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1 1 <br /> Environmental Services Division <br /> Mailingt P 0 Box 176,Salida,CA95368 <br /> ■ } i 4612 ttlernan Court,Salida,CA 9368 <br /> C. <br /> Consolidated Manifest Phon,:209545107$1 FAX209.546.2241 <br /> qE70RGE <br /> ODUCTS COMPANY Invoice <br /> EPAi�CAR00�00�47019 II <br /> CA Tnansporter}Nujnber 3844' <br /> CA LICsnse 0 7586l'!8 <br /> GENERATOR: Invoice I � <br /> Site EPA ID#: ��, Invoice Date;; <br /> Contact Person: Driver Printed Signature: <br /> Name Truck#: 1 <br /> Address: tPO# <br /> a <br /> City,State,Zip: :.r #f <br /> Site Phone: TERMS: { <br /> Product Shipping Name Waste CA Manifest#0 Quantity Uinl{s;l Price Amount <br /> Code <br /> Non-RCRA Hazardous Waste Liquid(Used 011):Lubricating 221 �i i a <br /> Non-RCRA Hazardous Waste Liquid(Used 011): Industrial 221 Gai <br /> Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze); 134 Ga� <br /> Non-RCRA Hazardous Waste Liquid(Oil&Water) 223 ' al <br /> Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 352 Druml(s) { <br /> Drained Used Oil Filter Drum(s) Dryma(s)! <br /> Empty Drum(s) EPC <br /> Transportation&Truck Time ' <br /> 1 HRJ <br /> is { <br /> i <br /> { { <br /> I I i <br /> a <br /> Unless otherwise specified on this Consolidated Manifest Receipt(Invoice)Terms: Accounts due on the 10th of the month following month of purchase. Post due 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%. <br /> By signing I hereby certify that I have not mixed any of the waste described above with any other hazardous waste,:the total halide content is'L�SS than 1,0001ppm,`and the <br /> waste does not contain any PCB's.I have complied with the requirements of the applicable California used oil management regulation to determine 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 Is1ricorrect. 1 <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 rec(uce th�volume and tox city of waste <br /> generated to the degree I have determined to be economically affordable and that I have selected the practicable method of treatments storage,or disp sal currently <br /> available to me which minimizes the present and future threat to human life and the environment.Or,if I am al small quantity generator,i hav made a`Good with effort to <br /> minimize my waste generation and select the waste management method that is available to me that I can afford, <br /> George W.Lowry,Inc.hereby advises the above Generator that generators shipment of Used Oil and 011y/Water may be transported to a facility that 16 required to comply <br /> with federal regulations applicable to management of Used Oil and Oily/Water, but that Is;not required to comply with the more';stringentrequirements lapplicable to <br /> hazardous waste management facilities.California facilities that handle or process Used Oil and 011y/Water are required to meet those more stringent requirements,and <br /> some out-of-state facilities that.process Used Oil and Oily/Water also meet those'Irequirements engineering certifications of tanklintegrit ,aridIfinancial assurances 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 OII and 1O11y/Water management <br /> standards and not these more stringent requirements. <br /> This notification is for the Informational purposes,only. I 3 { <br /> By both parties signing this invoice It will serve as arilagreement that George W.Lowry,Inc. will submit confirmation for(certain waste stream sl)to the generator that their <br /> waste has been.transported to a permitteo'transferAcllity or,permitted treatment,storage or disposal facility. <br /> Lowry Driver Signature X-1 Date <br /> Signature*of Generator,Representative or Agent of Generator: X Date ' <br /> i <br /> Recycling,Transfer,Treatment,Storage,Disposal Facilities. Name: ! L <br /> Address I <br /> Lj <br /> Bakersfield Transfer California Oil Recycling Ramos Environmental Yuma Environmental City,state,zip: 1 1' <br /> 1620 E.Brundage Lane 5300 Claus Road 1515 S,River Road 2730 E.13th <br /> Bakersfield,CA03307 Riverbank,CA 96367 West Sacramento,CA 95691 Yuma,AZ,85365 Phone: <br /> 661-322.8258 209.863.8181 916371-5747 928-344=9826 <br /> CAL00028258 CAL0000190817 CAD004003556 AZR000515924 ± EPA ID: <br />