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— AMERICAN VALLEY _ 1 1 7 6 4 0 <br /> WASTE OIL, INC. Invoice Number: <br /> P. O.Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 a FAX 209-668-3880 <br /> EPA#CAL000827878 <br /> BILL TO: JOB SITE: \Invoice Date: <br /> h •v ,y.1 �c �,;.,, <br /> Phone Customer P.O. Terms EPA# <br /> t- p <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 224 <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 few I court action 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 PCli 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 information 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 dace 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 minim¢es the present and future threat to human life and the environment:Or,B I am a small quantity generator,1 have made a good faith <br /> effort to minimise my waste generation and select the waste management method that is available to me that I can afford. <br /> By both patties 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 /> GENERATORI <br /> DRIVERII -� AUTHORIZED <br /> E: OiAr -._. <br /> SIGNATURE - ! SIGNATURE: DATE:: <br /> DISPOSAL/ RECYCLING FACILITY <br /> O 15'K-DIXON00CHEVRON <br /> O CPR O UNITED ENTERPRISES CORP RECEIVED <br /> 7300 CHEVRON WAY 2035 E.15TH ST. SUN PLLEY,C ST. <br /> DIXON,CA 95620 LA,CA 90021 SUN VALLEY,CA 91352 - <br /> 707-693-6008 213-746-0237 818-787-2649 <br /> EPA#CAT080012602 EPA#CALD00270577 EPA#CALOOD3790.59 0 C T 18 2013 <br /> ENVIRONMENTAI.,WIM IWO i3) <br /> HEALTH DEPARTMENT <br />