878 <br />JOB SITE: KHA►k9 AUTO <br />%-: L (;moi <br />LODE . SCA 3524« <br />Customer P.O. Payment Terms <br />C.O O. <br />PRODUCT SHIPPING DESCRIPTION <br />WASTE <br />CODE <br />USED OIL NON RCRA HAZARDOUS <br />WASTE LIQUID <br />221 <br />USED AUTOMOTIVE ANTIFREEZE, NON <br />RCRA HAZARDOUS WASTE LIQUID <br />343 <br />OILY WATER, NON RCRA HAZARDOUS <br />LIQUID <br />221WASTE <br />TRINITY HEAVY DUTY PREMIX <br />RECYCLED ANTIFREEZE <br />N/A <br />NON HAZARDOUS WASTE LIQUID <br />TRUCK TIME <br />WA <br />GREASWEEP N/A <br />Trinev E:xtexOed Lae Premix rpcycled Anttlr+eez <br />Invoice Number: <br />Invoice Date: <br />EPA# <br />CAI.00W32'331 <br />MANIFEST OUANTITY <br />PRICE I AMOUNT <br />I hereby .certify that I have not mixed this waste with any other waste, that the totai helidee are lase than 1000 P P.M_: and rat _ <br />the waeta dost not contain any P.C.B.'a. I further agree b accept the additional charges ler legal disposal it this waste is over TOTAL S ' <br />1000 P.P.M. total halides, or contains any PC -13-'s, <br />GENERATOR/ AUTHORIZED <br />DRIVER -. _ , .•• ,. � <br />SIGNATURE SIGNATURE SIGNATURE <br />TERMS- INVOICES OVER 30 SAYS ARE SUBJECT TO A 1.5% SERVICE CHARGE, CUSTOMER AGREIN TO PAY ALL LEGAL FEES IF <br />COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. , that le raquWed to 00"" <br />AnWk an Valley Wroth <br />asta 01 hoby advises e above Generator the Generators shipment of used al may be transported a pyo to haaardoue <br />whh federal rWdaWn S appllmbl management with the more strip requiremet'ab applies <br />e b mane meet of used oil, but that le not required t0 comply tib <br />wastB management fadlltlas• California facilities that handle or process used oil are required to meet !twee more stringent rttpuirafttsnls. and !horde cul of - <br />state facilites that process used ON also meet those requirements, engineering certifications of tank integrity. and financial assurarwai for ciosurs anti <br />acoWarriW releases. N is lawful to send used oil to out-011-9t8te faculties that comply only with federal used oil management standards and not these more <br />stringent r,equirernents. <br />This n6iflicatlon is for information purposes only. <br />Dam Generator signed Oats <br />Driver signed to <br />, reduce the vdume or quantity and .toxicity of the Hazardous <br />By signing Iia invoice aha gane►ator certifies that the generator has established a program <br />waste to the degree, as determined by the generator, to be economically practicable. <br />By both patties signing this involos it will serve as an agreement that Amertcan Valley will sutxnit oortflmmations ler (certain vastus tttfeltrns) to time ypttarotor <br />that their waste has bean transported to a license treatment or transfer facility. <br />Y Al <br />O RIVERBANK OIL TRANSFER O RAMos ENVIRONMENTAL SERVICES <br />5300 CLAUS ROAD • RIVERBANK, CA 95367 1515 SOUTH RIVER ROAD • W. SACRAMENTO, CA 96691 <br />209-863-8181 • EPA N CAL000190816 916-371-5747 • EPA it CA0044003666 <br />LB 39Vd A30d d QNV Q TZ9Z69C60Z 9s:ze 666T/5T/50 <br />