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AMERICAN VALLEY 17A79;-'; <br /> WASTE OIL, INC. Invoice Number: <br /> P.O.Box 340•Delhi,CA 95315 <br /> PH.1-800-732-4644 •FAX 209-668-3880 <br /> EPA#CAR000272302 <br /> (040 <br /> BILL TO: EAST BAY CLARKLIFT•CHM JOB SITE: EAST BAY CLARKLrr f <br /> 4701 OAKPORT ST 1813 MOFFAT BLVD Invoice Date: <br /> OAKLAND,CA 946014906 MANTECA.CA 95336 <br /> W( ) t) e4 <br /> Phone 209-m6.8987NIFE Customer P.O. Terms EPA# " <br /> C.O.I)). I CALMM27 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST 'QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 7[ f7L IV <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Metal Oil Filters <br /> RM FA T A <br /> TERMS:invoices over 30 Days are subject to a 1.5%service charge. Customer d0h9*M Wal legal fees If court action TOTAL <br /> becomes necessary to collect this hwaice. h <br /> By signing I herby cartfy that I have not mixed any of the waste described above with any other hazardous waste,the total halide content Is LESS than 1,a�ppm,and the <br /> waste does not Contain any PCBs.I have compiled with the requirements of the applicable California used all management regulation to determine this is true.I agree to <br /> accept the additional charges for the disposal of this waste If the information I have pmv'dei about this waste Is IncorrecL <br /> C,eneratoes Certification:By stgn'ng t certify that If I am a large quantity generator,I certify that I have a program in place to reduce the voknme and toxicity of waste generat- <br /> ed to the degree I have determined to be economically affordable and that 1 have selected the practicable method of treatment,storage.a disposal currently avallable to me <br /> which minimizes the present and future threat to human life and the environment:Or,it I am a small quantity generator.I have made a Good fahh effort to minimize my waste <br /> generation and select the waste manapernent method that is available to me that I can afford. <br /> American Valley Waste Oil hereby advises the above Gal n#"that generators shipment of used oil may be transported to a facility that is required to canpty with federal <br /> regulations applicable to management of uaad oil.but fiat is not required to comply with the more stringent requiremerds applicable to haze dour waste management facili- <br /> ties.California facilities that handle or procass used off are required to mall those mac stringent requirement,and some put-of-state facilities that process us«d oil also meet <br /> those requirements.angineedng cerdifications of tank integrity,and financial assurances for closure and accidental releases.It is lawful to send used ail to out of state facilities <br /> that comply only with federal used oil management standards and not these more alrirgent requirements. <br /> This rxAftation Is for Information Purposes only. <br /> By both parties signing this Invoice it will serve as an agreement that American VelleY Waste Oil will subrnh oonramation for(certain waste streams)to the gorvarator that thein <br /> waste has been transported to a licensed treatment or transfer facility, <br /> GENERATOR/ <br /> DRIVERAUTHORIZED_ ✓� <br /> SIGNATtlRE� Y DATE;" SIGNATURE: .l (may f� .�'i <br /> DISPOSAL/REQ Y126ING ACILITY <br /> I`O DK-DIXON ASSURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O YUMA YES LLC O AML'RlrAN VALLEY WASTE OIL.INC! <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. 650D US HWY 95 521 INDUSTRIAL DR STE M( <br /> DIXON,CA 95620 CERES,CA-95358 RIVERBANK, CA 95367 YUMA,AZ 85365 LIVINGSTON.CA 95334 <br /> 707-693.6008 209-541-1825 209.863.8181 928-344-9828 209.667.8857 <br /> EPA#CAT080012602 EPA#CAL000393680 EPA#CAL000190816 EPA#AZR00DS21146 EPA#CAL000443OD4 <br /> MFG I7 6 <br />