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AMERICAN VALLEYjb� a 13 3 418 <br />�6 cgs , <br />WASTE`OIL, INC. n; '" Invoice Number: <br />P. O. Box 340 Delhi, CA .95315 C <br />- PH. 1=800-732-4645' • FAX 209-668-3880 <br />EPA# CAL000827878 <br />C&S WHOLESALE <br />BILL TO: 4199 GIBRALTOR JOB SITE: 419 1l� ESALE <br />4199 GIBkIiLTOR Invoice Date: a <br />STOCKTON, CA 95205 STOCKTON, CA 95205 <br />i <br />Sales Rep <br />f1 t ct.s ul:a.ri ,Y'f���s'toct? c' <br />'Phonwog-234 4687 VFW <br />Customer P.O. <br />Termsllet 30 Days <br />EPA#CAL000332679 <br />i Y7 2-r!a �, (7 6� <br />PRODUCT SHIPPING DESCRIPTION <br />WASTE <br />MANIFEST <br />QUANTITY <br />PRICE <br />AMOUNT <br />CODE <br />' NO.N-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />3�`� <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />Drained Used Oil Filters <br />_ <br />_ <br />PRICES,WE HAVE BEEN FOFiGEfJ TO <br />CHANGE PRICING FOR WASTE OIL AND <br />f-Iti-EIR PICKUP,WEAiwa <br />TaxI <br />TERMS: Invoices over 30 Days are subject to a 1.5% service charge. CustQtl_r &groes to.pay all legal fees if court action <br />TOTAL <br />becomes necessary to collect this invoice. <br />By signing I herby certify that I have not mixed any of t1fe waste described above wlt any other hazardous waste, the total halide content is }.ESS than 1,000 ppm, <br />and the waste does not contain any PCBs. I have complied with the requirements of the applicable California used oil management regulation to determine this is <br />true. 1 agree to accept the additional charges forthe disposal of this waste if the Information I have provided about this waste Is incorrect. <br />Generator's Certification: By signing l certify that if I am a large quantity generator, I.certi#q that I have a program in place to reduce the volume and toxicity of waste <br />generated to the degree I have determined to be economically affordable and that I,have selected the practicable method of treatment, storage, or disposal currently <br />available to me which minimizes the present and future threat to human life and the environment: Or, if I am a small quantity generator, I have made a good faith <br />effort to minimize my waste generation and select the waste management method that is available to me that I can afford, <br />By both parties signing this Invoice it will serve as an agreement that American Valley Waste Oil will submit confirmation for (certain waste streams) to the generator <br />that their waste has been transported to a licensed treatment or transfer facility. / <br />' <br />iENERATOR/ <br />DRIVER c -'-r /''AUTHORIZED r jar �. <br />`r' <br />SIGNATURE: DATE: SIGNATURE:: -„ DATE: <br />DISPOSAL/ BECYCLING <br />ISPOSAL/.RECYCLING FACILITY ; <br />1 DK-DIXON O CFR O UNITED ENTERPRISES CORP RECEIVEL. <br />7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE ST. <br />DIXON, CA 95620 LA, CA 90021 SUN VALLEY; CA 91352 p <br />213-746-0237 818-787-2649 SEP O S % 1 <br />707-693-6008 <br />EPA# CAT080012602 EPA# CAL000270577 EPA# CAL000379059 <br />KITAI <br />-rr r�r..�••.'. ,,�..,— MPC (&2013) <br />