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OCT. 2. 2009 2: 22PM ITC COLLISION DIVISION N0. 719 P. 2 <br /> AMERICAN VALLEY <br /> 89712 <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 <br /> C--6 -� <br /> Invoice Date: <br /> ,$ILL TO. JOB SITE: <br /> INTERSTATE COLLIPION DIVISION INTERSTATE COLLISION DIVISION <br /> P.0 BOX 6463 641 S. HARRISON.X; SCOTT <br /> STOCKTON, CA 85206 STOCKTON, CA 95206 <br /> 6 MO. SCH <br /> Phone Customer P.O. Payment Terms EPA# <br /> 208-467-3561 ROGER Net 30 Days CAR0001'20543 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY <br /> CODE PRICE AMOUNT <br /> USED OIL NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 <br /> QED AUTOMOTIVE ANTIFREEZE, NON <br /> 9 CLIA-HAZARDOUS WASTE LIQUID 343 <br /> 11LY"NVATER, NON RCRA HAZARDOUS <br /> ' , iIVASTE,LIQUfD - 221 <br /> ki', TRINITY HEAVY DUTY'PREMIX <br /> ;4:RECYCLED 'ANTIFREEZE NIA <br /> ANON HAZARDOUS WASTE LIQUID <br /> .,t <br /> TRUCK TIME N/A <br /> GREASWEEP N/A <br /> Trinity Extended Life Premix recycled Arttifleez ' <br /> _ I hereby cerli y that I have hot mixed this waste with any other waste,that the total halides are less than 1000 p;P.Vl andrth <br /> the waste does not contain any?.C.e.'s.I further agree to accept the additional charges for legal disposal rf this we <br /> 1000 P.P.M.total halides,or contalnes P.C.S;s. r � " J. <br /> t` DRIVER GENERATOR/AUTHORIZED <br /> SIGNATURE SIGNATURE / SIGNATURE <br /> TERMS;INVOICES OVER 30 DAYS ARE SUBJECT TO A 1.5%SERVICE CHARGE.CUSTOM E5$':" WALL LEGAL FEES IF <br /> COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. <br /> + American Valley Waste Oil hereby advises the above Generator the Generators shipment of used ell m e transported to a facility that is required to comply <br /> with federal regulations applicable to management of used ell,but that Is not required to comply with the more stringentrequirements applloable4o hazardous <br /> waste management facilities.California facilities that handle or process used oil are required to meet those more'stringent requirements,and some out-ef- <br /> state facilities that process used oil also meet those requirements, engineering certifications of tank Integrl and financial assurances for closure and <br /> accidental releases.It is lawful to send used ell to out-ot-state facilities that comply only with federal u oil anagement standards and not these more <br /> ..4, stringent requirements. <br /> This notlflcatlorVlBYpr formatio urposes only. _ <br /> Driver signed Data,/-6---/-c3 Generator signed Date <br /> By signing the invoice the generator certifies that the generator has established a program to r the Valu r quantity and loxlclty of the hazardo <br /> waste to the degree,as determined by the generator,to be economically practicable. <br /> Sy both parties signing this invoice it will serve as an agreement that American Valley will sub firm <br /> for(certain waste streams)to the generator <br /> that their waste has been transported to at license treatment or transfer facility. <br /> DISPOSAL I REC CLING FACILITY. <br /> �/ <br /> O DK•DIXON D RAMOS ENVIRONMENTAL SERVICES <br /> 7300 CHEVRON WAY•DIXON, CA 96620 1515 SOUTH RIVER ROAD•W.SACRAMENTO, CA 95691 <br /> 800-727-2878• EPA S CAT080012602 916371.5747•EPA 0 CAD044003550 <br /> ns+ctot.aoom <br />