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Environmental Services Division
<br /> Mailing:P.O.Box 176,Salida,CA 95368
<br /> IAC- �{
<br /> 4,612 Kiernan Courf,Salida,CA 95368
<br /> '�►onsolidated Manifest Phone:209.545-Q7s4 FAX 20"452241
<br /> i EPA#CAR000047818
<br /> A PETROLEUM PRODUCTS COMPANY Invoice ± CA Transporter Number 3644
<br /> CA License#758518
<br /> a
<br /> GENERATOR' InvoiceNo," s
<br /> S1116EPA ID M Inv,`olce Date:
<br /> Contact Person: Driver Printed Signature:
<br /> Name: Truck#: Alky
<br /> PO
<br /> Address: �' $ ..
<br /> city,State,Zip:
<br /> Site Phone:
<br /> Product Shipping Name Waste CA Manifest#0 Quantity Units Price Amount
<br /> Code
<br /> Non-RCRAlazardous Waste Liquid(Used Oil):Lubricating
<br /> 221 Gal
<br /> Non RCRA Hazardous Waste Liquid(Used Oil): Industrial 221 Gat
<br /> Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134 ` cat
<br /> Non-RCRA Hazardous Waste Liquid(Oil&Water) 223 ' "' Gel +
<br /> Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 352 g Drutn(s)
<br /> ee,
<br /> Drutn(s)
<br /> Drained Used 011 FIItgrDrum(s) �
<br /> Empty Drum(s) aeon
<br /> Transportation&Truck Time t, HR.
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<br /> Unless oiherwlss specified on this Consolidated Manifest Receipt(invoice)Terms: Accounts due on the 10th of the month following month of purchase. Past due Total
<br /> accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1-1/2%per month,which is the ANNUAL PERCENTAGERATE of 18%,
<br /> x~�
<br /> By signing I hereby certify that I have not mixed any of the waste described above with any other hazardous waste,the total halide content Is LE$$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 deteimine,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 /> V,
<br /> Generator's Certification: By signing I certify that If'I am a large quantity generator, I certify that I have program in=place tolreduce 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 treatment, storage,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 have made a Good Faith 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 Oily/Water may be transported to a facility that is required to comply
<br /> with federal regulations applicable to management of Used Oil and Oly/Water;but that is not required to comply with the more stringent;requirements applicable to
<br /> hazardous waste management facilities.Californla facllities thathandie or,process Used Oil and'Oliy/Water are required';to meet those more;stringent requirements,and
<br /> some out-of-state facilitles that process Used Oil and Oily/Water also meet those requirements,engineering certifications=of tank integrity,and financial assurances for
<br /> 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 01,I and Oily/Water management
<br /> standards and not these more stringent requirements.
<br /> This notification is for the informational purpose�s`only,
<br /> By both parties signing this Invoice It"miliserve-As aR agreement that George W,Lowry,Inc. will submit confirmation for(certain waste stree ms)i the generator that their
<br /> waste has been transported to a permitted traliefef facility or permitted treatment,storage or disposal facility.,
<br /> Lowry Driver Signature X Date
<br /> Signature of Generator,Representative or Agent of Generator; X Qstte
<br /> Recycling,Transfer,Treatment,Storage,Disposal Facilities Name:
<br /> ❑ ; Address:
<br /> 13
<br /> Bakersfield Transfer California 011 Recycling Ramos Environmental Yuma Environmental City,state,21p:
<br /> 1620 E.Brundage Lane 5300 Claus Road 1515 S.River Road 2730 E.13th i phone:
<br /> Bakersfield,CA 93307 Riverbank,CA 96367 West Sacramento,CA 95691 Yuma,AZ,85365
<br /> 661-322-8258 ;, 209.863.8181 916371.5747 928-344-9826 " EPA ID:
<br /> CAL00028258^,r. CAL000019081� CAD004003556 AZROOD515924',
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