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F <br /> RECEIVED <br /> SEP 2 2 2016 <br /> Send Payment To: <br /> 2355 Road 192 nF T�q-A�L HEALTH <br /> 1 Lu <br /> Ph : 209-863-0888 - FUr9 V3� - 17 <br /> EPA#CAL000367042 ID#46-0727047 <br /> Job Site : LI .AND INSURED TRANSPORTER#3468 MCP#CA130615 <br /> GENERATOR <br /> Site EPA ID# Invoice No. MU 6 <br /> Contact Person <br /> Company Name }1h '(+.'} R i,Ar BIII To : <br /> Address 1 j.-e Name <br /> Eite <br /> State,Zip Address <br /> Phone '�G U `�� ` 1 3 �` City,State,Zip <br /> Date Customer PO Interval Net 30/C.O.D./Cash/Check Drivers Truck/Name <br /> ,L I <br /> PRODUCi Code CA Manifest# Quantity Units Price Amount <br /> Non-RCRA Hazardous Waste Liquid(U ed Oil) 221 Gal <br /> Non RCRA HaArdous Waste Liquid1 <br /> 01&Water) 223 Gal <br /> Non-RCRA Hazardous Waste Liquid(U Automotive Antifreeze) 133 Gal <br /> Non-RCRA Hazardous Waste Solids C taminated Nos) <br /> Non-RCRA Hazardous Waste Solids C ntaminated with Used Oil D(s) <br /> Drained Used Oil Filter Drum(s) DIw6(s) <br /> Empty Drum(s) 1 Eadi 1<c�s� <br /> Transportation&Truck Time&Washout <br /> Hazardous Testing <br /> y �l\`` .�,�i�Ce` <br /> We pay❑ Customer Pays <br /> Unless otherwise specified on this Conscli ated Manifest Receipt(Invoice)Terms:Accounts due on the 10th of the month following <br /> month of purchase.Past due accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1.5%per month,which is the Total <br /> ANNUAL PERCENTAGE RATE OF 18%. <br /> I hereby certify that 1 have not mixed this waste with any other waste that the total halides are I tha�1000 PPM,and that the waste does no contain <br /> any PCB's.1 further agreertC,,accept thb additional charges for legal disposal If this,waste is ov 1000 tP119,total hall or contains any PCB's <br /> GENERATOR o 1 - <br /> AUTHORIZED: DRIVER SIGNATURE. <br /> TERMS:INVOICES OVER30 DAYS ARE SUBJECT TOA 1.5%SERVICE CHARGE CUSTOM REED TO PAY ALL LEGAL FEES OF COURT <br /> ACTION BECOMES NECESSARY TQ COLLECT THIS INVOICE. <br /> Kem Oil here by advises the above Ginerator that Generators shipment of used oil may be transported to a facility that is required to comply with federal <br /> regulations applicable to managemen of used oil.But that is not required to comply with the more stringent requirements applicable to hazardous waste <br /> management facilities.Kem Oil Fitter Recycling 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 fina cial assurances for closure an accidental releases.It is lawful to send used oil to out-0f--state facilities that comply <br /> only with federal used oil management standards and not those more stringent requirements By signing the Invoice the generator certifies that the generator <br /> has established a program to red uthe volume or quantity and toxicity of the hazardous waste to the degree, as determined by generator, to be <br /> economically practicable.By both pa s signing this invoice twill serve as an agreement that Kem Oil will submit confirmations for(certain waste streams) <br /> to the generator that their waste has be, n transported to a licenced treatment or transfer facility. <br /> Riverbank Oil Transfer El NAME NAME <br /> 5300 Claus Rd,Bldg 11 ADDRESS ADDRESS <br /> Riverbank,CA 95387 CITY CITY <br /> Ph:209-863-0888 Fax:209-663-0887 STATE,ZIP STATE,ZIP <br /> EPA#CAL000190816 <br /> PHONE PHONE <br /> EPA ID EPA ID <br />