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'RECEIVEY <br /> a - AAailing:P.O.Box 176,Salida,CA 95366 <br /> 9'G <br /> GeOr(geW. 1.OWry, Inc. , 4612 Kiernan Court,Salida,CA 95368 <br /> is# ®V 2 2O1J <br /> Phone:209-545-0791 FAX 709.545-2241 <br /> 1. _ _ <br /> UEnvironmental Services Division EPA;B CAR000047019 <br /> rte-= __ "' CA Transporter Number 3844 <br /> �_� ENVIRONMENTALCA License 5 758518 <br /> HEALTH DEPARTMENT <br /> GENERATOR: Consolidated Manifest Invoice: "? 24901 <br /> Site BPA iD# 6CAC) Shipment Date: L <br /> Contact Person: r "" ! <br /> Name: Driver Signature(Printed): C, [n <br /> Address: ( �(j(�l'ur,L�� 1. i�./ Truck III f i <br /> City,State,Zip: 64c,a_�o PON tr' <br /> Site Phone: <br /> Product waste CA Manifest#0 Quantity units Price Amount <br /> Code <br /> Non-RCRA Hazardous Waste Liquid(Used 011):Lubiicatirg 221 Go <br /> Pion-RCRA Hazardous waste Liquid(Used Oil):Industrial 221Gal <br /> Gan <br /> Non RCRA Hazardous Waste Liquid(Used Automotive Andlieeze) 134 <br /> Non-RCRA Hazardous Waste Liquid(Oil&Water) 221 G <br /> at-RCRA Hazardous Waste solids Contaminated with Used Cil 223 3 v S-�U3 j/k rmnegs) <br /> Drained Used 0A Filter Drum(s) Dain(s) <br /> Empty Drum(s) Each <br /> Transpoftfiw&TruckTime <br /> Hazardous Test <br /> Unless oihw*iw specified on Uric Consa<idatad Manifest Receipt(Invoice)Teems:Accounts due on ore 101h of ora north foltoaaing morM cf p=hase. PiWduo to <br /> aomunts will be aged a FiNANCE CHARGE at the PERIODIC RATE of 1-1r2%per;month,wfkh is the ANNUAL PERCENTAGE RATE of 18%. (� <br /> By signing this receipt,the Generator cerfifies that a program has been established to reduce Me volume or quantity and toxicity of the hazardous waste to a degree as r <br /> determined by the generator,to be economically practicable. <br /> Generator certifies that all Hazardous Waste lamed on this Consolidated Manifest Receipt is profiled to meet the Waste Cafes as listed above. <br /> Note:George W.Lowry,Inc. hereby advises the Generator that X 's(Generator's signature) <br /> shipment of used oil may be transported to a facility that Is required to comply with federal regulations applicable to management of used oil but that is <br /> not required to comply Ah the more stringent requirements applicable to hazardous waste management fatalities. Cal)fomia facilities that handle or <br /> process used oil are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those require- <br /> ments These include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances <br /> for closure and accidental releases. It is lawful to send used oil to out of state facilities that comply only with that Federal used oil management stan- <br /> dards and not these more stringent requirements. <br /> This notification Is for information only. Lowry Driver Signapre X ``t <br /> Signature of Generator,Representative or Agent of Generator: X,4 df <br /> Lff <br /> Greenleaf Environmental !Rt•41ng <br /> 3474 Toyon Cr. 101 Hagen Drive <br /> Valley Springs,CA 95252 'Woodville,WI 54028 Nom: <br /> 209-754.4600 7154198.3363 <br /> CAL000214411 WtR000029751 Adder: <br /> Recyciing <br /> 8r Disposal Cft Sf 1*zip: <br /> FaCilltieS Riverbank Oil Transfer 5300 Rams Environmental <br /> Claus Road 1515 S.River Road <br /> Riverbank,CA 96367 West Sacramento,CA 95691 ane: <br /> 20943638181 916.371-5747 <br /> CAL0000190817 CAD0040036W EPa ID <br />