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AMERICAN VALLEY 183400 <br /> WASTE OIL, INC. Invoice Number: <br /> P.O . Box 340 • Delhi , CA 95315 <br /> PH . 1 -800-7324645 • FAX 209-668-3880 <br /> EPA# CAR000272302 <br /> BILL TO: EAST BAY CLARKLIFT-CHM '- lam 102 3e <br /> 4701 OAKPORT ST JOB SITE: EAST BAY C-ARKLIFT Invoice Date: <br /> OAKLAND, CA 946014906 1815 MOFFAT BLVD <br /> MANT'EC , CA -Qae6 <br /> Phone 209 46$ 8987 JENIFER� Customer ROI Terms �.r --- ---- - " —. . <br /> pACAL000394327 <br /> PRODUCT SHIPPING DESCRIPTION <br /> WASTE MANIFEST �tJANTf1Y PRICE AMOUNT <br /> CODE <br /> NON- RCRA Waste Liquid Used Oil/Mixed Oils <br /> , 221 <br /> NON- RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Metal Oil Filters <br /> OIL COLLECTION FEE — <br /> r _ <br /> I <br /> TERMS: Invoices over 30 Days are subject to a 1 ,5% service charge, Customer �_- <br /> becomes necessary to Collect this Invoice. 9 agrees to pay ail legal fees if spurt action TOTAL <br /> By sign V 1 herby certify that I have not mixed any of this waste described above with any othar hazardous waste, the total halide content is LESS than i ,noa ppm, and the <br /> waste does not contain any PCBs. I have complied with the requirements of the applicable Califomia used oil management ragutatlon to determine this Is true. I agree to <br /> accept the additional charges for the disposal of this waste It the information I have provided about this waste Is Incorrect, <br /> Ganotetor's Certification: By signing I certify that 8I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste gertzret- <br /> ed 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 <br /> which minimizes the present and future threat to human lite and the environment: Or, if I am a small quantity generator, I have rade a Good faith effort to minimize my waste <br /> generation and select the waste management method that Is available to me that t can afford, <br /> Amodean Valley Waste Oil hereby advises the above Gensraw that generators shipment of used oil may be transported to a facility that Is required to Comply Wit federal <br /> regulations applicabie to management of usual 011, but that is nut required to comply with the more stringent requirements applicable to hazardous waste management tttdli- <br /> gas, California facilities that handle or process used all are required to moot tfase more stringent requirement, and soma out-of-state facifl ise that process used ell also meat <br /> threose requirements, enginswft certifications of tank integrity, and financial assurances f0rctosure and accidental releases. It La tawfui to send orad �a e„ �.,e ti conte to meet <br /> rvv my wrth fod.rul unod oft mnnagcr,da armwarus unu mat areae mora sain9ent requirements. <br /> This notifloat(on Is for reformation purposes only, <br /> By both parties signing this Invoice it will serve as an agreement that American Valley Waste Oil will submit confirmation for (certain waste sbeams) to the generator that their <br /> waste has been transported to a licensed treatment or transfer facility, <br /> DRIVER /� GENERATOR! <br /> SIGNATUAE: DATE a7 aS GNATR� <br /> ! —;y Lis` DATEd <br /> DISPi OSAL I _RE ,Yt` INf ITY f <br /> O DK-DIXON Q9 ASBURYENVIRONMENTAL 0 RIVERBANK OIL TRANSFER O YUMAYES LLC fJ AMERICANVALLeYwnsteOIL, INC <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD, 6500 US HWY 95 521 INDUSTRIAL DR STE M <br /> j DIXON, CA 95620 CERES, CA 95358 RIVERBANK, CA95367 YUMA, AZ 85365 LIVINGSTON, CA 96334 <br /> 707-693.6006 209.541111825 2091863.8181 9281344-9828 200-687-8657 <br /> EPA# CAT080012602 EPA ` CAL000393680 EPA# CAL000190816 EPA# AZR000521146 EPA# CAL000443M <br /> MPG (112016) <br />