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Customer EPATT ���,� 1 <br /> Date: _ <br /> Driver EPA#CAL 000375092 <br /> State Manifest Document# <br /> CHP#CA192D1% CRYSTAL BLUE 41 <br /> x� ENVIRONMENTAL INVOICE NO. Q <br /> 4529 Baron Avenue • Sacramento, CA 95821 <br /> J� (310) 880-5820 PAY FROM THIS INVOICE <br /> Transporters Registration Next P/U Date: r <br /> CO. NAMEPHONE ((� <br /> L <br /> ADDRESS �- A \ <br /> CITY <br /> STATE �-t-\ ZIF <br /> QTY DESCRIPTION PRICE TOTAL <br /> \ k! Non-RCRA Hazardous Waste Liquid. Used oil/mixed oil. /per <br /> 1�� "No Placard required (221) gal <br /> Non-RCRA Hazardous Waste Liquid. Used anti-freeze. /per <br /> 'No placard required (343) gal <br /> FNon-RCRA Hazardous Waste Liquid. Oily Eor,, /per <br /> "No placard required (223) gal <br /> _ k . .. ,� a <br /> TOTAL -0- <br /> DE <br /> OTAL -0- <br /> DESTINATION OIL ALTERNATIVES <br /> 6ANG0 XR.E.S, 0 DK Dixon o Thermo Fluids <br /> 22211 B o Road 151 S.River Road 7000 Chevron Way 655 South Stanford Way <br /> Fa n,NV West Sacramento,CA 95691 Dixon,CA 95620 Sparks,NV 98431 <br /> N 00080655 CAD 044003556 CAT080012602 NAV 982 510 711 <br /> IMPORTANT NOCE REGARDING THE DISPOSITION OF YOUR USED OIL.PLEASE SIGN AFTER READING. <br /> Crystal Blue Env ronmental hereby advises the generator that your shipment of used oil may be transported to a facility that is required to comply with federal <br /> regulations applicable to management of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous waste man- <br /> agement facilities.California facilities that handle or process used oil are required to meet those more stringent requirements,and some out-of-state facilities <br /> that process used oil also meet those requirements.These include more stringent leak detection and prevention requirements,engineering certifications of tank <br /> integrity,and financial assurances for closure and accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil <br /> management standards and not these more stringent requirements. This notification is forinformation purposes only. <br /> GENERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name, <br /> are classified,packed,marked, labeled,and are in all respects in proper condition for transport by highway according to applicable state and federal regulations. <br /> 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 <br /> to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> 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 <br /> 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 <br /> 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 <br /> 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 <br /> information I have provided about this waste is incorrect. I heralaXcertify that all the information submitted in this and all attached documents contains true and <br /> am-1 <br /> -- accurate description of the waste.All relevant information <br /> Generator's Signature: regarding known or suspected hazards associated with <br /> Contact Person: the waste has been disclosed. I also certify that I have not <br /> mixed this waste with any other waste.Venue for purposes <br /> Transporter's Signat of enforcement shall be in Sacramento County. I declare <br /> under perjury that the foregoing is true and correct. <br /> Term Aet 10 days.Finance c ryear)on accounts not paid within 30 days. <br /> A$25.00 Fee will be charged for returned checks. <br />