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FEB / 25/ 2022 / FRI 04805 PM Tracy Truck Stop FAX No , 209832 2312 P , 004
<br /> Environmental services Division
<br /> <G;E0R1CG3E
<br /> Mailing: F,C. Box 176, Solldes CA 95366
<br /> ,NC' Consolidated Manifest Phone;4612
<br /> 5-0791 elAa, CA545-2
<br /> L 95368
<br /> OWRYPhone: 209-545-0791 FAxZ09-545-2241
<br /> 6UM PROD ucTa CQMPANY Invoice
<br /> EPA 9! C1�000047619
<br /> Y Viii CATranaporterNumb2r3844
<br /> CA License # 756510
<br /> GENERATOR , Invoice N2 40002385
<br /> Site EPA 10 #: , Invoice bate:
<br /> Contact Person : Driver Printed $IgndtUre : IN
<br /> l
<br /> Name: 4e Truck #:
<br /> Address : I1PO #
<br /> City, State, Zlp :
<br /> Site Phone: TERMS :
<br /> Product Shipping Name Waste CA Manifest #0 Quantity Unhe Price Amount
<br /> Code
<br /> Non-RGRA Hazardous Waste Liquid (Used 011): Lubricating 221 Gat
<br /> Non-RCRA Hazardous Waste Liquid (Used Oil): Industrial 221 Gal
<br /> Non RCRA Hazardous Waste liquid (Used Automotive Antifreeze) 134 Gal
<br /> Non-RCRA Hazardous Waste Liquid (Oil & Water) 223 Gal
<br /> Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 3B2 Drum(s)
<br /> Paper and/or Plastic Oil Filter Drum(s) 352 Drum(ej
<br /> Drained Used Oil (Metal) Filter Drum(s) Each
<br /> 1 mpty Drum(s) Each
<br /> Transportation & Truck Time MR,
<br /> Manifest Fee
<br /> Unieea otherwise specified on this Consolidated Manifest Receipt (Invoice) Terms: Accounts due on the 10th of the month following month of purchase. Past due Totala.�,. d7
<br /> accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1 -U2% per month, which Is the ANNUAL, PERCENTAGE RATE of 113%,P1 I
<br /> ,(�-✓
<br /> By signing I hereby certify that I have not mixed any of the waste described above With any other hazardous waste, the total halide content is LESS than 1 , 000 ppm, and
<br /> the waste does not Contain any PCB's, I have complied With the requirements of the applicable California used oil management regulation to determine this Is true. I agree
<br /> to accept the additional charges for the disposal of the waste if the 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 program In place to reduce the volume and toMolty of waste
<br /> generated to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, or disposal currently
<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 effort to
<br /> minimize my WaSte generation and select the waste management method that Is available to me that I can afford.
<br /> George W. Lowry, Inc, hereby advisee the above Generator that generators shipment of Used Oil and OIIyNVater may be transported to a facility that Is required to Comply
<br /> with federal regulations applicable to management of Used Oil and Oily/Water, but that is not required to comply with the more stringent requirements applicable to
<br /> hazardous waste management facilities • California facilities that handle or process Used Oil and OilyAVater are required to meet those more stringent requirements, and
<br /> some out-of-state facilities that process Used Oil and Oily/Water also meet those requirements, engineering certifications of tank integrity, and financial assurances for
<br /> closure and accidental releases, it is lawful to send Used Oil and OIIy/Water to out of state facilities that Comply only with federal Used Oil and OIIyNVater management
<br /> standards and not these more stringent requirements.
<br /> This notifleatlon Is for the informatlonal purposes only.
<br /> By both parties signing this Invoice it will serve as an agreement that George W. Lowry, Inc, will submit confirmatlon for (certain waste streams) to the generator that their
<br /> waste has been transported to a permitted trapsferf ilitVhr permitted treatment, storage or disposal facility.
<br /> Lowry Driver Signature X IW1I Date
<br /> Signature of Generator, Representative or Age t of Generator: Date ,
<br /> Recycling, Transfer, Treatment, Facllltie9 atment, Storage, Disposal Name;
<br /> Wl� ylL'� ❑ ❑ Address;
<br /> Bakerafreld Transfer California Oil Transfer LLC Ramos Environmental Sako oil Recycling, Inc. City, state, Zlpt
<br /> 1620 E. Brundage Lane 5300 Claus Road 1515 S. River Road 1217 3. Fiesta Ave.
<br /> Bakeratleld, CA 93307 Riverbank, CA 95367 West Sacramento, CA 96691 Parker, AZ 85344 Phone:
<br /> 661322•826a 209-86_3.818_1 916371 -6747 92H464.3202
<br /> Re 1A^I Time Feb al , 25 . 1f2022 4 : 04 eNo , 7114 AZR000516161 �PAIDi
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