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Jan. 5. 2013 12:07P.M No, 4018 P. 3 <br /> AMERICAN VALLEY litl'-10-91 <br /> WASTE OIL, INC. Invoice Number. <br /> P 0,Box 340 a Delhi, CA 95315 <br /> PH. 1-800-732-4645 # FAX 209-668-3880 <br /> CALOOD827878 <br /> BILL T4: JOB SITE! <br /> Ifivol"Ce Date: <br /> BROOKSIDE COUNTRY CLUB BROOKSIDE COUNTRY CLUB <br /> 3603 ST.ANDREWS DR 3130 BROOKSIDE RD. <br /> STOCKTON.CA 95219 STOCKTON,CA 95219 <br /> X:MARCH LANE <br /> ! Phone�l Customer P.O. Terms—/ VPA# <br /> 209-478-9963 ROBIN Not 30 Days GAL000205437 <br /> PRODUCT SHIPPING DESCRIPTION WASE e MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCNA 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 /> NON Hazardous Waste Liquid <br /> Trinity Hpavy Duty premixed Antifreeze <br /> i)Ale: <br /> Trinity Extended Life premixed Antifreeze Acct: <br /> I pity Case Goods Authorized Ely: <br /> Truck Wash Out PoSted <br /> Entenea 15y: <br /> Truck Time <br /> TERMS: Invoices over 30 Days are subject to a 1.5%servIoe charge. Customer agrees to pay all legal fees it court action TOTAL <br /> becomes necessary to collect this invoice. <br /> sysigning 1heCarl! that I have not mixed this waste with any other waste,that the total halides are less than 1000 RRM;and that the waste does not <br /> contain any ROT's. I fuyIh9r agree to accept the additional charges for legal disposal if the waste is over 1000 P.P.M.total halides,or contains any P-C-B'S <br /> Generato(s Cerriffoallon: By sloning 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 sl?nIng this Invoice it will serve as an agreement that American Valley Waste ON 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 may be transported to a facility trial 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 required to meet those more stringent requirements,and some out-of- <br /> state facilities that process used oil also meet those requirements, engineering carlilications 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 /> DRIVER <br /> GENERATOR/ <br /> I " HORIZEI) <br /> SIGNATUME&lrlll:�,�I;IaDATP /2'SITGNATURE: DATE: <br /> 0 14AME: <br /> DISPOSAL/ RECYCLINQ FACILITY <br /> ADDRESS: DK-DIXON 0 RAMOS ENVIRONMENTAL SERVICE <br /> CITY/ST.. 7300 CHEVRON WAY 1515 SOUTH RIVER ROAD <br /> DIXON,CA 95620 W.SACRAMENTO,CA 95691 <br /> PHONE: 707.693-6008 916-371-5747 <br /> EPAN: EPA#CAT080012602 EPA#CAD044003550 <br /> MIAC(4=0) <br />