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ANIERICAN VALLEY ECEIVED, 107718 <br /> WASTE OIL, INC. nvoice Number: <br /> y{ 2A P. O. Box 340 • Delhi, CA 95315 DEC 19 2013 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> CAL000827878 a&NVIRONMENTALS-- <br /> HEALTH 0EPARTMF-NT- �� <br /> BILL TO: JOB SITE: Invoice Date: <br /> MERRY XRAY COMPANY MERRY XRAY COMPANY INC <br /> 1045 NATIONAL DR. 1045 NATIONAL DR <br /> SACRAMENTO.CA 95834 SACRAMENTO,CA 949 <br /> Phone Customer P.O. Terms EPA# <br /> I Net 30 Days tnoninni&q <br /> 916-92&0450 JOHN <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> .a J "t <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 C C 7 �1 11 <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 /> Tri ty Extended Life premixed Antifreeze <br /> Trinity Case Goods <br /> Truck Wash Out <br /> Truck lime <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. J / C <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.P.M;and that the waste does not <br /> contain any P.C.6's. I further agree to accept the additional charges for legal disposal if the waste is over 1000 RRM.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 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 <br /> ,generator that their w1ste 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 If%% �� <br /> AUTHORIZED G� <br /> SIGNATURE: DATE: �� SIGNATURE: ` r1 DATE:. <br /> - <br /> 01, NAME: <br /> ' ` -� DISPOSAL / RECYCLING FACILITY <br /> y: <br /> AOORESs: DK-DIXON <br /> /� 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 <br /> 916-371-5747 <br /> EPA#: EPA#CAT080012602 EPA#CAD044003556 <br /> MPC(4/2010) <br />