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V ' MERICAN VALLEY 155974 WASTE OIL, iNCs Invoice Number : QMH C 4�y P.O. Box 340 • Delhi , CA 95315 }Z"P)r tp PH . 1 -800-7324645 • FAX 209-668-3880 �SDfiJr 11 V11 mo r - _ EpA 0NV%M4CAR000272302 FAST BAY CLARKLiFT-CHM ( ( momex , EAST BAY CLARKLIFT �� W 7 BILL To : 4701 OAKPORT ST JOB SITE: 1813 MOFFAT BLVD Invoice Date: OAKLAND, CA 946014906 MANTECA, CA 95336 Sales Rep Phon®09-465-8987 JENIFER Customer P.O. Terms EPA C. O.D. I CALnaD3gd32; PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE C AMOUNT CODE NO-N-RCRA Waste Liquid Used Oil/Mixed Oils 221 t- - NON-RCRA Waste Liquid Used Antifreeze 133 NON-RCRA Waste Liquid Used Oily Water 233 Drained Used Oil Filters 7 — OIL COLLECTION FEE VWAt I i � TERMS: involves over 30 Days are subject to a 1 .5% service charge Customer agrees to pay all legal fees it court action iTOTAL � r becomes necessary to collect this invoice. ® n By signing I herby certify that I have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than t ,coo pm, and d waste does not contain any PCBs. I have compiled with the requirements of the applicable Caltfomla used ori management regulation to dalennine this Is Imre. I agree to accept the additional charges for the disposal of this waste 8 the infonnatlon I have provided about this waste Is Inconaof. Generator's Certification: By signing 1 certify that if I am a large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generat- ed to Me degree I have determined to be economically affordable and that I have aelacted the practicable method of treahnerrf, storage, or disposal currently 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 Minimize my waste generation and select the waste management method that is available to me that 1 can afford. American Valley Waste Oil hereby advises the above Generator that generators shipment of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that Is root required to comply with the more stringent requrements applicable to hazardous waste management facili- t'ies. California facilities that handle or process used oil are required to meet those mora stringent requimmen4 and some out-of-state facilities that process used oil also meat those requirements, engineering certifications of tank Integrity, and f wocial assurances for closure and accidental releases. It is lawful to send used all to out of state facilities that comply only with federal used all management standards and not these more stringent requirements, P This notification Is for Information purposes only. ( By both parties signing this invoice it will serve as an agreement that American Valley Waste Oil will submit confirmation for (certain waste streams) to the generator that their waste has been transported to a licensed treatment or transferfacility, GENERATOR/ DRIVER AUTHORIZED a _ a I SIGNATURE DATE' x l SIGNATURE: TE: T 5 fd DISPOSAL / RECYCLING FACILITY O DK-DIXON JE�17A'SBURYENVIRONMENTAL O RIVERBANK OILTRANSFER O CFR O GLOBAL MATERIAL MGMT 73DO CHEVRON WAY 1920 MORGAN RD, 5300 CLAUS RD- 2035 E, 15TH SL 1640 N. BROADWAY DIXON, CA 95620 CERES, CA 95358 RIVERBANK, CA 95367 LA, CA 90021 STOCKTON, CA 95205 707-693-6008 707.693.BW8 209,863m 8181 213-74&0237 818-770.2577 EPAN CA7080012602 EPAtrCALOOD393680 EPA# CALOGO190816 EPA# CAL000270577 EPA# CAL000417316 I E E� E i