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AMERICAN VALLEY 1 <br /> WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 a Delhi, CA 95315 <br /> PH, 1-600-732-4645 • FAX 209-66pa&L000416714 <br /> DOM ENICS AUTO <br /> DOMENICS AUTO 435 N.HARRISON ST. [` <br /> BILL TO: 935 N. HARRISON ST. JOB SITE: STOCKTON, CA 95203 Invoice Date: <br /> STOCKTON, CA 95203 <br /> X: FREMONT <br /> Sales Rep. Albert KeRing <br /> Phone 209-943-104D ROBERT Customer P.O. EPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIQUANTITY PRICE I AMOUNT <br /> CODE <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 /> Drained Used Oil Filters <br /> OIL COLLECTION FEE ;DC-C 11 j <br /> I <br /> 907 <br /> I <br /> , <br /> ERMITISE VIr c� <br /> Saliag Tax <br /> TERM& bwoices oven 30 Days are subiw to a 1.5%service charge. Customerag,e s to pay all legal tees if court ecilon 'TOTAL <, �.. <br /> becomes necessary to collets this irmoice. Y lJ <br /> By signing I herby certify that I have not mixed anyof the waste described above with any other iazzrdous waste,the Dotal halide content is LESSthan 1,000 ppm, <br /> and the waste does not contain any PCBs.I have complied with tie 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:nfefmation I have provided about this waste is incorrect. <br /> Generator's Certification:By signing I certify that if 1 am a large quant itygener3toq I certify that I have a program in place ba reduce the volume and roxkity of waste <br /> generated to the degree I have determined to be economicaIy affordable anc that I have selected the practicable method of treatment,storage,or disposal currently <br /> ava'table tome wNch 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 tie waste management method that is available tome flat 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 treaty. nt or transfer facility. <br /> DRIVER � ��/' � AUTr10RIZEC !p' <br /> SIGNATURE: 1 - �� /ism' GATE: SIGNATURE: G DATE: -. <br /> i" <br /> DISPOSAL / RECYCLING FACILITY <br /> EMS <br /> ON 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 /> 707-693-6006 213-746-0237 818-767-2649 <br /> EPA#CAT080D126D2 EPA#CAL00027D577 EPA#CAL000379059 <br /> UPC(114013) <br /> —" £ d — — d9Z £0'L1,4LAeN <br />