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08•/30/2010 10:52 12093341873 FLAGCITV CHEVRON <br />BILL TO: FLAG CITY CHEVRON <br />6421 CAPITOL AVE <br />LODI, CA <br />'N69-3334-0975 KAREN <br />PRODUCT SHIPPING DESCRIPTION <br />AMERICAN VALLEY <br />WASTE OIL, INC. <br />F O. Box 340 o Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />CAL000827878 <br />mer P, <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />NON-RCRA Waste Liquid Used Antifreeze <br />NON-RCRA Waste Liquid Used Oily Water <br />NON Hazardous Waste Liquid <br />Trinity Heady Duty premixed Antifreeze <br />Trinity Extended Lite premixed Antifreeze <br />,TOB SITE: FLAG CITY CHEVRON <br />HVVII' 12 & NM 5 <br />LODI, CA <br />C, <br />TeO <br />Er"C <br />WASTE MANIFEST <br />QUAN <br />CODE <br />221 <br />133 <br />Trinity Case Goods <br />Truck Wash Out <br />Truck Time <br />TERMS: Invoices over 30 Days are subject to a 1.5% service charge, <br />becomes necessary to collect this invoice, <br />223 <br />LA <br />PAGE 03/04 <br />95467 <br />Invoice .Nurnl-)er: <br />�7- )���, <br />Invoice pate: <br />Bolles Rep: Stere <br />CAL000153066 <br />ICE I AMOUNT <br />�n!n 135,OD <br />agrees to pay all legal fees if court action i TOTAL � v <br />By signing I herby certify that I have not mixed This waste with any other Waste, that the total halides are less than 1000 RPM; and that the waste does not <br />contain any PC,S's. I further agree to accept the additional charges for legal disposal K the waste is over 1000 P.P.M, total halides, or contains any PC.B's <br />Generator's Certification: 13y signing I certify that I have a program in place to reduce the volume and toxicity of hazardous waste generated to the degree I <br />have determined to be economically practicable, <br />By both parties signing this Invoice It will serve as an agreement that American Valtey Waste Oil will submit confirmation for (certain waste streams) to the <br />generator that their waste has been transported to a ilcensed treatment or transfer facility, <br />American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may be transported to a facility that Is required to comply <br />With federal regulations applicable to management of used oil, bW that Is not required to comply with the more stringent requirements applicable to hazardous <br />waste management facilities. California facilities fllat handle or process used oil are required to meet those more striagant requirements, and some out -of <br />state facilities that process used oil also meet those requirements, engineering certifications of tank Integrity, and financial assurances for closure and <br />accidental releases, It is lawful to send used oil to Out-of-state facilities that comply only with federal used oil management standards and not these. more <br />stringent requirements. <br />This notification is for informaKn purposes only. <br />l <br />DRIVER GENERATOR/ <br />f C` <br />AUTHORIZED f <br />SIGNATURE, - DATE; ! ! SIGNATURE; Derr: 1� N ` <br />O NAME: -. DISPOSAL, / RECYCL.I_NG FACILITY <br />ADDRESS: -, O'DK-DIXON <br />O RAMOS F-NVIRONMEN1gt. SERVICE <br />(',rrY/sT: _ _ 7300 CI-IFVRON WAY 1515 SOUTH RIVER ROAD <br />PHONE: <br />DIXON, CA 95620 W, SACRAMENTO, CA 95691 <br />_ 707-693-6008 916-371.5747 <br />FPAI? EPA f# CAT080012602 EPA # CAD0440r)3554 <br />MPC (4/20101 <br />