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BILL TO: <br />AMERICAN VALLEY 124033 <br />WASTE OIL, INC. Invoice Number: <br />P. Olfbx 340 • Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />EPA# CAL000827878 <br />Y <br />JOB SITE: �"y1a$ `�a t s K r r_; S Invoice Date: <br />fes' r � �('�'t ��•�2 rrm.. <br />7 , t r , , ,&- j f 0 64'—/ /V l.% —V — <br />Phone <br />Ctistorner P.O. <br />Terms <br />E/PA# a o <br />PRODUCT" SHIPPING DESCRIPTION <br />WASTE <br />MANIFEST <br />QUANTITY. <br />PRICE <br />AMOUNT <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />U! <br />C. <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 />TERMS: Invoices over 30 Days are subject to a 1.5% service charge. Customer agrees 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 the waste described above with any other hazardous waste, the total halide content is LESS than 1,000 ppm, <br />and the waste does not contain any PCBs. l have complied with the requirements of the. applicable California used oil management regulation to determine this Is <br />true. I agree to accept the additional charges for the disposal of this waste If the info'rr'r` ti i have provided about this waste is Incorrect. <br />Generator's Certification: By signing I certify that If I am a large quantity generator, I certify that I have a program In place to reduce the volume and toxicity of waste <br />generated to the degree )-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 tome that I can afford. <br />By both parties signing this invoice it will serve as an agreement that American Valley Waste 011 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 />t <br />` GENERATOR/ <br />DRIVER �, ,ti# �J /AUTHORIZED � <br />� 1 <br />SIGNATURE: SIGNATURE: DATE: <br />lel <br />it..SS — <br />DI P SAL / RECYCLING FACILITY• <br />K-DIXON O CFR O UNITED ENTERPRISES CORP , I V <br />7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE ST. <br />DIXON, CA 95620 LA, CA 90021 SUN VALLEY, CA 91352 Q <br />213-746-0237 818-787-2649 SEP 0 8 2011,1 <br />707-693.6008 <br />EPA# CAT080012602 EPA# CAL000270577 EPA# CAL000379059 <br />�cni�nQnntnl�cniTn r <br />- n ,WC (612013) <br />_ - t=QrU CO�C� �Ac�l <br />