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Envirobmenta Services Division 'Mailing.P.O. 'o 176,Salida,CA 5368 GEORGESNC. �+/ 4612klernan'�o rt,5allda,'lCA85368 Consolidated Manifest Phonet2095 6 791 FAX 209.545.2241 i ® 'nVot� EPA#CAROOatI 7019 A PLOWRY ETROLEUFP ROOu" OOMPANY Invoice r CA Transporter umber 3844 CALlcense#7k 518! s GENERATOR: Invoice , Site EPA ID.#: Invoice Date:= Contact Person: Driver PrintedSignature; ]� j Name: �"_ Truck#: Address PO# i City,State,Zip: Site Phone: TERMS: Product Shipping Name waste CA Manifest#011, Quantity ; ! tfglt Price Amount Code �, Non-RCRA Hazardous Waste Liquid(Used.011)t Lubricating 221 Gal x ' Non-RCRA Hazardous Waste Liquid(Used 011): Industrial 221 Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) ; 134 Gpl Non-RCRA Hazardous Waste Liquid(Oil&Water) 223 Gnl Non-RCRA Hazardous Waste Solids Contaminated with Used 011 352 Dru"O Drained Used 011 Filter Drum(s) Drui4i() Empty Drum(s)' ' ; E 'h 4 Transportation&Truck Time ? H t1 � 1 I I! Unless otherwise specified on this Consolidated Manifest Receipt(Invoice)Terms:Accounts due on the 10th of the month following month of purchase. Past due ;° Total 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%. �' 1 By signing i hereby certify that I have not mixed any of the waste described above with any other hazardous waste,the total hallde content is LESS than 1,000 ppm,and the waste does not contain any PCB's.i have compiled with the requirements of the applicable California used oil management regulation to de{W{i nine this is true.I agree to accept the additional charges for the dlsposatof the waste if the Information i have provided about this waste Is incorrect I I � Generator's Certlficetlon;Ey signing I certify that If I am a large quantity'generator, I certify that I have program in place to reduce th,aJvoluim and toxicity of waste generated to the degree'f have determined to be economically affordable and that I have selected the practicable method of treatment,`atorage, or,dispoal currently avallable 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 Filth effort to minimize my waste generation and select the waste management method that is available to me that I can affords I George W.Lowry,Inc.hereby advises the above Generator that generators shipment of Used Oil and 011y/Water may be transported to a fac)lijy that Is required to comply with federal regulations applicable to management of Used 011 and Oily/Water, but that is not required to comply with the more)atringetit requirements applicable to hazardous waste management facilities,California facilities that handle or process Used Oil and OIIy/Wa'ter are required to meet those more Oingent requirements,and some out-of-state facilities that process Used oil and Oily/Water also meet those requirementsengineering certifications of tank integrity;and financial assurances for 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 Oily and'011y/Water management standards and not these more stringent requirements. l This notification is for the Informational purposes only, i By both parties signing this invoice it-will serve as an agreement that George W.Lowry,Inc. will submit confirmation for(certain waste streams)to the generator;that their waste has been transported to a permitted transfer facility or permitted treatment,storage or disposal facility. Lowry Driver Signature X it l Date o � , I 1 Signature of Generator,Representative or Agent of Generator: X Recycling,Transfer,Treatment,Storage,Disposal Facilities-- Name; Address: a0 13 I r Bakersfield Transfer California 011 Recycling;Ramos Environmental Yuma Environmental City,state,zip: 1620 E.Brundage Lane 5300 Claus Road 1515 S.River Road 2730 E.13th { Bakersfield,CA 93307 Riverbank,CA96367 West Sacramento,CA 95691 Yuma,AZ,85365 Phone: 661.322.8258 209.863.8181 916371.5747 928.344.9826 _ CAL00028258 CAL0000190817-1` CAD004003656 AZR000515924 EPA ID: