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AMERICAN VALLEY 126 42 1 <br /> WASTE OIL, INC. Invoice Number: <br /> �p �P�0 Box 340 • Del 95315 <br /> R �e lOQQ'732.4�j45,• F09.668-3880 <br /> EPA#CALD00827878 <br /> FARMINGTONFRESH FEB 0 6 Z017 FARMINGTONFRESH 7-Zz--I <br /> BILL TO: P O BOX 30667 JOB SITE: 7735 FRONTAGE 99 RD WEST- <br /> STOCKTON,CA 95215 invoice Date: <br /> STOCKTON.CA 96213 X ARCH <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT Slee Rep. <br /> Phont209-983-970D JIM Customer PO. Terms caw EPA# CAL000289855 <br /> Z-4-3c) <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used OiVMixed Oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 ,t/1 <br /> NON-RCRA Waste Liquid U OadWO SES 0 5I 0 <br /> Drained Used Oil Filters ad <br /> TERMS: Invoices over 30 Days are subject to a 1.5%service charge. Customer agrees to pay all legal fees d court action TATA <br /> becornn necessary to collect this invoice. <br /> By signors I herby certify that I have not mired any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm, <br /> and the waste tices 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 /> Generators Cenrtkation:By signing i certify that If 1 am a targe quantity generator,I certify that I have a program in place to reduce the yolume and toxicity of 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 /> available to me which minimizes the present and future threat M human fife and the environment!Or,if I am a small quantity generator,i have made a good faith <br /> effort to minimize my waste generation and select the waste management method that is available to me that I can afford. <br /> By both parties signing this'.voice 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 forillty. <br /> GENERATOR/ <br /> N � <br /> SIGATUOAT7-9, GNAI <br /> DATE, <br /> DISPOSAL/ RECYCLING FACILITY <br /> a�4)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 818787-2649 <br /> EPA#CATOBOO12602 EPAM CALOOOZ70577 EPA#CAL000379059 <br /> MPC iW.131 <br />