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Ph... 4.Manitesr Environmental Services Division Mailing:P.O.Box 176,Salida,CA 95368 FURIGEINIC� ConsolidatedManifest 4612 Kiernan Court,Salida,CA 95368 Phone:209-545-0791 rA)(209-545-2241 EPA#cAR000047019 LlUM PRODUCTa COM PAN1/ Invoice CA Transporter Number 3844 CA License#758518 GENERATOR: Invoice N° 400© 'a Site EPA ID#; Invoice Date: Contact Person: Driver Printed Signature: Name: Truck#: Address: PO# City,State,Zip: Site Phone: TERMS: punits Price Amount Quantity F Product Shipping Name Waste s Code C Gal L Non-RCRA Hazardous Waste Liquid(Used Oil):Lubricating 221 ( ( c Gal Non-RCRA Hazardous Waste Liquid(Used Oil): Industrial 221 Gal Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134 Gal Non-RCRA Hazardous Waste Liquid(Oil&Water) 223 Drum(s) Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 352 Drum(s) Paper and/or Plastic Oil Filter Drum(s) 352 fl 1 Each Drained Used Oil(Metal)Filter Drum(s) Each Empty Drum(s) HR- Transportation&Truck Time Manifest Fee th of the month following month of Unless s will bise e chargedea FINANCE CHARGE at he PERIODIC IInvoice)Terms:RATE of1-1/2%peAccounts month,which is theOANNUAL PERCENTAGE RATE of 18%.ase. Past due Total accounts will b hazardous j�aste,the total halide ortent�js LESS er By signing I hereby certify that I have not mixed le Coany of the mplied with the requ�emednts of the applicable California used oil management regulation to determine this in 1 strue.a9 the waste does not contain any PCB's. I h to accept the additional charges for the disposal of the waste if the information I have provided about this waste is incorrect. be economically affordable and that I have selected the practicable method of quantity generator1I have made a Good Fath eft Generator's Certification: By signing I certify to at If I am a large quantity generator, I certify that t have program in place to reduce the volume aor disposal Cun nd toxicity o generated to the degree I have determin available to me which minimizes the present and future threat to human life and the environment.Or,if I am a minimize my waste generation and select the waste management method that is available to me that I can afford. uired to c with the more stringent requirements applic� sported to a George W. Lowry, Inc.hereby advises the above Ge ofrUsedhOi generators Oily/Water, but that Holt aeqund�ed toacomply ter may b dttonm et those more stringentjac:1l'ity that is erequirremen with federal regulations applicable to management hazardous waste management facilities. California facilities that handle or process Used Oil and engineering are require some out-of-state facilities that process Used Oil and sOiilly//Oil and also meet those to out oQ ire a facslities that complyhonlytwdh fede al Used O t and Oilymaterncial sManz closure and accidental releases, it is lawful to send U standards and not these more stringent requirements. This notification is for the informational purposes only. By both parties signing this invoice it will serve as an agreeomeerm tted treatmentLst age or disposal fat lirylrmation for(certain waste streams)to the generator waste has been transported to a permitted .ansfer faculty P Date Lowry Driver Signature X Date Signature of Generator, Representative or Agent of Generator: X Recycling, Transfer, Treatment, Storage, Disposal Facilities Name: ❑ ❑ Address: 1.x.3 I City,state,Zip: Heritage Crystal Clean LLC California Oil Transfer LLC Ramos S Environmental Hs hwao95 11 miles S of Beatty 5300 Claus Road 1515 S.River Road Highway 1620 E.Brundage Lane West Sacramento,CA 95691 Beatty,NV 89003 Photo: Saksrstield,CA 93307 Riverbank,CA 95367 916-371-5747 775.553.2203 A" 1oe_r0aa 209-863.8181 rer%nnenn455P NVT330010000 EPA ID: _,,,