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BILL TO: FLAG CITY CHEVRON <br />6421 CAPITOL AVE <br />LODI, CA <br />AMERICAN VALLEY <br />WASTE OIL, INC. <br />P. O. Box 340 e Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />CAL000827878 <br />JOB SITE: FLAG CITY CHEVRON <br />HWY.12 & HWY 5 <br />LODI, CA <br />Y <br />95467 <br />Invoice Number: <br />'R,-ft-� � <br />Invoice Date: <br />Sales Rep: Steve <br />P <br />�'9-334-0975 <br />Customer P. � <br />Terms <br />EPA# <br />KAREN . <br />C.O.D. <br />CAL000153066 <br />PRODUCT SHIPPING DESCRIPTION <br />MANIFEST <br />QUANTITY <br />PRICE <br />AMOUNT <br />WASTE <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />NON Hazardous Waste Liquid <br />Trinity Heavy Duty premixed Antifreeze <br />Trinity Extended Life premixed Antifreeze <br />Trinity Case Goods <br />' <br />Truck Wash Out <br />Truck Time <br />TERMS: Invoices over 30 Days are subject to a 1.5% service. charge. Customer agrees to pay all legal fees if court action <br />TOTAL Ig`�"-- <br />becomes necessary to collect this invoice. <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 P.P.M; and that the waste does not <br />contain any P.C.B's. I further agree to accept the additional charges for legal disposal if the waste is over 1000 P.P.M. total halides, or contains any P.C.B's <br />Generator's Certification: By 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 Valley Waste Oil will submit confirmation for (certain waste streams) to the <br />generator that their waste has been transported to a licensed 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, but that is not required to comply with the more stringent requirements applicable to hazardous <br />waste management facilities. California facilities that handle or process used oil are required to meet those more stringent 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 information purposes only. <br />GENERATOR/ <br />DRIVER """" AUTHORIZED i ! }C� <br />SIGNATURE: DATE: SIGNATURE: E: j DATE: <br />O NAME: DISPOSAL/ RECYCLING FACILITY <br />ADDRESS: Q"DK-DIXON O RAMOS ENVIRONMENTAL SERVICE <br />CITY/ST: 7300 CHEVRON WAY 1515 SOUTH RIVER ROAD <br />DIXON, CA 95620 W. SACRAMENTO, CA 95691 <br />PHONE: 707-693-6008 916-371-5747 <br />. EPA#: EPA # CAT080012602 EPA # CAD044003556 <br />MPC (4/2010) <br />