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a. AMERICAN VALLEY -AECRVE[ <br /> WASTE OIL, INC. OCT`16 Z0151nvoiceNuAer: <br /> F. 71 P. 0. Box 340 • Delhi, CA 95315 <br /> PH."1-800-732-4645 • FAX 209-668-3880 ENVIRONMENTAL HEALTH <br /> EPA#CAL000827878 PERMIT(SERVICES <br /> 1QfiPl 9ESSUP'S DREAPa ?;,t.E itv� , <br /> BU-1,TO: ' S N YVILSCtyuYA/ JOB SITE t' `'IN JESSUPS DREAM N'r- <br /> .� $ E�CKTQN.'CA 9510`+ i N VVIL SON JVAY. InvO1CC7Oate: <br /> STC?: Kl .;i1 CA ',k20' <br /> Phone_ 467 ar hr Customer P.O. Terms EPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> z.. <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 /> DUE 40 THE DRASTIC FALL IN*CRUDE On <br /> f�ICFS WE HAVE BEEN FORCED TO <br /> 4-;HANGEPRICING FORWASTE011.ANDOC i 16 UT5- <br /> - <br /> i <br /> r �"\1 f-I O1TU nCDe TIIC� L <br /> TERMS: Invoices over 30 Days are subject to a 1.5%service charge. Cugtomer 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 waste,the total halide content is LESSthan1,000 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.I 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 reduce the 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 confirmation 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: S1GNpL11'R&:. DATE: <br /> DISPOSAL/ RECYCLING FACILITY <br /> O DK-DIXON O CFR O UNITED ENTERPRISES CORP <br /> 7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE ST. <br /> DIXON,CA 95620 LA,CA 90021 SUN VALLEY,CA 91352 <br /> 707-693-6008 213-746-0237 818-787-2649 <br /> EPA#CAT080012602 EPA#CAL000270577 EPA#CAL000379059 <br /> MPC 16/2013) <br />