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A-WuJCA1v VALLEY* 122052 <br />WASTE OIL, INC. Invoice Number. <br />P. O. Box 340 a Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />EPA# CAL000827878 <br />JIMTHORPEOILINC SAN JOAQUIN RTD <br />�3IL1Tn P.O.80X357 JOB SITE: 1533 LINDSEY voice Date: <br />LODI, CA 95241 STOCKTON, CA 95205 <br />Sales Rep: Steve CAD199 <br />Phone <br />Customer P.O. <br />Terms <br />EPA# <br />09-462-4581 <br />I <br />Net 30 Days <br />PRODUCT SHIPPING DESCRIPTION <br />MANIFEST <br />QUANTITY <br />PRICE <br />AMOUNT <br />WASTE <br />CODE <br />i <br />NON-RCRA Waste Liquid Used OU/Mixed Oils <br />i <br />1 221 <br />��� <br />:� 1 G <br />4-5 <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />i <br />223 <br />Drained Used Oil Filters <br />I <br />i <br />i <br />i <br />i <br />I <br />I <br />SA LES TAX - <br />i 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 />i /�Cl/1` <br />�( <br />I becomes necessary to collect this invoice. <br />1. `, <br />I By siening i herby rertifv that I have not mixed any of the waste described abate vAth any cther hazardcus waste, the total halide content is Liss than 1,lim ppm, <br />and the waste dans not contain any PCBs. I 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 />1 <br />Generator's Certification: By signing I certify that if I am a large quantity generator, i certify that I have a program in place to reduce the volume and toxicityof 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 />I available to me which minimizes the prreient and future threat to human life and the environment: Or, if I am a small quantity generator, l have made a good faith <br />effort to minimize my waste generatior u,.d select the waste management method that is available to me that I an afford. <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 generator <br />that their waste has been transported to a licensed treatment or transfer facility. <br />GENERATOR/ <br />DRIVER o J AUTHORIZED, <br />SIGNANRE: ',V,��/ OATE:J _ SIGNATURE: i � ° ATE, <br />j DISPOSAL I RECYCLING FACILITY <br />O-VK--D'IXON O CFR O UNITED ENTERPRISES CORP ` <br />7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE ST. <br />DIXON, CA 95620 LA, CA 90021 SUN VALLEY, CA 91352 <br />707-693-6008 213-746-0237 818-787-2649 <br />EPA4 CAT080012602 EPA# CAL000270577 EPA# CAL000379059 <br />MPG (&2013) <br />