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AMERICAN VALLEY 104127 <br /> WASTE OIL, INC. Invoice Number: <br /> P.O.Box 340 e Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> CAL00082787 3, <br /> �/ /W <br /> BILL TO:FOOTHILL ENGINEERING JOB SITE;VOGUE CLEANERS Invoice Date: <br /> 12793 PADDY CREEK LN 2316 N.CALIFORNIA <br /> LODI,CA 95240 STOCKTON,CA 95205 <br /> A . <br /> sales Rep: <br /> Ph2dMM9381 Customer P.O. TerknsO.O.D "-\T7 ) EPA#CAL000204507 <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 !/ 2 7 M, wo j <br /> NON Hazardous Waste Liquid <br /> Trinity Heavy Duty premixed Antifreeze <br /> Trinity Extended Life premixed Antifreeze i <br /> I <br /> Trinity Case Goods <br /> Truck Wash Out <br /> Truck Time <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 necessa to collect this invoice. N t/ <br /> By signing I herby certify that I have not mixed this waste with any other waste,that thel total halides are less than 1000 P.P.M;and that the waste does not <br /> contain any P.C.B's. I further agree to accept the additional charges for legal disposal if the waste is over 1000 P.P.M.total halides,or dontains any P.C,B's <br /> Generator's Certification: By signing I certify that I have a program in place to reduce the volume and toxicity of hazardous waste generated to the degree I <br /> have determined to be economically practicable. <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 <br /> generator that their waste has been transported to a licensed treatment or transfer facility. <br /> American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil maybe transported to a facility that is required to comply <br /> with federal regulations applicable to management of used oil,but that Is not required to comply with the more stringent requirements applicable to hazardous <br /> waste management facilities.California facilities that handle or process used oil are recufred to meet those more stringent requirements,and some out-of- <br /> state facilities that process used oil also meet those requirements, engineering certiEcations of tank integrity, and financial assurances for closure and <br /> accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these more <br /> stringent requirements. <br /> This notification is for Information purposes only. <br /> f GENERATOR/ ; V"� <br /> SDRIVERIGNATURE �I�e� IATE:/ / AUTHORIZED GATE:0 SIGNATURE: <br /> i <br /> , <br /> NAME: DISPOSAL RECYCLING FACILITY <br /> ADDRESS: O 0K-oIXON O RAMOS ENVIRONMENTAL SERVICE <br /> CITY/ST: 7306 CHEVRON WAY 1515 SOUTH RIVER ROAD <br /> DIXON,CA 95620 W.SACRAMENTO, CA 95691 <br /> PHONE: 707/693-6008 916-371-5747 <br /> EPAC EPAI#CAT080012602 EPA 0 CA0044003556 <br />