|
Envlionment I Service's Division
<br /> { t "y
<br /> ,,,,, a Malting:P.ODo'.J76,Salida,CA95368
<br /> SNC; X4612 Kleman Curt,Salida,CA 9368
<br /> Consol�dafied Manifest P„en :269.545�6711 FA 209-546224
<br /> EPA#CAR0000619
<br /> A PETROLEUM PRODUCTS COMPANY 01"1�iO�Ce 1
<br /> ,CA Transporter�IumI( ber 3x44
<br /> CA LlbQnse#758518 i
<br /> GENERATOR: Invoice i, © °Q
<br /> Site EPA 1D#: a Invoice Date:
<br /> Contact Person: Driver Printed Signaiure
<br /> 1 r
<br /> Name: Y- Truck#: I iI j I
<br /> Address s y ' t PO#
<br /> i.
<br /> City,State,Zip:;
<br /> x
<br /> Site Phone: TERMS:
<br /> Product Shipping Name code CA Manifest fl0 Quantity ; Univ °, ; Pace Amount
<br /> NonRCRA Hazardous Waste Liquid(Used 011);Lubricating 221 ; dell , i
<br /> Non-RCRA Hazardous Waste Liquid(Used 011); Industrial 221 ” Gall
<br /> NonRCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134
<br /> Non`RCRA Hazardous Waste Liquid(Oil&Water) 223 Dell ,
<br /> Non-RCRA Hazardous Waste Solids Contaminated with Used Oil ' 352 I Drum(6)
<br /> Drained Used Oil Filter Drum(s) Dru}n(s) i I
<br /> Empty Drum(s) Each
<br /> Transportation&Truck Time HR.I
<br /> 1
<br /> I i I
<br /> Unless otherwise specified on this Consolidated Manifest Receipt(Invoice)Terms: Accounts due on the 10th of the month following month of purchase. Past due i Total
<br /> accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1-1/2%per month,which is the ANNUAL PERCENTAGE RATE of 18%. S '
<br /> By signing I hereby certify that I have not mixed any of the waste described above with any other hazardous waste,lthe4otal halide content is LESS than 1,000 ppm,and the
<br /> waste does not contain any PCB's.I have complied with the requirements of the applicable California used oil management iregulation to dete�mine this is true.I agree to
<br /> accept the additional charges for the disposal of the waste if the Information I have provided about this waste Is incorrect.
<br /> Generator's Certification: By signing I certify that If I am a large quantity;generator, i certify that I have program in place to red Jce thew lune and toxicity of waste
<br /> generated to the degree I have determined to be economically affordable and that'I have selected the practicable method of treatment, st�rage, orjdisposal currently
<br /> 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 Inde a Good Faith effort to
<br /> minimize my waste generation and select the waste management method that is available tome that I can afford,
<br /> George W.Lowry,Inc.hereby advises the above Generator that generators shipment of Used Oil and Oily/Water may be transported;to a facilly I'at is equird to comply
<br /> with federal regulations applicable to management of Used Oil and OIIy/Water, but that Is not required to 6omplyi with the more istringeht 'ents applicable to
<br /> hazardous waste management facilities.California facilities that handle or process Used Oil and OIIy/Water are required to meet those more'stringent tequir'mants,and
<br /> some out-of-state facilities that process Used Oil and 011y/Water also meet those requirements, engineering certifications of tank integrityi and I nanciat aslurances for
<br /> closure and accidental releases,it is lawful to send Used Oil and Oily/Water to out of state facilities that comply;only with federal Used Oit andi O11 'star rnanagement
<br /> standards and not these more stringent requirements.
<br /> This notification Is for the informational purposes only.
<br /> By both parties signing this Invoice it will serve as,'an,'agreement that George W.Lowry,Inc, will submit confirmation for(certain waste streams)jo the generatorthat their
<br /> waste has been.transported to a permitted transfer febllity or permitted treatment,storage or disposal facility.
<br /> Lowry Driver Signature X _ Date
<br /> Signature'of Generator,Representative or Agent of Generator: X
<br /> Recycling,Transfer,Treatment,Storage,Disposal Facilities Name;
<br /> E3 ❑ 1 ®
<br /> Address:
<br /> Bakersfield Transfer California Oil Recycling Ramos Environmental Yuma Environmental City,State,zip: 1
<br /> 1620 E.Brundage Lane 5300 Claus Road 1515 S.River Road 2730 E.13th ! ;
<br /> Bakersfield,CA93307 Riverbank,CA 96367 West Sacramento,CA 95691 Yuma,AZ 85365 Phone: �-
<br /> 661.322.8258 209-863-8181- , 916.371.5747 928-344-9826
<br /> CAL00028258 CAL0000190817a CAD004003556 AZR000515924 EPA to;
<br /> I i
<br />
|