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AMERICAN VALLEE <br /> � --- � 1 39428 <br /> WASTE OIL, INC. <br /> 1 " � I voice Number: <br /> P. O. Box 340 • Delhi, CA 95315 OCT 19 2015 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA#CAL000827878 ENVIRONMENTAL <br /> ODYSSEY LANDSCAPE HF%4A_1 rIFPORTAAFNT, _ <br /> BILL TO: o W. ' 12 JOB SITE• IDl'8S�',LAi�� �E Invoice Date: <br /> • LODI, CA 95242 WO V4. IrtW i2 <br /> X 15 <br /> LODI, CA 95242 <br /> SOBS Rep 4rlencan VeSey <br /> Phone "l 97 RICKIE Customer P.O. TermsNet 30 Days EPA#(7AI OMR?RR7.A <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 � � C;yt <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Drained Used Oil Filters <br /> DUE TO THE DRASTIC FAI I "CRI UE OIL— <br /> PRICES,WE HAVE BEEN FORCED TO <br /> CHANGE PRICING FOR WASTE OIL AND <br /> I-ILI EIR PICK UP, <br /> tes <br /> TERMS: Invoices over 30 Days are subject to a 1.5%service charge. Customer agrees to pay all legal fees if court action TOTAL r <br /> becomes necessary to collect this invoice. ! CC <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, <br /> and the waste does not contain any PCBs.I have complied with the requirements of the applicable California used oil management regulation to determine this is <br /> true.I agree to accept the additional charges for the disposal of this 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 a program in place to reduce the volume and toxicity 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 <br /> effort to minimize my waste generation and select the waste management method that is available to me that I can afford. <br /> By both parties signing this invoice it will serve as an agreement that American Valley Waste Oil will submit confirmation for(certain waste streams)to the generator <br /> that their waste has been transported to a licensed treatment or transfer facility. <br /> f,� f <br /> j� GENERATOR/ f' / <br /> DRIVER i AUTHORIZED <br /> SIGNATURE• j� ( DATE: f ; . t SIGNATURE: DATE: <br /> 1ISPOSAL / RECYCLING FACILITY <br /> DK-DIXON O CFR O UNITED ENTERPRISES CORP <br /> 7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE ST. <br /> DIXON, CA 95620 LA,CA 90021 SUN VALLEY,CA 91352 <br /> 707-693-6008 213-746-0237 818-787-2649 <br /> EPA#CAT080012602 EPA#CAL000270577 EPA#CAL000379059 <br /> MPC•(6/2013) <br />