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AMERICAN VALLEYS <br />WASTE OIL, INC. <br />P. O. Box 340 • Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />BILL TO: JOB SITE: <br />I C MASTER "FECH J C MASTERS 1 E{:F! <br />4629N WEST LN#8 4629N-WESILIN #F <br />STOCKTON, CA 95210 STt/OCK(ON CA 952'10 <br />91327 <br />Invoice Number: <br />Invoice Date: <br />Phone <br />Customer P.O. <br />s ,• cr / <br />Terms <br />sales Rep: fAe3vve <br />EPA# <br />209-;r3 r -4641 HO <br />C.O: D. <br />CALODU153160 <br />PRODUCT SHIPPING DESCRIPTION <br />MANIFEST <br />QUANTITY <br />PRICE <br />AMOUNT <br />7WASTENON-RCRA <br />Waste Liquid Used Oil/Mixed Oils <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />�?,IT f <br />cf <br />�i11N <br />C� L <br />NON Hazardous Waste Liquid <br />Trinity Heavy Duty premixed Recycled Antifreeze <br />Trinity Extended Life premixed Recycled Antifreeze <br />Trinity Case Goods <br />Truck Wash Out <br />Truck Time <br />TERMS: Invoices over 30 Days are subject to a 1.5% service charge. Customer agrees to pay all legal fees if court action <br />becomes necessary to collect this invoice. <br />TOTAL °= <br />By signing I herby certify that I have not mixed this waste with any other waste, that the total halides are less than 1000 P.P.M; and that the waste does not <br />contain any P.C.B's. I further agree to accept the additional charges for legal disposal if the waste is 1000 P.P.M.. <br />over total halides, or contains any P.C.B's <br />Generator's Certification: By signing I certify that I have a program in place to reduce the volume and toxicity of hazardous waste generated to the degree I <br />have determined to be economically practicable. <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 <br />generator that their waste has been transported to a licensed treatment transfer facility. <br />or <br />American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may be transported to a facility that is required to comply <br />with federal regulations applicable to management of used oil, but that is not required to comply with the <br />more stringent requirements applicable to hazardous <br />waste management facilities. California facilities that handle or process used oil are required to meet those more stringent requirements, and some out-of- <br />state facilities that process used oil also meet those requirements, engineering <br />certifications of tank integrity, and financial assurances for closure and <br />accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these more <br />stringent requirements. <br />This notification is for information purposes only. <br />DRIVER GENERATOR/ AUTHORIZED <br />SIGNATURE fir, SIGNATURE SIGNATURE 11 <br />DISPOSAL I RECYCLING FACFLITY O NAME: <br />O DK-DIXON O RAMOS ENVIRONMENTAL SERVICE ADDRESS: <br />7300 CHEVRON WAY 1515 SOUTH RIVER ROAD CITY/ST: <br />DIXON, CA 95620 W. SACRAMENTO, CA 95691 PHONE: <br />707-693-6008 <br />916-371-5747 <br />EPA # CAT080012602 EPA # CAD044003556 EPA#: <br />MPC (10/2009) <br />