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BILL TO: <br />• AMERICAN VALLEY* <br />WASTE OIL, INC. <br />P. O. Box 340 • Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />CAL000827878 <br />Invoice Number: <br />JOB ,SITE: <br />Invoice Date: <br />Phone <br />Customer P.O. <br />Terms. <br />EPA# <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 />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />f <br />NON Hazardous Waste Liquid <br />Trinity Heavy Duty premixed Antifreeze <br />Trinity Extended Life premixed Antifreeze <br />J <br />r <br />Trinity Case Goods <br />Truck Wash Out <br />Truck Time <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 this waste with any other waste, that the total halides are less than 1000 PPM; and that the waste does not <br />contain any RC.B's. I further agree to accept the additional charges for legal disposal if the waste is over 1000 P.P.M. total halides, or contains any. P.C.B's <br />Generator's Certification: By signing I certify that I have a program in place to reduce the volume and toxicity of hazardous waste generated to the degree I <br />have determined to be economically practicable. <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 <br />generator that their waste has been transported to a licensed treatment or transfer facility. <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 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 />statefacilities that process used oil also meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and <br />accidental releases. It is lawful to send used oil to out-of-state facilities that comply only With federal used oil management standards and not these more <br />stringent requirements. <br />This notification is for information purposes only. <br />GENERATOR/ <br />DRIVER,GJ.' r "p,^� AUTHORIZED11 <br />SIGNATURE ° r �;-y :. DATE //, // SIGNATURE: DATE. <br />c r �/ �r <br />O NAME: DISPOSAL / RECYCLING FACILITY <br />ADDRESS: V DK-DIXON O RAMOS ENVIRONMENTAL SERVICE <br />CITY/ST: 7300 CHEVRON. WAY 1515 SOUTH RIVER ROAD <br />DIXON, CA 95620 W. SACRAMENTO, CA 95691 <br />PHONE: 707-693-6008 916-371-5747 <br />EPA#: EPA# CAT080012602 EPA # CAD044003556 <br />MPC (412010) <br />