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Send Payment To: <br /> Independence Independence Environmental Services, LLC <br /> P.O. Box 12623 <br /> Environmental Fresno, CA 93778 Ngo 5358 <br /> CAD983589631 <br /> Services 800-•971 -8010 DATE Z/ <br /> GENERATOR/JOB LOCATION BILL TO <br /> NAMF PO# <br /> ADDRESS — PHONE NO <br /> / . I � �ft <br /> CITY STATE ZIP GENERATOR EPA ID NO. , <br /> 2' 1 s <br /> PRODUCT CODE MANIFEST NUMBER QTY UNITS PRICE TOTAL <br /> Non-RCRA Hazardous Waste,Liquid GALLONS <br /> (Used Oil) 221 �r. �j_Sri 7�'jT 1r <br /> Non-RCRA Hazardous Waste, Liquid 133 GALLONS <br /> (Used Automotive Antifreeze) <br /> Non-RCRA Hazardous Waste, Liquid 223 GALLONS <br /> (Oily Water) <br /> Drained Used Oil Filters DM/55 <br /> Non-RCRA Hazardous Waste,Solids 352 <br /> Non-RCRA Hazardous Waste, Liquid <br /> Waste Paint Related Material 214 <br /> Waste Flammable Liquids 331 <br /> Waste Aerosol Cans 181 <br /> RCRA Hazardous Waste,Solid 181 <br /> Empty Drums,New <br /> Empty Drums, Disposal <br /> EPA E-Manifest Fee Manifest <br /> TSDF-OIUCOOLANT TSDF-OIL FILTERS TSDF-OILIOILY WATER TOTAL CHARGE <br /> World Oil-San Joaquin,LLC Commercial Filter Recycling Riverbank Oil Transfer a� ��� <br /> 14287 E.Manning Ave 33210 Western Ave 5300 Claus Rd d <br /> Parlier,Ca,93648 Union Cfty,Ca,94587 Riverbank,Ca, 95357 <br /> 559-498-0240 510-487-9277 209-863-8181 <br /> CAL000102751 CAL000091507 CAL000190816 <br /> � <br /> Generator certifies that it has established a program to reduce the TRANSPORTER SIGNATURE 1 DATEJ T A <br /> volume or toxicity of the hazardous waste to the degree determined j WL_ <br /> by generator to be economically practicable. <br /> GENERATOR SIGNATURE j,iSATE <br /> I hereby certify that I have read and have the authority to bind the - <br /> above listed generator to the terms on the front and back of this form. ,} <br /> Independence Environmental Services hereby advises used oil generator that generator's shipment of used oil may be transported to a facility that is required <br /> to comply with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable <br /> to hazardous waste management facilities.California facilities that handle or process used oil are required to meet those more stringent requirements,and <br /> some out-of-state facilities that process used oil also meet those requirements.These include more stringent leak detection and prevention requirements, <br /> engineering certifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out-of-state facilities <br /> that comp{y only with federal used oil management standards and not these more stringent requirements.This notification is for information purposes only. <br />