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AMERICAN VALLEY <br />WASTE OIL, INC. <br />P. 0. Box 340 • Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX .209-668-3880 <br />EPA# CAL000827878 <br />C&S WHOLESALE <br />BILL TO: 4199GABRALTOR JOB SITE: (;&3Wt-110LEGALE <br />STOCKTON, CA 95205 4199 GIBR/- LTOR <br />STOCK'f ON. CA 052105 <br />wiILS Reri f r <br />136535 <br />Invoice Number: <br />Invoice Date: <br />Phon"M-234-4687 WAM.' <br />Customer P.O. <br />TermsNel,30 <br />EPA#r;.,�j <br />Days <br />t�rx1^22c. r� <br />PRODUCT SHIPPING DESCRIPTION <br />MANIFEST <br />QUANTITY <br />PRICE <br />AMOUNT <br />WASTE <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />?�� w�� <br />7, <br />J- <br />(00`� <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 />PRICES+WF HA1/E BEEN FORCED TO <br />CHANGE PRICING FOR A 1' AND, - <br />FILTER PICK UP.. <br />f <br />Sales rax <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 />'becomes <br />TOTAL <br />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. I 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 information I have provided about this waste is incorrect. <br />fI <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 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 />,+ —GENERATOR/ <br />DRIVER^^ f Z ( AUTHORIZED <br />'V_ <br />r ? �= <br />SIGNATURE:4_'_'1_DATE: SIGNATURE ! :' DATE: <br />DISPOSAL / RECYCLING FACILITY <br />DK-DIXON O CFR ' O UNITED ENTERPRISES CORP REGFivEL <br />7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE$T. <br />DIXON, CA 95620 LA, CA 90021 SUN VALLEY, CA 91352 <br />SEP 0 8 2r"." <br />707-693-6008 213-746-0237 818-787-2649 <br />EPA# CAT080012602 EPA# CAL000270577 EPA# CAL000379059 <br />MPC (6/2013) <br />