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FROM FAX NO. An. 14 2011 04:09PM P3 <br /> AMERICAN VALLEY lou (59 <br /> WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> CAL000827878 <br /> BILL TO: JOB SITE: <br /> S&8 GAS MARKET S&B GAS MARKET Invoice Date: <br /> 515 W. 11TH ST 515 W.11TH ST <br /> TRACY,CA 95376 TRACY,CA 95376 <br /> X BESSY <br /> STs <br /> Phone Customer P.O. Terms EPA# <br /> 209-834-883Q SANJAtY C.0.D. CAL000863575 <br /> PRODUCT SHIPPING DESCRI TION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used il/Mixed Oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used ily Water KA i tJ <br /> NON Hazardous Waste Liquid <br /> t <br /> Trinity Heavy Duty premixed Anti reeze <br /> Trinity Extended Life premixed An freeze <br /> Trinity Case Goods �I S' <br /> Truck Wash Out <br /> Truck Time <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 herb Certify that I have not mi ed this waste with any other waste,that the total halides are less than 1000 P,P,M;and that the waste does not <br /> contain any P.C.B's. I further agree to acc t the additional charges for legal disposal if the waste is over 1000 PP.M.total halides,or contains any PC.B's <br /> Generators Certification: By signing I cern that I have a program in place to reduce the volume and toxicity of hazardous waste generated to the degree I <br /> have determined to be economically preen ble. <br /> By both parties signing this invoice It will srve as an agreement that American Valley Waste Oil will submit confirmation for(certain waste streams)to the <br /> generator that their waste has been trans rted to a licensed treatment or transfer facility. <br /> American Valley Waste Oil hereby advises t e above Generator the Generators shipment of used oil may be transported to a facility that is required to comply <br /> with federal regulations applicable to mana ment of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities.California faci ities that handle or process used oil are required to meet those more stringent requirements, and some out-of- <br /> state facilities that process used oil also eet those requirements, engineering certifications of tank integrity, and financial assurances for closure and <br /> accidental releases.It is lawful to send u oil to out-of-state facilities that comply only with federal used oil management standards and not these more <br /> Stringent requirements. <br /> This notification is for information purposes only. <br /> GENERATOR/ <br /> DRIVER T AUTHORIZED <br /> -SIGNATURE; - DATE: J SIGNATURE: DATE: G' <br /> DISPOSAL/ RECYCLING FACILITY <br /> ADDRESS: DK-DIXON O RAMOS ENVIRONMENTAL SERVICE <br /> CITY/ST: 7300 CHEVRON WAY 1515 SOUTH RIVER ROAD <br /> DIXON, CA 95620 W.SACRAMENTO, CA 95691 <br /> PHONE: 707-693-6008 916-371-5747 <br /> EPAk: <br /> EPA#CAT080012602 EPA#CAD044003556 <br /> MPC(4/2010) <br />