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AMERICAN VALLEY 7 <br /> WASTE OIL, INC. Invoice Number: <br /> P. 0. Box 340 - Delhi, CA 95315 <br /> PH. 1-800-732-4645 - FAX 209-668-3880 <br /> EPA. CAL000827878 <br /> r"•�f ' <br /> �•- - Invoice Date: <br /> BILL TO: JOB SITE: <br /> f _ , <br /> Phone Customer P.O. Payment Terms EPA# <br /> _3 t <br /> PRODUCT SHIPPING DE CRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> USED OIL NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 <br /> USED AUTOMOTIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> OILY WATER, NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 rt• ;(D Qj ) <br /> TRINITY HEAVY DUTY PREMIX <br /> RECYCLED ANTIFREEZE N/A <br /> NON HAZARDOUS WASTE LIQUID <br /> TRUCK TIME N/A <br /> GREASWEEP N/A <br /> I hereby certify that I have not mixed this waste with any other waste,that the total halides are less than 1000 P.P.M.;and that 99 <br /> the waste does not contain any P.C.B.'s I further agree to accept the additional charges for legal disposal if this waste is over TOTAL Y _ <br /> 1000 P.P.M.total halides,or containes any P.C.B.'s. <br /> DRIVER GENERATOR AUTHORIZED <br /> SIGNATURE/ <br /> SIGNATURE <br /> TERMS: INVOICES OVER 30 DAYS ARE SUBJECT TO A 1.5%SERVICE CHARGE.CUSTOMER AGREES T-0 PAY ALL LEGAL FEES IF <br /> COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. Y" <br /> American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may be transported to a facility that is required to comply <br /> with federal regulations applicable tom anagement of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities. Californi facilities 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 a so meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and <br /> accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federat'used oil management standards and not these more <br /> stringent requirements. <br /> This notification is for information purp ses only. <br /> <°•' .�,.,�• =`,�Y ,...�---r-�:.a.... <br /> Driver signed Date r Generator signed `"" Date <br /> By signing the invoice the generator certifies that the generator has established a program-to reduce the volume or quantity and toxicity of the hazardous <br /> waste to the degree,as determined b the generator,to be economically practicable. <br /> By both parties signing this invoice it will serve as an agreement that American Valley will submit confirmations for(certain waste streams)to the generator <br /> that their waste has been transported o a license treatment or transfer facility. <br /> DISPOSA / RECYCLING FACILITY <br /> O RIVERBANK OILTRA14SFER O RAMOS ENVIRONMENTAL SERVICES <br /> 5300 CLAUS ROAD RIVERBANK, CA 95367 1515 SOUTH RIVER ROAD-W. SACRAMENTO, CA 95691 <br /> 209-863-8181 -EPA it CAL000190816 916-371-5747-EPA#CAD044003556 <br /> MPC(10/e <br />