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AMERICAN VALLEY <br /> BASTE QIP, INC. �' $7�Q <br /> InvOice Number: <br /> P.O. Bax 340 ■ Delhi, CA 95315 <br /> PH. 1-500-732-4645 6 FAX 209-668-3880 <br /> ppRLLrrry 77 rEPA#CAR000272302 <br /> {] ro: <br /> an'ry RY int tvsc. -K JOB SITE: <br /> 16777 HOWLAND RQ t5'7?I i, Yr .�} PC Invoice Date: <br /> LATHROP. CA 9,5330 LATHROP,CA &g3 <br /> Phone -a'57Customer P.D. <br /> Terms EPA# <br /> Jeto 0 v�ys <br /> PRODUCT SHIPPING„ DESCRIPTION <br /> WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> i <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils <br /> 221 <br /> NUN-RCRA Waste Liquid Used Antifreeze133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Metal Oil Filters <br /> 01L GOLLEC;I ION FEL I <br /> LM <br /> TEAMS: Invoices over 30 Days are subvoice. to a 1.5%serving CFlarge. Customer agrees t4 pay all legal fees if court action TOTAL <br /> becomes necessary to Collect this invoice. <br /> By signing I herby certify that I have not mixed any of the waste described$have with any other hazardous waste.the iota!halide content is LESS than 1 Aura <br /> waste dues not contain any pC9s,I have cvmpfee uvryh the requirements a the applicable cher Nerya used ail management <br /> accept the additional charges for the di ppm,and ilia <br /> disposal of this waste it the Informanon I have provided about ribs waste is incorrect. regulation to determine this is true.I agree to <br /> Generator's Certsrcati--,By signing I certify that if I am a large quanrrty generator,1 certify that I have a programclalin lace <br /> ;t to the degree I have determined t r be realeco [ human <br /> Ile and <br /> and that f have selected the practicable method of treatment,storage,or disposal currently icily available tome <br /> A tD reduce the,or disposal <br /> volume and l waste le tome <br /> whic{t m nimizes the present and suture threat[e human I fy and the environment:i]r,ff I am a small quantity generator.I have made a Gadd faith effort to minimixe my waste <br /> generation generat- <br /> and select the waste management method that is available to me that I can attorcl_ <br /> American Valley Waste Oir hereby advises the above Generator That generators shipment of used ort May be transposed to a facility that is required to Cpnrp�y vfjrh federal <br /> regulations applicable to rnanagamant of used oil,but that is not required to comply with the more stringent requirements appjjeable to hazardous waste management facili- <br /> ties.California facilities that handle or process used oil are required to meet those more stringent requirement.and some <br /> those requirements.engineering certifications of tank integrity,and financial assurances for closure and accidental releases_It s lawfulto <br /> ste�tus process used oil also meet <br /> that comply only with federal used all management standards and not these more stringent requirements, Sed OIC to Out of Slate facjlltl9s <br /> Tt11a notification i8 for information pGrpOSeS Only. <br /> w bath Parties signing this invoice it will treat as an agreement that American Valley Waste Oil will submit CanFirmBtjolt for[Certain wasfe streams]to the generator that}heir <br /> waste has beeel transported to a licensed treatment or transfer facility, <br /> DRIVER GENEFiApR! <br /> SIGNATURE: . AUTHaR[ZE0 <br /> DATE r r SIGNATURE' <br /> QISPOSAL 1 RECYCLING FACILITY <br /> ❑ UK-DIXON &ASBURY ENVIRONMENTAL ❑ RIVERBANK OIL TRANSFER ❑ YUMA YES LLC <br /> 7300 CHEVRON WAY 1920 MORGAN RD. ❑ruvleRlcan vaLLevwasre at,INC <br /> DIXON,CA 95620 CERES,CA 95358 CLAUS RQ' 6500 US HWY 95 521 INDUSTRIAL DR STE M <br /> 707-693.6008 RIVERBANK, CA 95367 YUMA,AZ 65365 LIVINGSTON,CA 95334 <br /> EPA#CATOBOO12602 EPA#CA 400393680 209-863-81a1 <br /> 828-344-9828 209-667-8657 <br /> EPA#CAL000190818 EPA#AZR000521146 EPA#CAL000443004 <br /> Al PC(712016) <br />