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AMERICAN VALLEY <br />WASTE OIL, INC. <br />P. O. Box 340 • Delffl�CA 95315 <br />PH. 1.800-732-4645 • FAX 209-668-3880 <br />CAL000827878 <br />BILL TO: VALLEY TOW PROP <br />1313 S. STOCKTON JOS SITE: VALLEY TOW PROD <br />1313 S. STOCKLON <br />LORI, Cit 96208 LODI, CA 95246 <br />105159 <br />Invoice Number: <br />12--Z,2---(i <br />Invoice Date: <br />.res rrap: Rc,.-( <br />P 8-4455 MARTIN Customer P.O. Ter EPA# <br />N& 30 <br />Days CAL000348278 <br />PRODUCT SHIPPING DESCRIPTION <br />WASTE MANIFEST QUANTITY PRICE AMOUNT <br />CODE <br />NON-RCRA Waste Liquid Used OiVMixed Oils <br />221 <br />A> G] <br />(N (OCDy3 f' ! <br />f <br />t <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />NON Hazardous Waste Liquid <br />Trinity Heavy Duty premixed Antifreeze <br />Trinity Extended Life premixed Antifreeze <br />Trinity Case Goods <br />— I <br />Truck Wash Out <br />Truck Time <br />TERMS: Invoices over 30 Dacha <br />ys are subject to a 1.5% service rge. Customer agrees to pay all legal fees If court action <br />becomes necessary to collect this invoice. <br />TOTAL <br />ey signing I herby candy that I have not mixed this waste with any other waste, that the total halides are 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 it the waste is over 1000 P.P.M. total halides, <br />or contains any PC B's i <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 I <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 compiv <br />with federal regulations applicable to management of used oil, but that is not required to comply <br />with the more stringent requirements applicable to hazardous <br />waste management facilities. California facilities that handle or process used oil are required to meet those more stringent requirements, and sone out-of- <br />state facilities that process used oil also meet those requirements, engineering certifications <br />of tank integrity, and financial assurances for closure and <br />accidental releases. it is lawful to send used oil to out-of-state facilitles that comply only with federal <br />stringent requirements. used oil management standards and not these more <br />This notification is for information purposes only. <br />DRIVER ,—, f GENERATOR/.77 <br />SIGNATURE: DATEI�'�(�T( /SIGNATURE: DATE:.' <br />0 NAME: <br />ADDRESS <br />DISPOSAL/ ECYCLING FAC7RAMOS <br />DK-DIXON amsr: O MENTAL ERVICE <br />7300 CHEVRON WAY 5 SOUTHR RIVER <br />ER ROAD <br />PHONE, DIXON, CA 95620 <br />W. SACRAMENTO, CA 95691 <br />707-693-6008 916-371-5747 <br />EPAa. EPA # CAV, 012602 EPA # CAD044003556 <br />MPC W2010] <br />