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AMERICAN VALLEY - <br /> WASTE OIL , IMC : Invoice Number: <br /> P.O . Box 340 • Delhi , CA 95315 <br /> PH . 1 -800-732 -4645 e FAX 209-668- 3880 <br /> EPA# CAR000272302 <br /> BILL TO : JOB 3ITEI Invoice Date : <br /> Phone Customer P. O. Terms EPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON -RCRA Waste Liquid Used Oil/Mixed Oils 221 I ` <br /> NON -RCRA Waste Liquid Used Antifreeze 133 <br /> NON -RCRA Waste Liquid Used Oily Water 223 <br /> I Compliant Drained Used Metal Oil Filters <br /> l <br /> TERMS : Invoices over 30 Days are subject to a 1 . 5% service charge. Customer agrees to pay all legal fees if court action TOTAL <br /> becomes necessary to collect this invoice. <br /> By signing I herby certify that I have not mixed any of the Nvaste described above with any ether hazardous waste, the total halide content is LESS than ' , 000 ppm, and tie <br /> f waste does rot contain any PCBs. I have complied with the requirements of the apps€cable California used oil management regulation to determine this is true , agree to <br /> I accept the additional charges for the disposal of this waste V the information t have provided about this waste is incorrect. <br /> j Generator's Ceertilication: By signing I certify that if t am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicty of waste generat- <br /> ed to tf•.e degree I have determined to be economically affordable and that I have selected :he practicable method of treatment , storage, or disposal currently available to me <br /> which minimizes the present and future threat to human life and the environment: Or, if 1 am a small quantity generator, I have made a Good faith effort to minimize my waste <br /> generation and select the waste management method that is available to me that I can afford. <br /> American Valley Waste Oil hereby advises the above Generator that generators shipment o` used oil may be transported to a facility that is required to comply cfith federal <br /> regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facili - <br /> ties. California facilities that handle or process used oil are required to meet those more stringent requirement, and some out-of-state facilities that process used olt also meet <br /> those requirements, engineering certifications oftanh integrity, and financial assurances for closure and accidental releases. It is lawful to send :.rsed oil to out of state faclities <br /> that compty only with federal used oil management standards and not these more stringent requirements . <br /> I his notification is for information purposes only. <br /> By both parties signing this invoice It will serve as an agreement that Americar. Valley Waste Oil will submit confirmation for (certain waste streams) to the generator that their <br /> waste has been transported to a licensed treatment or transfer facility. <br /> GENERATOR ' <br /> DRIVERAUTHORIZED <br /> SIGfN&ATURE: DATE: SIGNATURE: DATE; <br /> DISPOSAL / RECYCLING FACILITY <br /> Q DK- DIXDN 044 ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O YUMAYES LLC O AMERICAN VALLEY WASTE OIL, INC <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD, 6500 US HWY 95 521 INDUSTRIAL DR STE P! <br /> DIXON , CA 95620 CERES , CA 95358 RIVERBANK, CA 95367 YUMA, AZ 85365 LIVINGSTON, CA 95334 <br /> 707-693-6008 209-541 - 7 $25 209-863-8181 928-344-9828 209-667-8857 <br /> EPA# CAT080012602 EPA# CAL000393680 EPA# CAL000190816 EPA# AZR000521146 EPA# CAL000443004 <br /> MPC (712016) <br /> vad Z £ 98- 1, 06 60Z ' OUI ' aell ! N Vl R8 j e 0 I• L 6l• 6Z AON <br />