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I <br /> •AMERICAN VALLE ( C IV C Li o>ce Number:OIL, INC. <br /> P.O. Box.340`• Delhi, CA 95315 JUN 2 4 2015 <br /> PH. 1-800-732-4645 • FAX 209-668 880 <br /> CAL000827878 NVIRONMENT/�U <br /> NFA!TFInFoeoree�n)Y'� ,[,,C � �� <br /> BILL TO: JOB SITE: <br /> ACME SO LW Invoke Date: <br /> 214 K CRAMENTO ST. <br /> STOCKI'ON,CA 95206 LODI,CA 95240 <br /> SM OIL <br /> Phone Customer P.O. Terms EPA# <br /> Net 30 De ys CAL000316056 <br /> PRODUCT SHIPPING DESCRIPi ION WASTE MANIFES1 QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used I it/Mixed Oils 221 r tJ t�7 <br /> i <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> NON Hazardous Waste Liquid <br /> Trinity Heavy Duty premixed Antifreeze <br /> I <br /> Trinity Extended.Life premixed Antifreeze <br /> unity Case Goods <br /> Truck Wash Out <br /> i <br /> Truck Time <br /> TERMS: Invoices over 30 Days are subject to a 1.5%service charge. Customer agrees to pay all lega fees if court action 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 re less than 1000 P.P.M;and that the waste does not <br /> contain any P.C.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 arx 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 rr ay 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 ft e more stringent requirements applicable to hazardous <br /> waste management facilities.California facilities that handle or process used oil are required to mee those more stringent requirements,and some outof- <br /> state facilities that process used oil also meet those requirements, engineering certifications of to ik 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 federa used oil management standards and not these more <br /> stringent requirements. I <br /> This notification is for information purpose's only. <br /> GENERATOR/ <br /> DRIVER "� �A" .� AUTHORIZED , -- <br /> SIGNATURE// `�, 1 DATE: -.��` i i SIGNATURE. <br /> DATE. ! <br /> O NAME: ! DISPOSAL/ RECYC ING FACILITY <br /> ADDRESS: -01DK-DIXON O RAMOS ENVIRONMENTAL SERVICE <br /> CITY/ST: 7300 CHEVRON NAY 1515 SOUTH RIVER ROAD <br /> DIXON,CA 956 0 W.SACRAMENTO,CA 95691 <br /> PHONE: ! 707-693-6006 <br /> 916-371-5747 <br /> EPA#: EPA If CAT06001 602 EPA#CAD044003556 <br /> MPc(92010) <br />