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RECD JUL 22 2015 <br /> AMERICAN VALLEY 1362,31 <br /> WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA#CAL000827878 <br /> INTERSTATETRUCKCENTER INTERSTATE TRUCK CENT <br /> BILL TO: P.O.BOX6463 JOB SITE: Invoice Date: <br /> STOCKTON, <br /> STOCKTON, CA 95206 925 NKTCA 95206 <br /> 1WOIL 1M 6M SU <br /> Sales Rep Stave <br /> Phone ; 5821"t Customer stoP.Q.P. © Terms EPA# <br /> i o**t 30 Deys CAD981571979 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE 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 /> HAZARDOUS WASTE PICK UP-ABSORBENTS A ID OIL 195W ^� <br /> UNIVERSAL WASTE-AEROSOLS <br /> 55 GAL O/TOP U.N CERT STEEL RECON 5� r <br /> Sales Tax <br /> a TERMS:Invoices.over 30 Days are subject to a i b%service charge. Customer agrees to pay all legal fees if court action TOTAL c <br /> becomes necessary to collect this invoice. <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 isLESS 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-1 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 reducethe 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 confirmatioriior(certain waste streams)to the generator <br /> that their waste has been transported to a licensed treatment or transfer facility. / - <br /> GENERATOR/ r <br /> DRIVER AUTHORIZED <br /> SIGNATURE: DATE: SIGNATURE. `�,_, DATE:' WJ 5' <br />