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AMERICAN VALLEY 110 3 <br /> WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> CAL000827878 <br /> BILL TO: JOB SITE: n oice Date: <br /> JIM THORPE OIL INC CITY OF LODI CORP YARD <br /> P.O.BOX 357 1331 S.HAM LN <br /> LODI,CA 95241 LODI,CA 95240 <br /> Sales Rep:Steve <br /> Phone `' Customer P.O. Terms EPA# <br /> 209-462-4581 .� Net 30 Crays CAC002586896 <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 <br /> V <br /> NON Hazardous Waste Liquid <br /> Trinity Heavy Duty premixed Antifreeze <br /> Trinity Extended Life premixed Antifreeze <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 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 P.RM;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 PC.B's <br /> By signing I G y e a program in place to the toxicity of hazardous waste:generated to the degree I <br /> Generator's Certification: B si nin I certify that I hav <br /> -ha <br /> Byvbothpaies determined gn to be <br /> this nvoicel1t will asoma <br /> ' 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 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 some out-of- <br /> state facilities 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 AUTHORIZED <br /> SIGNATURE. ,? „ DATE: SIGNATURE: DATE: 1 <br /> 0 NAME' DISPOSAL / RkYCLING FACILITY <br /> ADDRESS: 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(4/2010) <br />