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AMERICAN VALLEY WASTE OIL , INC . Invoice Number : P. O . Box 340 • Delhi , CA 95315 PH . 1 -800-7324645 • FAX 209-668-3880 EPA# CAR000272302 BILL TO : JOB SITE: Invoice Date: Phone Customer RO , Terms EPA# PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT CODE NON - RCRA Waste Liquid Used Oil/Mixed Oils 221 NON - RCRA Waste Liquid Used Antifreeze 133 NON - RCRA Waste Liquid Used Oily Water 223 Drained Used Oil Filters TERMS: Invoices over 30 Days are subject to a 1 .5% service charge. Customer agrees to pay all legal fees if court action TOTAL becomes necessary to collect this invoice. By signing I herby 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 waste does not contain any PCBs. I have complied with the requirements of the applicable California used oil management regulation to determine this is true. I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect. Generator's Certification: By signing I certify that If i am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generat- ed to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment: Or, if I am a small quantity generator, I have made a Good faith effort to minimize my Waste generation and select the waste management method that is available to me that i can afford. American Valley Waste Oil hereby advises the above Generator that generators 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 not required to comply with the more stringent requirements applicable to hazardous waste management facili- ties, California facilities that handle or process used oil are required to meet those more stringent requirement, and some out-of-state facilities that process used oil also meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out of state facilities that comply only with federal used oil management standards and not these more stringent requirements. This notification is for information purposes only. By both parties signing this invoice it will serve as an agreement that American Valley Waste Oil will submit confirmation for (certain waste streams) to the generator that their waste has been transported to a licensed treatment or transfer facility. GENERATOR/ DRIVER AUTHORIZED SIGNATURE : DATE: ; ;:SIGNATURE: DATE: DISPOSAL / RECYCLING FACILITY O DK.DIXON O ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O CFR O GLOBAL MATERIAL MGMT 7300 CHEVRON WAY 1920 MORGAN RD, 5300 CLAUS RD , 2035 E. 15TH ST. 1640 N . BROADWAY DIXON, CA 95620 CERES, CA 95358 RIVERBANK, CA95367 LA, CA 90021 STOCKTON , CA 95205 707-693.6008 209-541 -1825 209-863-8181 213-746-0237 818.770-2577 EPA# CAT080012602 EPA# CAL000393680 EPA# CAL000190816 EPA# CAL000270577 EPA# CAL000417316 MPG (7/2016)