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AMERICAN VALLEY 118C23 <br /> WASTE OIL, INC. Invoice Number: <br /> P.O. Box,340 Delhi, CA 95315 • <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA#CAL000827878 <br /> BILL TO: <br /> l�^y rw OB SITE- -ST AND EASY#16 <br /> _- <br /> 8y37 y } RtD� J ' 139, i:r E�_YOS.�"M rE . 'Invoice Date: <br /> C7,J/ �ft1'^,dA1�l�'y,i�;kr.J ;y�„ 4 'Af���•i Ei-CA'R,CA !;1,53n <br /> 3 r. .1.1 s C�fN CA �`L4 211115 <br /> Phone Customer P.O. Terms EPA# <br /> 2Xi� r'`�' s r r n y <br /> I.,�ti}••��?1�..."�u�t1.) .i•'� <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 /> p <br /> Drained Used Oil Filters , <br /> OCT 03213 <br /> ENIRONM NTAL <br /> ;ALE, <br /> VIENT <br /> TERMS: Invoices over 30 Days are subject to a 1.5°%service charge. Customer agrees to pay all legal fees Tf•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 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 /> NI TW nr_m <br /> available to me which minimizesthe 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 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 `,� C .+' bl AUTHORIZED <br /> SIGNATURE:' � f,�^�?cam >` f DATE: SIGNATURE: = ;r..t rr?i DATE: <br /> ¢ - <br /> r <br /> DISPOSAL / RECYCLING FACILITY <br /> 0 DK-DIXON 0 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#CA7080012602 EPA#CAL000270577 EPA#CAL000379069 . <br /> MPC(812013) <br />