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a <br /> Environmentat Seq�{ices Division <br /> MaII1ng::P.O.Bo 1 6,Sallda,CA5368 <br /> �(� 4612 Kiernan Co�rt�s�lida;CA 95368 <br /> O <br /> INC. Consolidated IY/anife'st Phone;209545079'1 iFAX209545.2241 <br /> `, ■GE <br /> EPA#pCAR00004761sj } <br /> A PETROLEUM PROOUCT8 COMPANY I n oice : CATremsperfer Nllrjlb6r 3844 <br /> CA L14enas#,76 5181 <br /> GENERATOR: <br /> Invoice o i <br /> Invoice Date: ' i ' <br /> Site EPA tD'#: a <br /> Driver Printed Signature <br /> Contact Person: <br /> t Truck#: <br /> Name I i <br /> f.t t ��� <br /> Address t e PO# <br /> t . <br /> State <br /> City, Zip, <br /> y , F '4 t TERMS: <br /> Site'Phone: <br /> Product Shipping Name waste CA"Manifest#0 Quantitys, Units j( Price Amount <br /> Code <br /> Non-RCRA Hazardous Waste Liquid(Used 011);Lubricating <br /> 221 r IG ; <br /> Non-RCRA Hazardous Waste Liquid(Used 011): Industrial <br /> 221 <br /> Gal <br /> Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134 { } <br /> Non•RCRA Hazardous Waste Liquid(Oil&Water) <br /> 223 <br /> Non RCRA Hazardous Waste Solids Contaminated with Used Oil 352 <br /> r rn Drums) I ) <br /> Drums) <br /> Drained Used Oil Filter Drum(s) <br /> { Ea�hll " 1I <br /> EmptyDrum(s) <br /> 10IR!I <br /> Transportation&Truck Time <br /> { 1 1 <br /> i <br /> FUnlss otherwise specified on this Consolidated Manifest Receipt(Invoice)Terms: Accounts dueon the 10th of the month following month of purchase. Past due 1!I Total <br /> accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1.112%per month,which is the ANNUAL PERCENTAGE RATE of 18%a i ! <br /> u � <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 ESS than)1,000 ppm,and the <br /> o,,Seta einac'nnt rnntnin Rnv PCB's.i have comolled with the requirements of the applicable California!used oil management regulation to d termine this is true.(agree to <br /> information I have provided about this waste is incorrect, _ <br /> rge quantity generator, I certify that I have program in place to reduce"thev llirrle!and toxicity of waste' <br /> Iy affordable and that I have selected the practicable method of treatment, s}orcge,or tlisposal currently, <br /> o human life and the environment,Or,if I am'a$mall quantity,generator,I haveamOde a Good Faith effort to <br /> nt method that is available to me that I can afford, <br /> at generators shipment of Used Oil and Oily/Water may be transported to a fgc:liiry'that Is reqIred to comply <br /> `t 511 and OilyMater,but that Is not required to comply with the more string¢¢nti requirements applicable to <br /> it handle or process Used Oil and Oily/Water are required to meet ithose mdre's tring4nt requirements,and <br /> iter also meet those requirements, engineering!certifications of tank integrity,end financial'assurances for <br /> and Oily/Water to out of state facilities that comply only with federal Used 011 Orjd O8y/Water management <br /> en(3 iwVL t C It that George W.Lowry,Inc.'will submit confirmation for(certain waste streams)to,the generator that their <br /> rmitted treatment,storage or disposal facility <br /> VV R� A - Ce'U� Date, � <br /> of Generator: X , <br /> Gate!"' <br /> ,Disposal Facilities }' <br /> Name i <br /> Address; <br /> iV <br /> Bakersfield Transfer' Recycling California Oil Reo clin Ramos Environmental Yuma Environmental city,state tlpi <br /> 1620 E.Brundage Lane 5300 Claus Road 1515 S.River Road 2730 E.13th ? 1 <br /> ' <br /> Bakersfield,CA 93307 Riverbank,CA 96367 West Sacramento,CA 95691 Yuma,AZ,85365 Phope <br /> 661.322.8258 209.863.8181 916371.5747 928.344.9826 "EPA`tD: <br /> CAL00026259 CAL0000190817 CAD004003556 AZR000515924 w <br />