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ARCHIVED REPORTS_XR0008835
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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13889
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3500 - Local Oversight Program
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PR0545719
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ARCHIVED REPORTS_XR0008835
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Entry Properties
Last modified
11/19/2024 3:45:50 PM
Creation date
6/3/2020 11:27:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008835
RECORD_ID
PR0545719
PE
3528
FACILITY_ID
FA0005335
FACILITY_NAME
CHARLES JACOBS
STREET_NUMBER
13889
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
13889 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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' AMERICAN ,VALLEY 52285 <br /> WASTE OIL, INC. Invoice Number <br />' P O Box 340 • Delhi, CA 95315 <br /> . PH 1-800-732-4645 • FAX 209-668-3880 <br /> EPA CAL000827878 <br /> //I r/b J� <br /> Invoice Date <br /> BILL TO: ,SOB SITE. <br /> 7S bon Ca <br />' Phone Customer PO Payment Terms EPA# <br /> PRODUCgHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br />' USED OIL N4 RCRA HAZARDOUS <br /> WASTE LIQUI 221 <br /> USED AUTOM TIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> OILY WATER, NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 <br /> TRINITY HEAVY DUTY PREMIX <br />' CYCLED ANTIFREEZE NIA <br /> ON HAZARDOUS WASTE LIQUID <br />' TRUCK TIME NIA <br /> GREASWEEP NIA <br /> tI 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 PC B s I further agree to accept the additional charges for legal disposal if this waste is over TOTAL <br /> 1000 P P M total halides or containes any P C B's <br /> DRIVER' GENERATOR AUTHORIZED SIGNATURE w SIGNATURE / SIGNATURE �- <br /> TERMS INVOICES OVER 30 HAYS ARE SUBJECT TO A 1 5%SERVICE CHARGE CUSTOMER AGREES O PAY 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 be transported to a 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 stringent requirements applicable to hazardous <br /> waste management facilities California facilities that handle or process used oil are required to meet those more stringent requirements, and some out of- <br /> state facilities that process used oil also meet those requirements engineering certifications of tank integrity, and financial assur ces 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 stands and not these more <br /> stringent requirements <br /> This notification is for information purposes only _ <br /> 1 '� ' r <br /> Driver signed ,�.f�� Date�- ! Generator signed Die <br /> By signing the invoice the generator certifies that the generator has established a program to reduce the v me or quantit d toxicity of the 6 zardous <br /> ste to the degree,as determined by the generator to be economically practicable <br /> both parties signing this invoice it will serve as an agreement that American Valley will submit confirmations for(certain waste streams)to the generator <br />' at their waste has been transported to a license treatment or transfer facility <br /> DISPOSAL/ RECYCLING FACILITY <br /> O RIVERBANK OIL TRANSFER O 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 4 CAD044003556 <br /> MPG(10!2004 <br />
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