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AMERICAN VALLEY G'4 <br /> WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 - Delhi, CA 95315 <br /> PH. 1-800-732-4645:- FA.X-209-668-3880 <br /> EPA. CAL000827878 <br /> Invoice Date: <br /> BILL TO: JOB SITE: <br /> Phone <br /> iCustomer P.O. Payment Terms EPA# <br /> 7; <br /> PRODUCT SHIPPING DETCRIPTION WASTE MANIFEST 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 /> RECYCLED ANTIFREEZE N/A <br /> NON HAZARDOUWASTE LIQUID <br /> TRUCK TIME N/A <br /> GREASWEEP N/A <br /> I hereby certify that I have not mixed this waste with any other waste,that the total halides are legs than 1000 P.P.M.:and that <br /> the waste does not contai"ny RC.B.'s.I further agree to accept the additional charges tar legal disposal if this waste is over <br /> 1000 P.P.M.total haliders,or TOTAL <br /> ,�Eontajpes pqT.C.B.'s. <br /> DRIVER <br /> /AUTHORIZED(_...... <br /> SIGNATURE GENERATOR <br /> SIGNATURE/ SIGNATURE <br /> TERMS: INVOICE�6VEIR 3'0' DAY" ARE SUBJECT To A 1.5%SERVICE CHARGE.CUSTOMER AGREES TO PAY ALL LEGAL FEES IF <br /> COURT ACTION BECOMES NECE 3SARY TO COLLECT THIS INVOICE. <br /> American Valley Waste Oil hereby adviso s 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 ma iagement of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities.California :acilities that handle or process used oil are required to meet those more stringent requirements,and some out-of- <br /> slate facilities that process used oil al f o meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and <br /> accidental releases.1I4s la%&%ul to,.send ised oil to out-of-state facilities that comply only with federal used oil management standards and not these more <br /> stringent requirenidn'ts e <br /> This notification is I ?"'7; <br /> t0VnfPrrnatic,9,purpo!es on!Y..— <br /> Driver signed <br /> 7'. ...... Generator signed Date <br /> By sighing the invoice the generator ceilifies 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 tie generator,to be economically practicable. <br /> By both parties signing this invoice it wil serve as an agreement that American Valley will submit confirmations for(certain waste streams)to the generator <br /> that their waste has been transported to a license treatmen!or transfer facility. <br /> . ...DISPOSAL) RECYCLING FACILITY <br /> 0-AIVER13ANK OIL TRANSFER 0 RAMOS ENVIRONMENTAL SERVICES <br /> 5300 CLAUS ROAD-RIVERBANK, CA 95367 1515 SOUTH RIVER ROAD-W.SACRAMENTO,CA 95691 <br /> 209-863-8181 -EPA 4 CAL0001 90816 916-371-5747- EPA 4 CAD044003556 <br /> MPC(10/21x)4) <br /> J -d 80E96ae60a j1 -jL4SLj e0i7 :60 90 ce Rew <br />