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09/18/2013 14:56 120933d1873 <br />FLAGCITV CHEW` <br />AMERICA -N VALLEY <br />WASTE OIL, INC, <br />.J <br />P. 0. Box 340 • Delhi, CA 95315 <br />PH, 1-800-732-4645 • FAX 209-668-SS80 N IM E NTAL <br />_ ..ww <br />�.,. EP W,CAL000827878 t i DEPARTMENT <br />RILL TO:11a.vR(04 <br />FLAG C17"Y CHl; ON i, f-i►AfY 1 `� tri t' � <br />C,4 " f d:, d.1(:-11, t. eci,v f,..C,if 91 ,tti l;r'I <br />[(� <br />Phone Customer P.O. <br />PRODUCT SHIPPING DESCRIPTION WASTE <br />CODE <br />NON-4ICRA Waste Liquid Used Oil/Mixed Olis 221 <br />NON-RCRA Waste Liquid Used Antifreeze 133 <br />NON-RCRA Waste Liquid Used Oily Water 223 <br />Drained Used Oil Filters <br />1 <br />I <br />G, 0.0 <br />PAGE 04/09 <br />117941 <br />Invoice Nurn.ber: <br />Invoice late: <br />PRICE I AMOUNT <br />TERAAS: invoices over 30 Days aro subject to a 15% sorvlce charge. Customer eigrees to pay all legal fees If court SCOOP TOTAL <br />beoomes neoesaary to collect this invoice. <br />By slgning I herby certify that I have not mixed any of the waste described above with any other hazardous waste, the total hallde content Is LESS than 1,000 ppm, <br />and the waste does not contain any PCBs, t have compiled with the requirements of the applicable California used oil management regulation to determine this Is <br />true, I agree to accept the additional chorges for the.dlspocal ofthis waste ifthe information I have provided about this waste Is Incorrect, <br />Generator's Certification, By signing I certify that 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 be economically affordable and that I have %elected the practicable method of treatment, storage, or disposal curmntly <br />available to me which minimizes the present and 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 select the waste management method that Is avallable to me that I can afford, <br />By both partles signing this invoice it will serve as an aproement that American Valley Waste oil will submit confirmatlon for (certain waste streams) to the generator <br />thnt their waste has been transported to n llcensed treatment or transfar facility. <br />GENERATOR/ <br />DRIVER r AUTHORIZED <br />SIGNATURE: DATE: SIGNATURE. <br />DISPOSAL / FACILLTY <br />DK�DIXON <br />Q CM <br />0 UNITED ENTERPRISES OORP <br />7300 CHEVRON WAY <br />2035 E. 15TH ST. <br />11190 PRNR091= S7, <br />DIXON, CA 95620 <br />LA, CA 90021 <br />SUN VALLEY, CA 81352 <br />707-693-6008 <br />213.746-0237 <br />818.787-2649 <br />EPA# CAT080012602 <br />EPA# CAL000270577 <br />EPA# CAL0003790599 <br />DATE,`? -&". ".1.,,f <br />MPC (4/2013) <br />