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AMERICAN VALLE' . $- <br /> WASTE OIL, INC. Invoice Number: <br /> R O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA# CAL000827878 <br /> BILL TO: JOB SITE: Invoice Date: <br /> Phone ustomer P.O. Terms EPA# <br /> PRODUCT SHIPPING DESCRIP ION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used O I/Mixed Oils 221 <br /> NON-RCRA Waste Liquid Used A itifreeze 133 <br /> NON-RCRA Waste Liquid Used O ly Water 223 <br /> Drained Used Oil Filters <br /> TERMS: Invoices over 30 Days are subject t 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 herby certify that I have not mixe any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm, <br /> and the waste does not contain any PCBs.I ha e complied with the requirements of the applicable California used oil management regulation to determine this is <br /> true.I agree to accept the additional charges f r the disposal of this waste if the information I have provided about this waste is incorrect. <br /> Generator's Certification:By signing I certify th t if I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste <br /> generated to the degree I have determined to e economically affordable and that I have selected the practicable method of treatment,storage,or disposal currently <br /> available to me which minimizes the present a d future threat to human life and the environment:Or,if I am a small quantity generator,I have made a good faith <br /> effort to minimize my waste generation and se ect the waste management method that is available to me that I can afford. <br /> By both parties signing this invoice it will serve 3s an agreement that American Valley Waste Oil will submit confirmation for(certain waste streams)to the generator <br /> that their waste has been transported to a licei sed treatment or transfer facility. <br /> GENERATOR/ <br /> DRIVER AUTHORIZED <br /> SIGNATURE: DATE: ; SIGNATURE: DATE: , <br /> DISPOSAL / RECYCLING CILITY <br /> O DK-DIXON O CFR O UNITED ENTERPRISES CORP <br /> 7300 CHEVRON WAY 2035 E. 5TH ST. 11190 PENROSE ST. <br /> DIXON, CA 95620 LA,CA 9 021 SUN VALLEY,CA 91352 <br /> 707-693-6008 213-746- 237 818-787-2649 <br /> EPA#CAT080012602 EPA#C L000270577 EPA#CAL000379059 <br /> MPC(612013) <br />