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AMERICAN VALLEY -L-Lo 0 2 O <br /> WASTE OIL, INC. Invoice Number: <br /> P.O.Box 340 • Delhi,.CA 95315 <br /> PH. 1-800-732-4645 9 FAX 209-668-3880 <br /> � 2ii-3 <br /> BILL TO: <br /> DESTINATION YWHERE JOB SITECAL000827878• DESTINATION ANYWHERE <br /> 28818 S.CORRA HOLLOW RD •28818 S.CORRAL HOLLOW RD Invoice Date: <br /> TRACY,CA 953 TRACY,CA 95377 <br /> Shea Rep: <br /> Phd ' - - Y Customer P.O. TermsC. EPA#CAL000373684 <br /> PRODUCT SHIPPING DES RIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid U ed Oil/Mixed Oils 221 <br /> NON-RCRA Waste Liquid U ed Antifreeze 133 <br /> NON-RCRA Waste Liquid U ed Oily Water 223 <br /> NON Hazardous.Waste Liqu <br /> Trinity Heavy Duty premixed ntifreeze <br /> Trinity Extended Life premixe Antifreeze <br /> Trinity Case Goods <br /> Truck Wash Out <br /> Truck Time <br /> TERMS: Invoices over 30 Days ares bject to a 1.5%service charge. Customer agrees to pay all legal fees if court action TOTAL <br /> becomes necessary to collect this in ice. <br /> By signing I herby certify that I have of mixed this waste with any other waste,that the total halides are less than 1000 P.P.M;and that the waste does not <br /> contain any P.C.B's. I further agree t accept the additional charges for legal disposal if the waste is over 1000 P.P.M.total halides,or contains any P.C.B's <br /> Generator's Certification: By signing certify that I have a program in place to reduce the volume and toxicity of hazardous waste generated to the degree I <br /> have determined to be economically racticable. <br /> By both parties signing this invoice it ill serve as an agreement that American Valley Waste Oil will submit confirmation for(certain waste streams)to the <br /> generator that their waste has been t nsported to a licensed treatment or transfer facility. <br /> American Valley Waste Oil hereby ad ses 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 anagement of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities.Californ facilities that handle or process used oil are required to meet those more stringent requirements,and some out-of- <br /> state facilities that process used oil Iso meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and <br /> accidental releases.It is lawful to se d 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 pur oses only. <br /> GENERATOR/ l <br /> DRIVER _ ✓ t AUTHORIZED <br /> SIGNATURE: �// DATE: SIGNATURE: DATE: ) � / <br /> i <br /> O NAME: DISPOSAL/ RECYCLING FACILITY <br /> ADDRESS: DK-DIXON O RAMOS ENVIRONMENTAL SERVICE <br /> CITY/ST 7300 CHEVRON WAY 1515 SOUTH RIVER ROAD <br /> DIXON,CA 95620 W.SACRAMENTO,CA 95691 <br /> PHONE: 707-693-6008 916-371-5747 <br /> EPA#CAT080012602 EPA#CAD044003556 <br /> EPA#: <br /> MPG(4/2010) <br />