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„_.:. .., <br /> wo <br /> AMERICAN VA:LLEY 123191 <br /> RECEIVED WASTE OIL, INC. Invoice Number: <br /> - <br /> R 0. Box 340 • Delhi, CA 95315 <br /> APR 1 5”2014 PH. 1-800-732-4645 • FAX 2(9-668-3880 <br /> EPA# CAL000827E 78 r / <br /> BILE q)gRONMENTAL HEALTH J0I3 SITI+; Invoice Date: <br /> � � ''~ <br /> �i _.. <br /> '(k <br /> 1 'one ,� Customer P.O. TerEPrA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE Mf NIFEST ;QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used OiUMlxed Oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Drained Used Oil Fitters <br /> I <br /> f <br /> .__._._. _......._._. ..__.�_. <br /> TERMS: invoices over 30 Days are subject to a 1.5%,service charge. Customer agrees to l ey all legal fees if court action TOTAL <br /> becomes necessary to collect this invoice. t. <br /> By signing i herby certify that I have not mixed any of the waste described above w:th any other iazarcious 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 ui the applicab e 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 ha re 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 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 selectt d 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 envirorme,t:Or,if I am a small quantity generator,I have made a good faith <br /> effort to minimize my waste generaticn and select the waste managen:rnt method that is avails>le to me that I can afford. <br /> By both parties signing this invoice it will serve as an agreement that American Valley Waste Oil,Mi submit confirmation for(certain waste streams)to thegenerator <br /> that theirwaste has been transported to a licensed treatment or transfer facility. <br /> GJENERATOF <br /> DRIVER °<,r Ir ��" r AUTHORIZE[ `. <br /> SIGNATURE: '' DATE: `} SIGNATURE_ _— DATE: <br /> _ t <br /> DISPQSAL (REGYQ lNG FAIUTY <br /> O DK-DIXON Q CFR O UNITED ENTERPRISES I:ORP _-_�,___.. •w <br /> 7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE ST. <br /> DIXON,CA 95620 LA,CA 9D021 SUN VALLEY,CA 91352 <br /> 707-693-6008 213-746-0237 818-787-2649 <br /> EFA#CAT080012602 EPA#CAL000270577 EPA#CAL000379059 <br /> MiPG(E12Q13) ' <br />