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AMEmCAN VALLEY <br />WASTE OIL, INC. <br />P. O- Box 340 • Dethi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />EPA. CAL000827878 <br />BILI. TO: JOB SITE: I�1,A;!'4S, AUTO' <br />K�-fAt�4�; AUTO <br />720 E- LORI 720 E LOD! <br />LODI. CA 95240 L001, C -A 95240 <br />K.,— i-� <br />�13)d1.34 <br />Invoice Number: <br />Invoice Date: <br />Phone <br />Customer P.O. <br />Payment Terms <br />EPA# <br />:O9 -;367 -987th MATHEV�! <br />�;. ;;. �, <br />Ci -10003K.1331 <br />PRODUCT SHIPPING DESCRIPTION <br />WASTE <br />MANIFEST <br />QUANTITY <br />PRICE <br />AM <br />VIP". <br />CODEA <br />USED OIL NON RCRA HAZARDOUS <br />WASTE LIQUID <br />221 <br />ODS.. <br />USED AUTOMOTIVE ANTIFREEZE, NON <br />jr <br />RCRA HAZARDOUS WASTE LIQUID <br />343 <br />OILY WATER, NON RCRA HAZARDOUS <br />WASTE LIQUID <br />221 <br />TRROTY HEAVY DUTY PREMIX <br />RECYCLED ANTIFREEZE <br />N/A <br />NON HAZARDOUS WASTE LIQUID <br />TRUCK TIME <br />N/A <br />GREASWEEP <br />N/A <br />Trinity Dden f -d Lite Premix T-gy ltM Afrtifr z. <br />I � tl i hm not "toed this waste with arty other waste, that the taw halides are lees than 1000 P.P.M.: and that <br />It w contain any PC.B.'s. I furttwr agree to accept the additional charges for legal disposal if this waste k am <br />1000 or contar,es RC.B.�s. TOTAL <br />DRIV GENERATOR AUTHORIZED - <br />SI(3NATttE SIGNATURE SIGNATURE <br />INVOICES OVER 30 DAYS ARE SUBJECT TO A 1.5% SERVICE CHARGE. CUSTOMI`R A13R4ES.TO-PAY ALL LE13AL FEES IF <br />kCTION BECOMES NECESSARY TO COLLECT THIS INVOICE. <br />Arriori®n Valley Waste Oti hereby advises the above Generator the Generators shipment of used oll may be transported to a tsr liity that is regtrked to oomtply <br />with federal regulations applicable 10 management of used oil, but that Is not required to comply wMh the mors sh*Vent requirements applicable to ha"Fdous <br />waste ffNUUQsment %dtitles. California facilities that handle or process used oG are required to most those more stdrKWd roquiremertti. and some out-of- <br />state fecNidss that process used oll also meet those requirements, ongineering cer0f ations of tank r&Kpfly, arxi financial assurancee for closure And <br />acoidentdl releases. It is lawful to send used oll to out-of-state fadliWs that comply only with federal used oil management standands and not Uwe mow <br />stringent requirenvu t9. <br />This notification is for inlorrnation purposes only. <br />�J <br />Drkw 04� Date Generator signed <br />By ung the Invotl$tl generator certifies that the genera r has estWlshed a program to reduce the. voiume or quantity and toxi&y of the hazardaws <br />Waste to Ur deprse. as dabflt*W by the Wmator, to be socnornioelly practicable. <br />By both parties signing this Invoice It will serve as an agreement that American Valley will submit confirmations for (certain waste streams) to the generator <br />that t ok wwte has been bwvgx W to a license treatrrmtt or tenter fadlity. <br />DISPOSALL RECYCLING FACILITY <br />O RIVERBANK OIL TAANWER <br />5300 CLAUS ROAD - RIVERBANK, CA 95367 <br />209-863-5181 - EPA a CAL0001 goal 6 <br />80 30Vd >130d d QNV Q <br />O RAMOS IDWONMENTAL SERVICES <br />1515 SOUTH RIVER ROAD • W. SACRAMENTO, CA gmi <br />918-371-5747 - EPA s CA00440OS556 <br />1Z9Z69CG0z 99:Z0 6667151150 <br />