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AMERICAN VALLEY <br /> IS <br /> WASTE OIL, INC. Invoice Number: <br /> UE P.O. Box 340 - Delhi, CA 95315 <br /> PH, 1-800-732-4645 • FAX 209-668-3880 <br /> EPA#CAR000272302 <br /> BILL TO: JIM SANTINI JIM SANTlN! <br /> 20707 SEXTON RD JOB SITE: 24707 N11NI SEXTON RD Invoice Date: <br /> ESCALON,CA 95920 ESCALON,CA 95320 <br /> -- ' R-- 4R(O. i r� <br /> Phone 209479.1497�M Customer PO. Terms EPA# <br /> C.G.D. CAL000339394 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> i <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 /> Compliant Drained Used Metal Oil Filters <br /> FAP U TY FU EL SURCHARGE <br /> I <br /> RAI EST <br /> TERMS: Invoices over 30 Days are subject to a 1.51%service charge. Customer agrees to pay all legal fees if court action TOTAL A <br /> becomes necessary to collect this invoice. <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 is LESS than 1,000 ppm,and the <br /> waste does not contain any PCBs.I have complied with the requirements of the applicable California used oil management regulation to determine this is true.I agree to <br /> accept the additional charges for the disposal of this waste it 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 a program in place to reduce the volume and toxicity of waste generat- <br /> ed to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment,storage,or disposal currently available to me <br /> which minimizes the present and future threat to human life end the environment.Or,if 1 am a small quantity generator,I have made a Good faith effort to minimize my waste <br /> generation and select the waste management method that is available to me that I can afford. <br /> American Valley Waste Oil hereby advises the above Generator that generators shipment of used oil may be transported to a facility that is required to comply with federal <br /> regulations applicable to management of used oil.but that is not required to comply with the more stringent requirements applicable to hazardous waste management facili- <br /> ties.California facilities that handle or process used oil are required to meet those more stringent requirement,and same out-of-state facilities that process used oil also meet <br /> those requirements,engineering certifications of tank integrity,and financial assurances for closure and accidental releases.It is lawful to send used oil to out of state facilities <br /> that comply only with federal used oil managernent standards and not these more stringent requirements. <br /> This notification is for information purposes only. <br /> By both partiesslgNng thi invoice it will serve as an agreement that American Valley Waste Oil will submit confirmation for(certain waste streams)to the generator that their <br /> waste has been transport d to a licensed treatment or transfer facility. <br /> GENERATORI <br /> DRIVER AUTHORIZED <br /> SIGNATURE: DATE: �1 I �J *' SIGNATURE: pJ V(,��7�c.,uL. DATE: A; R � <br /> DISPOS .114ECYCLING FACILITY <br /> O DK-DIXON Q ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O YUMAYES LLC GAERICANVALLEYWASTEOIL,INC <br /> ' <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. 6500 US HWY 95 521 INDUSTRIAL DR STEM <br /> DIXON.CA 95620 CERES,CA 95358 RIVERBANK, CA 95367 YUMA.AZ 85365 LIVINGSTON,CA 95334 <br /> 707-693-6006 209-541-1625 209-863-8181 928-344-9828 209-667-8857 <br /> EPAIt CAT080012602 EPA#CAL000393680 EPA#CAL000190816 EPA#AZRo00521146 EPA#CAL000443004 <br /> MPC(7i2016) <br />