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*AMERICAN VAL <br /> WIVEL 12292 <br /> WASTE OIL, INC. Invoice Number: <br /> UN 2 4 2015 <br /> P.O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-M ONMENTAL <br /> EPA#CAL000827878 yC IT J nCOg7T�pCA1T <br /> ACME 4AW <br /> BILL TO: ACME SAW JOB SITE: 214 N.LCRAMENTO ST. Invoice Date: <br /> 1204 E.MAIN LODI, A 95240 <br /> STOCKTON, CA 95 206 <br /> Sales Rep: Albert Kelling <br /> Phone ustomer P.O. Terms Net Days EPA# AL000316056 <br /> 209-948-6. 35 DIANA <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST' QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 r ,, <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Drained Used Oil Filters <br /> SALES 1,V .. <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 <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 v aste,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.)agree to accept the additional charges for the disposal of this waste if the Information I have provided about this waste is incorrect. <br /> Generators Certification:By signing I certify that if I am a large quantity generator,I certify that I have a proram in place to reduce the volume and toxicity of waste <br /> generated to the degree I have determined�o be economically affordable and that I have selected the practi able 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 an 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 th it I can afford. <br /> By both parties signing this invoice it will serve as an agreement that American Valley Waste Oil will submit c nfirmation for(certain waste streams)to the generator <br /> that their waste has been transported to a licensed treatment or transfer facility. <br /> GENERATOR/ - - � <br /> DRIVER AUTHORIZED <br /> SIGNATURE: DATE:_ SIGNATURE: DATE: <br /> ISPOSAL I RECYCLING FACILITY <br /> a bK-DIXON O CFR O UNITED ENTERPRISES CORP <br /> 7300 CHEVRON WAY 2035 15TH ST. 11190 PENROSE ST. <br /> DIXON,CA 95620 LA,C}t 90021 SUN VALLEY,CA 91352 <br /> 707-693-6008 213-746-0237 818-787-2649 <br /> EPA#CAT080012602 EPA#CAL000270577 EPA#CAL000379059 <br /> MPC(a2013) <br /> I <br />