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Mailing:P.O.Sox 176,Salida,CA 95368 <br /> 4612 Kieman Gout%Salida,CA 95368 <br /> U' Geome W. Lowm Im . f' Phone.209,54&0791 FAX 209-S45-2241 <br /> entalServices DivisionEPA#CAROo0047019 <br /> Nq <br /> 1V®V y ® 201CA Transporter Number 3844f, CA License#758518 <br /> AL <br /> GENERATOR: HEALTH DEPART 0 ENT Consolidated Manifest Invoice: ;t 25403 <br /> Site EPA ID#: <br /> Shipment Dade: t � !, -' <br /> Contact Person: ! I <br /> Name: Driver Signature(Printed): <br /> r <br /> Address: t Truck# <br /> City,State,Zip: fa PON <br /> Site Phone: <br /> Product waste CA Manifest#0 Quantity units Pike Amount <br /> Code <br /> r <br /> ,Kon-RCRA Hazardous Waste liquid(Used 010:Lutxicalntg 221 _ - <br /> r <br /> Non-Ri RCRA Hazardous Waste Liquid(Used 01:Industrial 221 Gal <br /> Non RCRA Hazardous Waste Liquid(Used Automotive AntBfeeze) 134 <br /> Non-RCRA Hazardous Waste Liquid(018 Water) 221 Gat <br /> Non-RCRA Hazardous Waste Solids Contaminated with Used 01 223 m++mlml <br /> Drakted Used Oil Filter Dnan(s) <br /> i <br /> Empty Drum(s) Each <br /> Transportation&Truck Time 4 <br /> Hazardous Test <br /> SZ <br /> Unless otherwise specified on this Consolidated Manifest Reedpt(Invores)Tams:Accounts due on the 101h or nae manta fo4ating month of purchase. Past due Total ( � <br /> accounts vA be charged a FINANCE CHARGE at the PERIODIC RATE of 1412%per month,which is to ANNUAL PERCENTAGE RATE of 1896. <br /> By signing this receipt,the Generator certifies that a program has been established to reduce the volume or quantity and toxidty or the hazardous waste to a degree as <br /> determined by the generator,to be economically practicable. <br /> Generator certifies that all Hazardous Waste fisted on this Consolidated Manifest Receipt is profiled to meet the Waste Codes 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 with the more stringent requirements applicable to hazardous waste management facilities. California 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 dosure and accidental releases. itis lawful to send used oll to out of state fanure <br /> hat comply only with the Federal used off management stan- <br /> dards and not these more stringent requirements. ,� �/? <br /> This notification is for information only. Lowry Driver Sign f rte/ i a <br /> Signature of Generator,Representative or Agent of Generator: X <br /> r` r <br /> Greenleaf Environmental CRI Recycling i <br /> 3474 Toyon Cr. i01 Hagen ode <br /> Valley Springs,CA 95252 Woodville,Wl 5amm <br /> 40 8 N <br /> 263-754-4600 715698-3363 t <br /> CAL08021 11 VAR000029751 h Adm: <br /> 5 <br /> Recycling <br /> 8r Disposal �rtk <br /> �yyam,Zip:Orr Transfer 5300 Rams Environmental <br /> Claus Road 1515 S.River Road <br /> Riverbank,CA 96367 West Sacramento,CA 95691 Phone: <br /> 209-863.8181 916-371-5747 <br /> CAL0000190817 CAD004003WS EPA rD: <br />