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AMERICAN VALLEY <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: Invoice Date: <br /> Phone Customer P.O. Terms EPA# <br /> PRODUCT SHIPPIN DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Li juid USE d Oil/Mixed Oils 221 <br /> NON-RCRA Waste Liquid Us I <br /> d Antifreeze 133 <br /> NON-RCRA Waste Lil juid USE d Oily Water 223 <br /> NON Hazardous Wase Liquid <br /> Trinity Heavy Duty prE mixed Aitifreeze <br /> Trinity Extended Life p-emixed ntifreeze <br /> Trinity Case Goods <br /> Truck Wash Out <br /> Truck Time <br /> TERMS: Invoices over 30 DE ys are sutiect to a 1.510 service charge. Customer agrees to pay all legal fees if court action TOTAL. <br /> becomes necessary to collet this invoice. <br /> By signing I herby certify tha I have nc t mixed 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 RC.B's. I further agree to ccept the additional charges for legal disposal if the waste is over 1000 P.P.M.total halides. or contains any PC.B's <br /> Generator's Certification: By signing I artily 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 econ mically practicable. <br /> By both parties signing this i voice it II serve as an agreement that American Valley Waste Oil will submit confirmation for(certain waste streams) to the <br /> generator that their waste ha 5 been trai isported to a licensed treatment or transfer facility. <br /> American Valley Waste Oil hE reby advis as 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 tomanagement of used oil.but that is not required to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities California 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 also meet those requirements. engineering certifications of tank integrity. and financial assurances for closure and <br /> accidental releases. It is law ul to send used 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 AUTHORIZED <br /> SIGNATURE: DATE: SIGNATURE: DATE: <br /> O NAME DISPOSAL / RECYCLING FACILITY <br /> ADDRESS: O 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 /> r-nn . r+nrno--�nn <br />