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Environmenta Services Divilon
<br /> Mallin:P.O. 0 176,Salida,CA5368
<br /> GEORGEINC. ■ 4612 F Isman i4o rt,0alida,'CA 9b388
<br /> Consolidated Manifest Phone:20954g 7911 FAx209-575.2241
<br /> ® Invoice EPA#!CAR00'¢07019
<br /> 7PETROLEUM LOWRY
<br /> PRODUCTS COMPANY CA Transport�r Number 3844
<br /> CA Lla as#, 5 5'81
<br /> GENERATOR: Invoice
<br /> r�
<br /> � r
<br /> Site EPA ID#: , ' , ' Invoice Dates'
<br /> Contact Person: Driver Printed Signature ;f
<br /> Name A. Truck#: ; I
<br /> Address: " PO# j
<br /> City,State,Zip; �
<br /> Site Phone: TERMS:
<br /> Product Shipping Name waste CA Manifest#0 Quantity ' Urlit Price Amount
<br /> Code ���
<br /> I '
<br /> Non-RCRA Hazardous Waste Liquid(Used 011):Lubricating 221
<br /> N, j Gfil
<br /> tvofi.".1 ^Hazardous Waste Liquid(Used 011): Industrial 221
<br /> Non RCRA Ha;�;1rdou%Waste Liquid(Used Automotive Antifreeze) 134 Gal I {
<br /> Non-RCRA Hazardowi Waste Liquid(Oil&Water) 223 Gal
<br /> Non-lkCIRk Hazardous Waste Solids Contaminated with Used Oil 3521 ` .-. _ ', ! oro'( ) I
<br /> Drained Used-Oil Filter Dntm(s) 1' Dru,( >
<br /> I
<br /> Empty Drum(s) Each
<br /> 1
<br /> Transportation&Truck Time HR.�
<br /> ,
<br /> Unless otherwise specified on this Consolidated Manifest Receipt(Invoice)Terms:Accounts du,;,on the 10th of the month following month of purchase. Past due ' Total
<br /> accountswill be charged a FINANCE CHARGE at the PERIODIC RATE of 1-1l2%per month,whichis the ANNUAL PERCENTAGE RATE of 18%.
<br /> By signing I hereby certity 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
<br /> waste does not contain any PCB's.)have,complied with the requirements of the applicable California used oil Imenagement regulation to date rmlRe 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 reduce the v tuns 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,'et rage,or'disposal 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 he a ads a Good Faith effort to
<br /> minimize my waste generation and select the waste management method that is available tome that I can afford. t I
<br /> George W.Lowry,ina,hereby advises the above Generator that generators shipment of Used Oil and 011yMater may be transportedltot a ftJ1111 Ili y that is required to comply
<br /> with federal regulations applicable to management of Used Oil i and Oily/Water, but that is not required to comply with the more 16tringalit requirements `pplicable to
<br /> hazardous waste management facilities.California facilities that handle or process Used Oil and Oily/Water are required to'meet:those mots 'tringent requirements,and
<br /> some out-of-state facilities that process Used Oil and';Oily/Water also meet those requirements,engineering icertificationsiof tank in#egrityff nd financial assurances for
<br /> closure and accidental releases,it is lawful to send Used 011 and 011y/Water to out of state facilities that+comply only,with federal Used 011 a d0ly*ater management
<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 wilk rve as an"dgreement that George W.Lowry,Inc. will submit confirmation for(certain waste stream) o the generator{that their
<br /> waste has been transported to a permitted transfer faaliity or,permitted treatment,storage or disposal facility.
<br /> Lowry Driver Signature X Date
<br /> Signature of Generator,Reproa6ntative or Agent of Generator: X at
<br /> Recycling,Transfer,Treatment,Storage, Disposal Facilites Name;
<br /> Address:
<br /> ❑ -
<br /> Bakersfield Transfer California Oil Recycling Ramos Environmental Yuma Environmental city,state,zip f
<br /> 1620 E.Brundage Lane 5300 Claus Road 1515 S.River,Road 2730 E.13th
<br /> Bakersfield,CA 83307 Riverbank,CA 96367 West Sacramento,CA 95691 Yuma,AZ,85365 Phone:
<br /> 661-322.8258 209.863.8181 916.371.5747 928-344.9826 1
<br /> CAL00028258 CAI.000019081171 CAD004003556 AZR000515924 EPA ID:
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