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AMERICAN VALLEY .� 89881 <br /> WASTE OIL, INC. Invoice Number: <br /> P.O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA. CAL000827878 P `+ <br /> Invoice Date: <br /> BILL TO: JOB SITE: MANTECA. TIRE <br /> M.ANT ECA TIRE 201 W. EOISON <br /> 201 W. EDISON MANTECA, CA. 95336 <br /> MANTECA, CA 95336 <br /> Sales Rep:iG eol, 1 <br /> Phone Customer P.O. Payment Terms EPA# ss <br /> 209-239-3553 GREG Net 30 Days 1 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> USED OIL NON RCRA HAZARDOUS <br /> WASTE LIQUID 221V <br /> USED AUTOMOTIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> OILY WATER, NON RCRA HAZARDOUS 221 <br /> WASTE LIQUID <br /> TRINITY HEAVY DUTY PREMIX N/A <br /> RECYCLED ANTIFREEZE <br /> NON HAZARDOUS WASTE LIQUID <br /> TRUCK TIME N/A <br /> GREASWEEP N/A <br /> Trinity Ex erld,-�Nl Life Premix recycled Ardi <br /> I hereby cerfify that I have not mixed this waste with any other waste,that the total halides are less than 1000 P.P,M.;and that ,r <br /> the waste does not contain any P.ce.s.I further agree to accept the additional charges for legal disposal if this waste is over TOTAL f 4 <br /> 1000 P.P.M.total halides 6r' ontainee an__P-C.B:s. <br /> DRIVER ' GENERATOR AUTHORIZED <br /> SIGNATURE ` l��-t � 7�, ✓`"� SIGNATURE SIGNATURE <br /> TERMS:INVOICES 9VER 30 DA S ARE SUBJECT TO A 1.5%SERVICE CHARGE.CUSTOMER AGREES TO PAY ALL LEGAL FEES IF <br /> COURT ACTION BECOMES NE ESSARYTO COLLECT THIS INVOICE. <br /> American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may be transported to a facility that is required to comply <br /> with federal regulations applicable to management of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities.California facilities that handle or process used oil are required to meet those more stringent requirements, and some out-of- <br /> state facilities that process used oil also meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and <br /> accidental release�-4 lawful to send used oil to out-of-state facillt es that comply only with federal used oil management standards and not these more <br /> stringent requirements. { - " / —• <br /> This notification is for r ion p<Trposes only. "" `-1 <br /> Driver signed_ 9''1 -✓ Date T : rte` Generator signed <br /> By signing the in the en ator certifies that the generator has established a program to reduce the volume or quantity and toxicity of the hazardous <br /> waste to the degr e,as determined by the generator,to be economically 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 their waste has been transported to a license treatment or transfer facility. <br /> DISPOSAL I RECYCLING FACILITY <br /> 01 DK-DIXON O RAMOS ENVIRONMENTAL SERVICES <br /> 7300 CHEVRON WAY•DIXON,CA 95620 1515 SOUTH RIVER ROAD•W.SACRAMENTO, CA 95691 <br /> 800-727-2879•EPA#CAT080012602 916.371.5747•EPA#CAD044003556 <br /> MPC(otao <br /> 0l'd 9ZLL-6£Z-60Z )PUBS USA f,106eJO 699:60 Ol b0 )00 <br />