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w_ <br /> 4 <br /> AMEERICAN VALLE10 4892M` <br /> Invoice Num <br /> P:0-Box 340 • Delhi, CA 95315 ` <br /> PH. 1-800-732-4645 FAX 209-668-3880 <br /> EPA. CAL000827878 <br /> LD // / � <br /> Invoice Date: <br /> BILL TO JOB SITE: <br /> JIM THORPE OIL INC. TRECISSI _,FLYING SERVICE <br /> P.O. BOX 357 1 9i9 N. LOWER SACRAMENTO - <br /> LQDI, CA 95241 LODIr CA 95240 <br /> X: ARMSTRONG <br /> Phone Customer P.O. Payment-Terms <br /> a, <br /> 209-369-4408 yet <br /> 0002584302 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> USED OIL NON RCRA HAZARDOUS <br /> WASTE LIQUID . 221` <br /> USED AUTOMOTIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> OILY WATER, NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 I <br /> TRINITY HEAVY DUTY PREMIX <br /> RECYCLED,ANTIFREEZE N/A <br /> NON HAZARDOUS WASTE LIQUID <br /> TRUCK TIME N/A <br /> �GREASWEEP N/A <br /> I hereby certify that I have not mixed this waste with any other waste,that the total halides are less than 1000 P.P.M.;and that <br /> the waste does not contain any RC.B.'s.I further agree to accept the additional charges for legal disposal if this waste is o r <br /> 1000 P.P.M.total halides,or containes any RC.B.'s. TOITAL <br /> DRIVER. GENERATOR AUTHORIZED <br /> r <br /> SIGNATURE l SIGNATURE SIGNATURE <br /> TERMS:INVOICES OVER 30 DAYS ARE SUBJECT TO A 1.5%SERVICE CHARGE.CUSTO7tran <br /> EST a.AY ALL LEGAL FEES IF <br /> COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. <br /> American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may ported t facility that is required to comply <br /> with federal'regulations applicable to management of used oil,but that is not required to comply with the more s 'ngent r uirements applicable to hazardous <br /> waste management facilities California facilities that handle or process used oil are required to meet those rr{ore stringent requirements,and some out-of-+ <br /> state facilities that process used oil also meet those requirements, engineering certifications of tank integrity, and financial assurances for closure'and <br /> accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management s ndards and'not these more' <br /> stringent requirements. <br /> ,..,�. <br /> This notification is for information purposes only. <br /> e <br /> Driver signed Date I .� f `=%`)"Generator signed f ;` Date ` <br /> By signing the invoice the generator certifies that the generator has established a program to(educe the voluril ,,pkquanti nd toxicity of the hazardous <br /> waste to the degree,as determined by the generator,to be economically practicable. �' a <br /> By both parties signing this invoice it will serve as an agreement that American Valley will rbmit�onfirmatI s for(certain waste streams)to the generator <br /> that their waste has been transported to a license treatment or transfer facility. ' <br /> __�DISPOSAL/ RECYCLING FACILITY <br /> O RIVERBANK OIL TRANSFER ® RAMOS ENVIRONMENTAL SERVICES <br /> 5300 CLAUS ROAD•RIVERBANK,CA 95367 1515 SOUTH RIVER ROAD•W.SACRAMENTO,CA 95691 <br /> 209-863-8181 •EPA#CAL000190816 916-371-5747•EPA#CAD044003556 <br /> c MPC(1012064) <br />