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Customer,EPA# 1 .."• 1 !1EGOV4 Date: x, Driver EPA#CAL 000375092 State Pvanifest Document# CHP#CA1 92005 FEB 2 6 2016 CRYST�iPMOMENTAL ENVIRONMEffrAL 07°mr:hll INVOICE NO. 0 613 Adora Circle a Roseville, CA 95678 ---- PAY FROM THIS INVOICE (310) 880-5820 Transporters Registration No: 6104 1 Next P/LI Date: c cm s, PHONE an Al CO. NAME ADDRESS CITY STATE r t ZIP QTY DESCRIPTION PRICE TOTAL Non-RCRA Hazardous Waste Liquid. Used oil/mixed oil. /per "No Placard required (221) gal Non-RCRA Hazardous Waste Liquid. Used anti-freeze. /per *No placard required (343) gal Non-RCRA Hazardous Waste Liquid. Oily water. /per "No placard required (223) gal TOTAL DESTINATION OF OIL ALTERNATIVES R.E.S. o DK Dixon o Kern Oil o Thermo Fluids 1515 S.River Road 7000 Chevron Way 5300 Clause Road 655 South Stanford Way West Sacramento,CA 95691 Dixon,CA 95620 Riverbank,CA Sparks,NV 98431 CAD 044003556 CAT080012602 CAL0000190816 NAV 982 510 711 IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR USED OIL. PLEASE SIGN AFTER READING. Crystal Blue Environmental hereby advises the generator that your shipment of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous waste man- agement facilities.California facilities that handle or process used oil are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements.These include more stringent leak detection and prevention requirements,engineering certifications oftank 'Integrity,and financial assurances foe closure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and got these more stringent requirements. This notification is for information purposes only. GENERATORS CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name, are classified,packed,marked,labeled,and are in all respects in proper condition for transport by highway according to applicable state and federal regulations. If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generated and select the best waste management method that is available to me and that I can afford.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 waste does not contain any PCBs.I have complied with the requirements of the applicable California used oil management regulations to determine this is 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.I herertify that all the information submitted in this and all attached documents contains true and accurate description of the waste.All relevant information Generator's Signature: regarding known or suspected hazards associated with Contact Person: the waste has been disclosed.I also certify that I have not mixed this waste with any other waste.Venue for purposes Transporter's Signature: of enforcement shall be in Sacramento County.I declare jf JA . L under perjury that the foregoing is true and correct., Term net 10 days.Finance charge of 2%per month(24%per year)on accounts not paid within 30 days. A$25.00 Fee will be charged for returned checks.