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AMERICAN VALDW 4 2 t, 4 <br />WASTE OIL, INC. AUG 14 2015 Invoice Number: <br />P. O. Box 340 - Delhi, CA 95315 C-MIROIVMEN AL <br />PH. 1-800-732-4645 - FAX 209-668-3880 -cn+ r1 nCrannt 4C"1 -f <br />EPA# CAL000827878 <br />BILL TO: JOB SITE: <br />Invoice Date: <br />Phone <br />Customer P.O. <br />ITerms "` <br />EPA# <br />PRODUCT SHIPPING DESCRIPTION <br />WASTE <br />MANIFEST <br />QUANTITY <br />PRICE <br />AMOUNT <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />Drained Used Oil Filters <br />r _ <br />TERMS: Invoices over 30 Days are subject to a 1.5% service charge. Customer agrees to pay all legal fees if court action <br />TOTAL <br />becomes necessary to collect this invoice. <br />By signing I herby 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, <br />and the waste does 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 />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 <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 to human life 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 invoice 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 facility. <br />GENERATOR/ <br />DRIVER AUTHORIZED <br />SiuidATURE: DATE. SiGNWURE: DATE. <br />DISPOSAL / RECYCLING FACILITY <br />O DK-DIXON 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 818-787-2649 <br />EPA# CAT080012602 EPA# CAL000270577 EPA# CAL000379059 <br />I <br />MPC (6/201: <br />