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Environmental Services Division Melling: P.O. Box 176, Salida, CA 95368 GEORGE �pjQ, � OtiS ® ' IC� ��@d a �11 �@$ � „, 46l2KlemanCourt, Solids, CA95368 Consolidated Phone: 209x545-0791 FAX 209,545.2241 aLOWRY i"i VO1 Cs�; EPA # CAR000047019 qAPIETROLEUM PRODUCTp MPANY 1 Y �r CA Transporter Number 3844 bA License # 758518 GENERATOR : Invoice N0� 4:0 0 a 0 Site EPA ID #; Invoice Date: ( f Contact Person: Driver Printed Signature: +.1 Name: Truck #: Address: t ` VI , PO # City, State, Zip: SitePhone: TERMS: Product Shipping Name Waste CA Manifest #0 Quantity units price Amount Code Non RCRA Hazardous Waste liquid (Used Oil); Lubricating 221 t t � cal Non-RCRA Hazardous Waste Liquid (Used Oil): Industrial 221 cal Non RCRA Hazardous Waste Liquid (Used Automotive Antifreeze) 134 cal Non-RCRA Hazardous Waste Liquid (Oil & Water) 223 Go Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 352 Drum(s) Drained Used Oil Filter Drum(s) Drum(s) Empty Drum(s) Each Transportation & Truck Time HFL Unless otherwise specified on this Consolidated Manifest Receipt (Invoice) Terms: Accounts due on the 10th of the month following month of purchase. Past due Total _ accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1 -1/2% per month, which Is the ANNUAL PERCENTAGE RATE of 18W 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 LESS than 1 ,000 ppm, and the 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 accept the additional charges for the disposal of the waste if the Information I have provided about this waste is incorrect. 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 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) available to me which minimizes the present and future threat to ltuman life and the environment. 'Or, it 1 am a small quantity generator, I have made a Good Faith effort to minimize my waste generation and select the waste management meth"od that is available to me that I can afford. 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 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 hazardous waste management facilities. California facilities that handle or process Used Oiivand Oily/Water are required to meet those more stringent requirements, and some out-of--state facilities that process Used Oil and Oily/Water also meet those requirements, engineering certifications of tank integrity, and financial assurances for 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 Oil and 011y/Water management standards and not these more stringent requirements. This notification is for the Informallonai purposes only. By both parties signing this invoice it will serve as an agreemenat. qGeorge W. Lowry, Inc. will submit confirmation for (certain waste streams) to the generator that their waste has been transported to a permitted transfer facility or * rmltted treatment, storage or disposal facility. Lowry Driver Signature X ..'` Date t Signature Of Generator, Represet•fta r lent of Generator: X Date Recycling, Transfer, Treatment, Storage, Disposal Facilities Name: 13 C3 ❑ ® Address: Bakersfield Transfer Callfomla 011 Recycling Ramos Environmental Yuma Environmental City, state, zip: 1620 E. Brundage Lane 5300 Claus Road 1515 S. River Road 2730 E. 13th Bakersfield, CA 93307 Riverbank, CA 96367 West Sacramento, CA 95691 Yuma, AZ, 85365 Phone: 661 &32208258 209.863-8181 , 916.3715747 928.344.9826 CAL00028258 CAL000019081 CA0004003656 AZR000515924 EPA to :