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AMERICAN VALLEYT <br /> WASTE OIL, INC. Invoice Numbef <br /> ' P O Box 340 - Delhi, CA 95315 <br /> . PH 1-8001-732-4645 - FAX 209-668-3880 <br /> EPA CAL000827878 <br /> Invoice Date <br /> ' RILL TO. JOB SITE; <br /> Rik <br /> I b C r.- . <br /> ' Phone Customer P O Payment TermsEPA# <br /> ' PRODUCT SHIPPING DESCRIPTION WASTE IiMANIFESTa ' QUANTITY PRICE AMOUNT <br /> CODE <br /> USED OIL NON RCRA HAZARDOUS <br /> ' WASTE LIQUID 221 <br /> USED AUTOMOTIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> ' OILY WATER, NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 <br /> TRINITY HEAVY DUTY PREMIX <br /> CYCLED ANTIFREEZE N/A <br /> HAZARDOUS WASTE LIQUID <br /> ' TRUCK TIME NIA <br /> GREASWEEP NIA <br /> 1 I heri6QkelitiFMHha e- r&4d this waste with any other waste,that the total halides are less than 1000 PPM and that <br /> the waste does not contain any P C B's I further agree to acu-ept the additional charges for legal disposal if this waste is over TOTAL <br /> 1000 PP M total halides,or contames any P C B's <br /> ' DRIVER GENERATOR/AUTHORIZED <br /> SIGNATURE SIGNATURE / SIGNATURE <br /> TERMS INVOICES OVER 30 DAYS ARE SUBJECT TO A 1 5% SERVICE CHARGE CUSTOMER AGREES TO PAY ALL LEGAL FEES IF <br /> COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE <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 faciltties that handle or process used o4 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 />' Driver signed Date Generator signed Date <br /> By signing the invoice the generator certifies that the generator has established a program to reduce the volume or quantity and toxicity of the hazardous <br /> waste to the degree,as determined by the generator,to be economically practicable <br /> Moth parties signing this invoice it will serve as an agreement that American Valley will submit confirmations for(certain waste streams)to the generator <br />' 4W their waste has been transported to a license treatment or transfer facility <br /> DISPOSAL / RECYCLING FACILITY <br /> G RIVERBANK OIL TRANSFER 0 RAMOS ENVIRONMENTAL SERVICES <br />' 5300 CLAUS ROAD• RIVERBANK CA 55387 1515 SOUTH RIVER ROAD•W SACRAMENTO,CA 95691 <br /> 209 883-8181 • EPA 4 CAL000190816 916 371-5747• EPA H CA0044003556 <br /> rePc(1012oo4 <br />