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FSE IVED <br /> SEP 2 2 2016 <br /> Send Payment To: <br /> 2355 Road 192, DgW%N ENTMAL HEALTH <br /> Ph : 209-863-0888 - Fax : 03-863-b 87T <br /> EPA#CAL000367042 ID #46-0727047 <br /> Job Site : L .AND INSURED TRANSPORTER#3468 MCP#CA 130615 <br /> GENERATOR <br /> Site EPA ID# Invoice No. M <br /> Contact Person <br /> Company Name i-,K f`_ it c!I I N S jt ;, , BIII TO <br /> Address % Name <br /> City, State,Zip Address <br /> Site Phone City, State,Zip <br /> Date ) Customer PO Interval Net 30/C.0.D./Cash/Check Drivers Truck/Name <br /> PRODUCT' waste CA Manifest# Quantity Units Price Amount <br /> Code <br /> Non-RCRA Hazardous Waste Liquid(Used Oil) 221 Gal <br /> Non-RCRA Hazardous Waste Liquid(Oi &Water) 223 Gal <br /> Non-RCRA Hazardous Waste Liquid(LIE ed Automotive Antifreeze) 133 Gal <br /> Non-RCRA Hazardous Waste Solids Co itarninated Drum(s) <br /> Non-RCRA Hazardous Waste Solids Co taminated with Used Oil Drum(s) <br /> Drained Used Oil Filter Drum(s) Dmms(s) <br /> Empty Drum(s) Ead <br /> Transportation&Truck Time&Washout HR. <br /> Hazardous Testing <br /> We pay Customer Pays 0 �` <br /> rUnless otherwise specified on this Consolidated Manifest Receipt(Invoice)Terms Accounts due on the 10th of the month following '— <br /> month of purchase.Past due accounts will charged a FINANCE CHARGE at the PERIODIC RATE of 1.5%per month,which is the Total <br /> U <br /> ANNUAL PERCENTAGE RATE OF 18%. <br /> I hereby certify that I have not mixed thi$waste with any other waste that the total halides are less than 1000 PPM,and that the waste does not contain <br /> any PCB's.I further agree t accept theladditional charges for legal disposal If this,waste is over 1000 PPM,total,hal)des,or contains any PCB's <br /> � <br /> GENERATOR or4� ti I I <br /> AUTHORIZED: DRIVER SIGNATURE: <br /> TERMS: INVOICES OVER 30 DAYS AgE SUBJECT TO A 1.5%SERVICE CHARGE CUSTOMER AGREED TO PAY-A L LEISAL FEES OF COURT <br /> ACTION BECOMES NECESSARY TO OLLECT THIS INVOICE. <br /> Kern Oil here by advises the above Ge InIerator that Generators shipment of used oil may be transported to a facility that is required to comply with 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 <br /> management facilities.Kam Oil Filler R cycling is authorized to file a request for EPA#from DTSC.California facilities that handle or process used oil are <br /> required to meet those more stringent requirements,and some out-of-state facilities that process used oil&also meet those requirements,engineering <br /> certifications of tank integrity,and financial assurances for closure an accidental releases.It is lawful to send used oil to out-of-state facilities that comply <br /> only with federal used oil management sandards and not those more stringent requirements By signing the invoice the generator certifies that the generator <br /> has established a program to reduce the volume or quantity and toxicity of the hazardous waste to the degree, as determined by generator, to be <br /> economically practicable.By both parties signing this invoice it will serve as an agreement that Kem Oil will submit confirmations for(certain waste streams) <br /> to the generator that their waste has bee6 transported to a licenced treatment or transfer facility. <br /> Riverbank Oil Transfer E NAME NAME <br /> 5300 Claus Rd,Bldg 11 ADDRESS ADDRESS <br /> Riverbank,CA 95387 CITY CITY <br /> Ph:209-863-0888 Fax:209-863-0867 <br /> EPA#CAL000190816 STATE,ZIP STATE,ZIP <br /> PHONE PHONE <br /> EPA ID EPA ID <br />