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jEnvironmentaliServices Divis on <br /> Mailing:P.O.Bqz 176,Salida,CA 95368 <br /> n�e� �+pJ 4612K�ernandburtiSalida,CA95368 <br /> Consolidated Manifest Phoner209.545.0791 FAX209.540.2241 <br /> qGEORGEINC. <br /> Q' EPA#FAR000047019 <br /> OLEUM PRODUCTS COMPANY invoice" CATransporter Number 3644 <br /> t i <br /> CA License#756518 , <br /> GENERATOR: <br /> Invoice j X014® <br /> Site EPA ID#: =Q°„- .+ _. �. <br /> Invoice Date: 1 �� <br /> Contact Person: Driver Printed Signature <br /> Name:' Truck# <br /> � r <br /> Address ' v. t PO#' ? ii <br /> i <br /> City,State,Zip;A' <br /> Site Phone: TERMS: !' <br /> Product Shipping Name Waste CA Manifest#0{ Quantity yEGa <br /> Price I Amount <br /> Code <br /> 31 <br /> Non•RCRA Hazardous Waste Liquid Used,Oil:Lubricating Gat q ( ) 221 <br /> s <br /> Non-RCRA Hazardous Waste Liquid(Used Oil): Industrial 221 <br /> Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134 {! °el! <br /> I <br /> Non-RCRA Hazardous Waste Liquid(011&Water) 223 <br /> Non-RCRA Hazardous Waste Solids Contaminated with Used 011 352 ; Dru`h(s) <br /> t � � <br /> Drained Used Oil Filter Drum(s) <br /> ” Drums) <br /> � t <br /> Empty Drum(s) Eao I <br /> Transportation&Truck Time I HR j <br /> f <br /> i c <br /> i <br /> Unless otherwise specified on this Consolidated Manifest Receipt(invoice)Terms: Accounts due on the 10th of the month foil owing month of purchase. Past due Total f <br /> accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1-1/2%per month,which is the ANNUAL PERCENTAGE <br /> a 1 <br /> By signing I hereby certify that I have not mixed any of the waste described'above with any other hazardous waste,:the total hall'de content Isl 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 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 Is Incorrect, j r <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 thevolume 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 treatmentj`storage,or disposal currently <br /> available to me'which minimizes the present and future threat to human life and the environment,Or,if Liam a small quantity generator,I have made a Good alth 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 O)ly/Water may be transported to a facility that is 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 stringent requirements;applicable to <br /> hazardous waste management facilities.California facilities that:handle or process Used Oil and Oily/Water are required to meet ttlose more stringent requirements,and <br /> some out-of-state facilities that process Used Oil and Oily/Water also meet those requirements, engineering certifications of tank llntegrit ,and financial assurances for <br /> closure and accidental releases,it lawful to send Used Oil and Oily/Water to out of state facilities that comply only with federal Used OII and Oily/Water management <br /> standards and not these more stringent requirements. <br /> I <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)to the generator that their <br /> waste has been.transported to a permitted transfer facility or permitted treatment,storage or disposal facility. <br /> Lowry Driver Signature Xi <br /> Date <br /> m <br /> Signature'of Generator,Representatrye,trr Agent of Generator: X { 3 � f Date <br /> 3 <br /> ,I , — <br /> Recycling,Transfer,Treatment,Storage,Disposal Facilities j Name: <br /> ® Addreswors I <br /> 4 �} <br /> Bakersfield Transfer California Oil'Recycling Ramos Environmental Yuma Environmental City,state zip <br /> 1620 E,Brundage Lane 5300 Claus Road 1515 S.River Road 2730 E.13th l <br /> Bakersfield,CA 93307 Riverbank,CA 96367 West Sacramento,CA 95691 Yuma,AZ,85365 Phone:' <br /> 661.322.8258 209.863.8181 916.3715747 928.344.9826 EPA ID <br /> CAL00028258 CAL00001908174 CAD004003556 AZR000515924 <br /> i <br />