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, AMERICAN VALLEYREC <br />- <br />,Ad 4 <br />WASTE <br />D1L INC. EIVE�r Voice Number: <br />P. O. Box 340 • Delhi, CA 95315 0 C T 18 2013 <br />PH, 1 800-732-4645 • FAX 209-668-3880 <br />EPA# CAL000827878 ENVIRONMENTAL <r,r . 93 <br />?, <br />HEALTH DEPARTMENT r, _-- <br />BILL TO: rti J.OB-.$1TE: t=i..t��:a t tI"t' {':s�� .�,i r{: FP i Invoice Date: <br />C t nr� --rrrr�r ir.':ers a_,,...,. d•�I'ti':7•`n'.r"1± `4" ";� <br />1f <br />�.1=i r� � ' �k•�i"7 3'' I,. Y0�'Mr7..: ...,,. I �{.?I�.`Ie" <br />LODI. <br />1 <br />q ) t1 <br />Phone Customer P.O. �,.. <br />T mS <br />,. <br />PRODUCTSHI�PPING� ESCRIPTION. WASTE MANIFEST QUANTITY OUNT <br />PRicE AM <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 _-- <br />NON-RCRA Waste Liquid Used Antifreeze 133 — <br />NON-RCRA Waste Liquid Used Oily Water 223- <br />Drained <br />23 Drained Used Oil Filters <br />urt action J TOTAL <br />---- <br />TERMS: Invoices over 30 Days are subject to a t .S% service charge- Customer agrees to pay all legal fees tl co ; , <br />becomes necessary to collect this Invoice.is <br />By signing I herby certify that I have not mixed any of the waste described above with any other hazardous waste, the total halide content latioLESS thann to determine this <br />this Is <br />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 regu <br />true. I agree to accept the additional charges for the disposal of this waste if the Information I have provided about this waste Is incorrect. ? j <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 />I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, or disposal currently <br />generated to the degree <br />nt and future threat to human life and the environment: or, if I am a small quantity generator, I have made a good faith <br />available to me which minimizes the prese <br />effort to minimize my waste generation and select the waste management method that is available to me that !can afford. <br />`By both parties signing this invoice it will serve as an agreement that: American Valley Waste oil wilt submit confirmation for (certain waste streams) to the generator <br />I that their waste has been transported to a licensed treatment or transfer -facility. <br />GENERATOR! <br />AUTHORIZED PATE; ' 3: <br />DRIVER ---_.—_—__ —_ -- QnT=N SIGNATURE:. <br />SIGNATURE:..,,'4—�. <br />DISPOSAL /,,RECYCLING FACILITY O O uNiTEo ENTERPRISES CORP "DK-DIXON O CFR <br />2035 E. 15TH ST. 11190 PENROSE ST, <br />7300 CHEVRON WAY LA, CA 90021 SUN VALLEY, CA 91352 <br />DIXON, CA 95620 2A, CA -0237 818-787-2649 <br />707-693-6008 EPA# 6-0237 27Q577 I=PA# CAL000379059 <br />EPA# CAT080012602 <br />MPC (R/2013) <br />