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AMERICAN VALLEY 122 r 14 <br /> WASTE OIL, INC. Invoice Number: <br /> P.O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 a FAX 209-668-3880 <br /> EPA# CAL000827878 <br /> BILL TO: JOB SITE: Invoice Date: <br /> Phone Customer P.O. Terms EPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <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 22J <br /> Drained Used Oil Filters <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 waste,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.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 /> Generators 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 1 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: - SIGNATURE,- DATE: <br /> DISPOSAL / RECYCLING FACILITY <br /> O DK-OIXON 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(a2p13) <br />