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~~~``�� 0 � ' Environmental Services Division
<br /> qGEORIGOEINC. Msiling:P,O,Box 170,Salldo,CA 80380
<br /> �� VConsolidated Manifest 4814KI20944ernan -0701 llde,CAe".2Phone:208 8dS-0701 FAX 109•ed5.2201
<br /> LBUM PNoOueYa compnNr
<br /> Invoice EPA t{CARB00047018
<br /> CATraneporter Numbor 3844
<br /> � CA Lieenae N 780618
<br /> GENERATOR• Mt 000 �bo 5517 inwa No 40 ,.A �
<br /> Site EPA ID#: G D U 1 `� i `� r �' Invoice Date: t
<br /> Contact Person; Driver Printed Signature,,-
<br /> Noma:
<br /> ignature;
<br /> Nemo: �� '
<br /> : ' ' �f � F•� Truck#:
<br /> Address: y` "r1) L PO#
<br /> City,State,zip:
<br /> Sits Phone.,
<br /> Product 8hipping Name waste CAManifest#D
<br /> Coda Quantity unite ppea Amount
<br /> Non-RCRA Hazardous Waste Liquld(Used 011);Lubricating 221r�,( t• `���1 ( Z �!, % Out f r)
<br /> Non-RCRA Hazardous Waste Liquid(Used Oil): Industrial 221 /II cGal
<br /> Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134 Got
<br /> Non•RCRA Hazardous Waste Liquid(Oil&Water) 223 oat
<br /> Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 352 Drum(s)
<br /> Drained Used Oil Filter Drum(s) Drum(s)
<br /> Empty Drum(s) anon
<br /> Transportation&Truck Time HR.
<br /> Unless otherwise Specified on ihle Consolidated Manifest Receipt(Invoice)Terms:Accounts due on(he 101h of the month following month of purehane. Peet due t
<br /> s000unts Ydii bo charged a FINANCI:CHARGE at the PERIODIC RATE of 1.1/29•per month,which is tho ANNUAL PERCENTAGE RATE of 18%, Total .
<br /> sy elgning I hereby certify 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,I have compiled 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,
<br /> Generator's Certification: By signing I certify that If I am a large quantity generator, I ceHify that I have program in place to reduce the volume 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,storage, or disposal currently
<br /> available to me which minimizes the present and future threat to human life and the environment.Of,If I am a small quantity generator.I have made a Good Faith effon to
<br /> minimize my waste generation and select the waste management method that Is available to me(hat I can afford.
<br /> George W.Lowry,Inc,hereby advises the above 00119ratof that generators shipment of Used 011 and Oily/Water may be transported to a facility that is required to comply
<br /> with federal regulations applicable to management of Uasd OII and OIIY1W4Ier, but that Is not required to comply with the more stringent requirements applicable to
<br /> hazardous weals management facilities,California facill(ies 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 requirements, engineering earlincatione of tank integrity,and financial assurances for
<br /> closure and accidental releases,it Is lawful to send Used 011 and 011y/Water to out of slate facilities that comply only with federal Used 011 and 011y/Water management
<br /> standards and not those more stringent requirements,
<br /> This notl0oallon Is for the Informallonal Rurposes only,
<br /> By both parties signing this Invoice it wt serve eV�/�sg� ement that George W,Lowry,Inc. will submit connrmalion for(certain waste streams)to the generator that their
<br /> Waste has been,transported to a perms d Ire Afef facillt r parmhtad treatment,storage or dispose acilily.
<br /> Lowry Driver Signature X / �•_•,.•. date , I '
<br /> Signature'of Generator,Represantative or Agent of Generator: X 'e,Date
<br /> Recycling,Transfer,Treatment,Storage,Dfspoeal Facilities Name:
<br /> Q1 �. Addreaei
<br /> BakotafiSld Transfer California 011 Raoyeling Ramos Environmental Yuma Environmental city,stele,zip:
<br /> 1810 E.Brundage Lane 0300 Claus Road 1515 8,River Road 2730 E.13th
<br /> Sakeraflotd,CA 83307 Riverbank,CA 96387 Weal Sacramento,CA 93891 Yuma,AZ,85365 Phone:
<br /> 661.9228268 209.883.8181 916371-5747 828.344.9826
<br /> CALOOD20268 CALOON100817 CAD00400366s AZR000616924 !PAID:
<br /> i
<br /> 9001900'd M091960MMO nt.n-RIG-rn7 un A-imn-1 Qn-71 or�7,r•n„n
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