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1 1 wa L <br /> ivy <br /> AMERICAN VALLEY EB <br /> WASTE OIL, INC. F Invoice Number: <br /> P.O. Box 340 • Delhi, CA 95315 ENTAL HEALTH <br /> PH. 1-800-732-4645 • FAX 2 NErp\RnjIENT <br /> EPA#CAL000416714 <br /> FARMINGTON FRESH <br /> P.O BOX 30667 FARMINGTON FRESH <br /> BILL TO: STOCKTON.CA 95213 JOB SITE: 7735 CA-99 Invoice Date: <br /> STOCKTON, CA 95213 <br /> X ARCH <br /> Sales Rep <br /> Phongo9_ggy97pp,11M Customer P.O. Terms COD EPA AL000289S55 <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 2�3 <br /> Drained Used Oil Filters - <br /> HAZARDOUS WASTE PICK-UP, REFRIGERATION OIL � /� p'c� , ,,,�_ <br /> as) ZS_3ZS3`1(;�j� I r�3�� rO . LG <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 Iherby certify that I have not mixed any of the waste described above with any other hazardous waste,the total halide content Is LESS than 1,000 ppm,and the <br /> waste does not contain any PCBs.I have compiled with the requirements of the applicable California used oil management regulation to determine this is true.I agree to <br /> accept the additional charges for the disposal of this waste if the information I have provided about this waste Is Incorrect. <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 toxicity of waste generat- <br /> ed to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment,storage,or disposal currently available to me <br /> which minimizes me present and future threat to human life and the environment:Or,if I am a small quantity generator,I have made a Good faith effort to minimize my waste <br /> generation and select the waste management method that is available to me that I can afford. <br /> American Valley Waste Oil hereby advises the above Generator that generators shipment of used oil may be transported to a facility that is required to comply with federal <br /> regulations applicable to management of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous waste management facili- <br /> ties.California facilities that handle or process used oil are required to meet those more stringent requirement,and some out-of-state facilities that process used all also meet <br /> those requirements,engineering certifications of tank Integrity,and financial assurances for closure and accidental releases.It is lawful to send used oil to out of stale facilities <br /> that comply only with federal used oil management standards and not these more stringent requirements. <br /> This notification is for Information purposes only. <br /> By both parties signing this Invoice It will serve as an agreement that Amencan Valley Waste Oil will submit confirmation for(certain waste streams)to the generator that their <br /> waste has been transported to a licensed treatment or transfer facility. <br /> ?fj f� /��y �" GENERATOR/ <br /> DRIVER /// /� / AUTHORIZED <br /> SIGNATURC-v �.,._ ,{-,' ���-'z4'" DATE: I2- �!' SIGNATURE: " '"�:•;�i' l y + �i%1'i�a,% DATE: <br /> DISPOSAL/ RECYCLING FACILITY <br /> O DK-DIXON O ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O CFR O GLOBAL MATERIAL MGMT <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. 2035 E.15TH ST. 1640 N.BROADWAY <br /> DIXON,CA 95620 CERES,CA 95358 RIVERBANK, CA95367 LA,CA 90021 STOCKTON,CA 95205 <br /> 707.693-6008 707-693-6008 209-863-8181 213-746-0237 818.770-2577 <br /> EPA#CAT080012602 EPA#CAL000393680 EPA#CAL000190816 EPA#CAL000270577 EPA#CAL000417316 <br /> MPC(7/21n 6) <br />