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<br /> Environmental Services Division
<br /> Melling;P,O,Sax 178,Salida,CA 00300
<br /> (G;r3E0RCxEt�0• ConsolidatedKLOWRY Manifest 4a1a Klaman court,aeuea,cA asses
<br /> Phone;209 805-0791 PAX 200.846.2241
<br /> WT OYe COMPANY YY�e a pe®® SPA N CARD00047019
<br /> �7 ® CATrenaporterNumber 3844
<br /> CA License 0 788010
<br /> GENERATOR: CAL 03 3� ��"� -� N° 40 ,
<br /> i rr
<br /> SbEPA IO#: G n U 1 `� r �' Invoice Data: •• t
<br /> Contact Person: Driver Printed Slgnature; •,,s
<br /> No itt „ f F'1 Truck#:
<br /> Address: PO#
<br /> City,State,21p;
<br /> Site Phone: TERMg;
<br /> Product Shipping Name waste CA Manifest#0 quant) unite
<br /> coec Quantity Price Amount
<br /> Non-RCRA Hazardous Waste Llquld(Used 011);Lubricating 221 ,r t/) t % , Gal r
<br /> ti't• t f r �! �G/� �-, bra
<br /> Non-RCRA Hazardous Waste Liquid(Used oil): Industrial 221 67 S ��2 Gal
<br /> Non RCRA Hazardous waste Liquid(Used Automotive Antifreeze) 134 gal
<br /> Non•RCRA Hazardous Waste Llquld(011&Water) 223 Gal
<br /> Non-RCRA Hazardous Waste Solids Contaminated with Used oil 362 orum(e)
<br /> Dralned Used Oil Filler Drum(s) t]rumlel
<br /> Emply Drum(s)
<br /> Each
<br /> Transportatlon&Truck Time NR.
<br /> Unless otherwise specified on this Consolidated Manifest Receipt oleo)Terms! Accounts due on the 101h of the month tollovnnq hamh or purchase. Peel tlue
<br /> accounts will bo charged n FINANCE CHARGE at the PERIODIC ME of 1-112%per monur,which Is the ANNUAL PERCENTAGE RATE of 18%. Total t
<br /> gy 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,end 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 certify 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 10 human life and the environment,or,if I am a small quantity generator,I have made a Good Fakh 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 thel generators shipment of Used 011 and OIIY/W8ter 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 fecillliea that handle or process Used Oil and OIIylWatar are required to meet those more stringent raqulremsnts,and
<br /> some out-o►-stale facilities that process Used Oil and Oily/Water also meet those requirements,engineering certifications of lank integrity,and financial assurances for
<br /> closure and accidental releases,it is lawful to send Ueed Oil and 011ylWaler to out of state facilities that comply only with federal Used Oil and Oily/Water management
<br /> standards and not ihsse more stringent requirements.
<br /> This notl0callon is for the Informational Rurposes Only-
<br /> By both parties signing this invoice it wi serve a eg$emant that George W,Lowry,Inc. will submit confirmation for(certain waste streams)to the generator that their
<br /> Waste has beer"IranspoHed to a permi d lm d e faclll Qr parmhled treatment,storage or dispose ecility.
<br /> Lowry Driver Signature X `� date
<br /> Signature'of Generator,Represantative or Agent of Generator; X �1 'Data
<br /> Recycling,Transfer,Treatment,Storage,Dlepoeal Facilities
<br /> Nam®;
<br /> C3 M % 1 ® Addreast
<br /> Bakersfield Transfer California Oil Recycling Romeo Environmental Yuma Environmental city,state,zlpr
<br /> 18Y0 E.Brundage Lana 9300 Claus Road 1515 S,River Road 2730 I°,13th
<br /> 9akeraflold,CA 93307 Riverbank,CA 96307 West Sacramento,CA 99691 Yuma,AZ,85368 Phone:
<br /> 881322.9269 209.883.8181 916371-5747 928-344-9826
<br /> CAL00020259 CALOODOIQOO17 CAD004003556 AZRO00016024 CPA ID;
<br /> 9001900'd ZKOBLSISOM:1 ;!t7Ln-A14-rn7 un A'imn-I cn•7t 01n9rrn)rn
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