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AMERICAN VALLEY L <br /> WASTE OIL, INC. Invoice Number: <br /> P.O.Box,340 Delhi, CA 95315 <br /> P.H. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA#CAL000827878 <br /> BILL TO: s4r =�wr. Citi. JOB SITE.- ; <br /> VAN v139 YtRf»l�Rl iEy Invoice Date: <br /> 8'37"p �Sltrfv' q.u(' x�, �h�i .fir ,f:? .`�.i.�°}r.7F' <br /> Phoney ,yS rfy a{ Customer P.O. Terms <br /> r 1 { EPA# 5 <br /> 2Li;,'4�7fr,.. CK)6 X1 1_4 't.'i i1e_f 30 [),,ay iFYSL�s3C���1�J,iprt <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 - 223 <br /> Drained Used Oil Filters' <br /> Pr <br /> 0 A ` d^"A <br /> .:'nAz.E a�� <br /> TERMS: Invoices over 30 Days are subject to a 1.5°k service charge. Customer agrees tb 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 /> Generator's Certification:By sighing 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 l 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 1 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 /> ) <br /> GENERATOR/ <br /> DRIVER } s ALMHORIZED <br /> SIGNATURE: DATE: SIGNATURE: DATE: <br /> r <br /> DISPOSAL / RECYCLING FACILITY <br /> O DK-DIXON O CFR 0 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(WO13) <br />