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AMERICAN VALLEY 174753 WASTE ® ILS INC . Invoice Number: P.O . Box 340 • Delhi , CA 95315 PH . 1 -800-732-4645 • FAX 209-668-3880 _ _ EPA# CAR000272302 (cio BILL TO. EA61 BAY GLARKLIFT-CHNI C"4 JOB SITE: EAST BAY CLARKLIFf Invoice Date: 4701 OAKPORT ST 1813 MOFFAT BLVD OAKLAND, CA 946014906 MANTECA, CA 95896 CXi 1 ) Xl III e4/L �_ _ Phone Customer P, O, Terms EPA# 209-46&8907 .KNIFE-- C.OA. CAL0003944527 PRODUGT SHIPPING DESCRIPTION WASTE MANIFEST !QUANTITY PRICE J AMOUNT CODE NON- RCRA Waste Liquid Used Oil/Mixed Oils j 221 NON-RCRA Waste Liquid Used Antifreeze 133 NON-RCRA Waste Liquid Used Oily Water 223 Compliant Drained Used Metal Oil Filters ( ( f l ' j j i TERMS: Invoices over 30 Days are sub}ecl to a 1 .51 service charge. Customer , g i ws`i j a4 legal fees If court action TOTAL R Y becomes necessary to collect this invoice. By signing I henry eenity that I have not mixed tory of the waste described above with any other hazardous waste the total halide convent is LESS then 1 ,ODD ppm, and the waste does not contain any PCBs. I have conpllod with the requirements of the applicable California uead oil management regulation to determine this Is true. I agree to accept tile additional charges for the disposal of this waste If the Moneation i have provided about tats waste is Incorrect. Generator's Cerifficalion: By signing I earthily that If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generat- ed to the dogma I have delefmined to be economically affordable and that I have selected the practicable method of treatment, storage, or dispomi currently available to me which minimizes the present and future threat to hurnan life and the environment; or, if I am a small quantity generator, I have made a Good faith effort to mirimrze my waste generation end select the waste numagement matlod that is available to me that I can afford. American Vallay Waste Oil hereby advfass the above Generator that generators shipment of used oil may he transported to a facility that is required to comply wim federal I regulations applicable to management of used oli, but that Is not required to comply with the more stringent requirements applicable to hazardous waste management feel,(- tlas. California facilities that handle or process used all are required to inset those more stringent requi mint, and some out-ohstate facilities that process used all also meet i those requirements, engineering certifications of tank Integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out of state facilities I that comply only with federal used ON management standards and not these more stringent requirements. This notification Is for Information purposes only. By both parties signing this invoice it will solve as an agreement that American Valley Waste ON will submit confirmation for (certain waste streams) to the generator lftai their I waste has boon transported to a licensed treatment or transfer facility. GENERATORI ee DRIVER j, nom - DATE: n • ff # SIGNATURE. ' "r ' � ��} � h SIGNATURE: _ ! t � I I - ( DATE ` —ti- IDISPOSAL I RPCY ING FACILITY DK-DIXON ASBURYENVIRONMENTAL Q RIVERBANKOIL TRANSFER O YUMAYES LLC O 11� NO 521INDUA LEY INDUSTRIAL TEM 73D0 CHEVRON WAY 192(1 MORGAN RD. 5300 CLAUS RD, 6500 US HWY 95 521 INDUSTRIAL DR STEM DIXON, CA 95620 CERES , CA 95368 RIVERBANK, CA 95367 YUMA, AZ 85365 LIVINGSI"ON, CA 95334 707-6936008 209.541 -1825 209.883-8181 926 3449828 209.667.6857 EPA# CAT080012602 EPA# CAL0003938M EPA# CALOD0190816 EPA# AZR000521146 EPA# CAL000443004 E -- - AIPG 17120181 I I