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CAWI!V�EET <br /> Environmental Services Division <br /> ��= Mailing:PA.Box 175,SaSda,CA 55366 <br /> GEORGEINC. 4612 Kiernan Court,Sallda,CA 95366 <br /> Consolidated}'► Manifest Phone:209.545.0791 FAX 209.546-2241 <br /> inV©I�e EPAiiCAR0000470197ANVI3 G0raPA.riT CA Transporter Number 3844 <br /> CA License#758516 <br /> GENRATDR: Invoice N° 0 <br /> Site EPA ID#: a �'�}"'3r r 4 s'«•.::' Invoice Date: <br /> Contact Person: Driver Printed Signature: <br /> r <br /> Name: ! ` Truck#: '? <br /> h <br /> Address: +'.yts ? i a Po# <br /> City,State,Zip: <br /> Site Phone: sac/'I. TERMS: <br /> Product Shipping Name Waste CA Manifest#0 Ruantityl units Price Amount <br /> Code <br /> Non-RCRA Hazardous Waste Liquid(Used Oil);Lubricating 221 sal <br /> Non-RCRA Hazardous Waste Liquid(Used Oil); Industrial 221 cat <br /> Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134 Gal <br /> Nan-RCRA Hazardous Waste Liquid(Oil&Water) 223 Gel <br /> -Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 352 ' ;� - ro f Dnrmts) <br /> Drained Used Oil Filter Drum(s) prumts) <br /> Empty Drum(s) Each <br /> Transportation&Truck Time tart <br /> Unloss otherwise speoiried on this Consolidated Manifest Receipt(Invoice)Terms: Accounts due on Sia loth of the month foil owing month of purchase. Past due TDta)-r.' ' <br /> aunts will be charged a FINANCE CHARGE at tha PERIODIC RATE of 1-112%per month,which Is She ANNUAL PERCENTAGE RATE at-181A, <br /> � ��.�� •�e <br /> cco <br /> �i <br /> By signing I hereby 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 PCB's.I have complied with the requirements of the applicable California used oil management regulation to determine ihis is true.I agree to <br /> accept the additional charges for the disposal of the waste if the information I have provided about this waste is incorrect, <br /> Generator's Certification: By signing I certify that If h am a.'large quantity generator, t certify that t have program in place to reduce the volume and toxicity of waste <br /> generated to the degree I have determined to be ocertomically affordabte and that I have selected the practicable method of treatment,storage,or disposal curranliy <br /> available to me which minimizes the present and future threat to human I&and the environment.Or,If I am a sma4 quantity generator,I have made a Good Faith effort(o <br /> minimize my waste generation and select the waste management method that is available to me that 4 can afford. <br /> George W,Lowry,$no,hereby advises ttie above Generator that generators shipment of Used Oil and OilyiWater may be transported to a facility that is required to comply <br /> with federal regulations applicable to management of Used Oil and OilylWater, but that is not required to comply with the mare stringent requirements applicable to <br /> hazardous waste management facilities.California facilities that handle or process Used Oil and OifyMater are required to meet those more stringent requirements,and <br /> some out-of-state facilities that process Used Oil and Oily/Water also meet those requirements;engineering certifications of tank Integrity,and financial assurances for <br /> closure and accidental releases, it is lawful to send Used Olt and OIIylWater to out of state facilities that comply only with federal Used Oil and 04ylWater management <br /> standards and not these more stringent requirements: <br /> This notification is for the informational purposes only. <br /> By both parties signing this invoice it wilt serve 4s ran,agreement that George W.Lowry,Inc. will submit confirmation for(certain waste streams)to the generator that their <br /> waste has been.transported to a permitted transfer facil'lty or r i ed treatment,storage or disposal facility, <br /> Lowry Driver Signature X ' �' _ °'L !y _ Dat <br /> Signatureof Generator,Representative or Agent of Generator: X T:` '>', r;W`.. <br /> 9 `- -s �_ Date <br /> I. <br /> Recycling,Transfer, Treatment,Storage, Disposal Facilities Name, i <br /> 'Address; <br /> ® 0 13 <br /> kersfield Transfer California Oil Recycling Ramos Environmental Yuma Environmental I City,State,Zip: <br /> 620 E.Brundage Lane 5300 Claus Road 1515 S,River Road 2730 E.13th <br /> Salcorsfleldr CA 83307 Riverbank,CA 96387 West Sacramento,CA 95691 Yuma,Az,6536& Phone: <br /> 661.322-8258 209.863.1118-1 916-371.5747 928444-9826 <br /> CAL00028258 CAL000019DB17 CAD004903556 AZR000515924 EPA ID: <br />