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4I1&4 7drm � � INVOICE <br /> 4 • <br /> Oka & <br /> Manifest# , <br /> 1922 W. Belmont Ave.• Fresno, CA 93728-2626 l* <br /> (559) 498-0240 Fax (559) <br /> 498-0256 EPA# l `�9 Z <br /> 707 p/bss <br /> EPA#CAL 000188148 DATE HALIDES f s <br /> NAME I - ❑ <br /> UNIFIE-D WESTERN GROCERS �` <br /> PO.# --77 rr.. , <br /> ADDRESS Lf G 4 V o <br /> '1990 Piccoli Rd 1 P. 0. BUX 60753 Terminai Anex <br /> • <br /> CITY Stockton] LA STATECAgKi5,9006t1 PHONE# 209-931-2311 <br /> RICE AMOU NT <br /> NON-RCRA HAZARDOUS WASTE <br /> USED OIUMIXED OILS STATE CbDE 221 <br /> US WAS E <br /> U�ED ANTI-FREEZE) <br /> O STATE COBE 133LIQUID <br /> USED OIL FILTERS <br /> BARREL DISPOSAL . <br /> ANTIFREEZE <br /> WASH RACK <br /> OTHER <br /> TERMS: NET 30 DAYS <br /> PLEASE PAY FROM THIS INVOICE • � - <br /> leE to enforce COIIeGlleni,the purchaser will he Ilahla for all expenses of collection. <br /> 1.5%INTEREST MULL B8 CHARGED AFrER an LAYS.In the event Of Judicial proceedJ <br /> If I am a large quantity generator,I certify that I have a program in place to reduce SJER 1922 W.Belmont,Fresno CA 93728-2626(559)498-0240 <br /> the volume and toxicity of waste generated to the degree I have determined to be �� / <br /> economically practicable and that I have selected the practicable method of D"Par ler-14287 E.Manning,Parlier,CA 93648 <br /> treatment,storage,or disposal currently available to me which minimize the present D McKittrick-56533 Hwy.58W,McKitirick,CA 93251 (661)762-7366 <br /> and future threat to human health and the environment;OR,if I am a small quantity El DIK Environmental-3650 E.26th St.,Vernon,CA 90023(323)268-5056 <br /> generator,I have made a good faith effort to minimize my waste generation and Q Tamco-112459 Arrow Hwy,Rancho Cucamonga,CA(909)B99-0660 <br /> select the best waste management method that is available to me and that I can Altemate facility: <br /> afford. <br /> 'I FURTHER AGREETO ACCEPT THE ADDITIONAL CHARGES FOR LE <br /> GAL <br /> .I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; CONTAINS ANY P.C.B'S. <br /> AND THAT THEMASTE DOES NOT CONTAIN ANY P.C.B'S.. <br /> This is to c�rt'r�tktQt t ab�ve named articles are properly classified,described,packaged,rgarked fJob eled,a d are in proper condition for transportation,according to[he applica� <br /> re tiL s 4foj�[the)J!e hneint of Transportation. //yy} )yv7 <br /> PRINT NAME <br /> DRIVER SIGNATURE GENERATOR'S SIGNAT RE <br /> �_ _ THIS DOCUMENT MUST BE KEPT FOR AT LEAST 3 YEARS__ <br />