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�}T71l• AMERICAN VALL .. O <br /> L 0 WASTE OIL, INC, <br /> ��*GEIVE iavojee Number: <br /> P.O. Box 340 • Delhi, CA 95315 MAR 16 2015 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> --' EPA#CAL000827878 ENVIRONMENTAL.", <br /> '-JC:61'ru rlcod0riAoAIT <br /> BJ LL TO: ARCO AMP JOBSITE: 1100 AMP <br /> M <br /> i 1q0 S.MAIN 11+ 0 mss,t�A.AlN Ztl�ly ;tee Jute: <br /> P ANA ECA,CA 95337 MAi TSCA,(;A .i37 <br /> Sates ROD: <br /> Phone Customer.P.O. Terms EPA# <br /> 200-82-5,6784 ,JESSE C.0.a C,Ai 000313907 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used OIVMixed oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water i7_.; � 1�, r }. C) <br /> Drained Usod Oil Filters l J <br /> f <br /> SALES TAX- <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 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 wasto iy 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 /> available to me which minimizes the present and future threat to human life and the environment;Or,If I am a small quantity generator,I have made a good faith <br /> c 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.Qn agreement that Amerlcen valley WastP 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 /> �Y'9 tj GENERATOR/ _ <br /> DRIVER i ✓ f.s �� AUTHORtZED "r'"���; a• <br /> SIGNATURRy7 Edi' �� r DATE: / SIGNATURE ` DATE: ' <br /> "ASPOSAL RECYCLING FACILITY <br /> DK-DIXON 0 CFR O 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 /> 707-593-6008 213-746-0237 818-787-2649 <br /> EPA#CAT080012602 EPA#CAL000270577 EPA#CAL000379069 <br /> '.� MPC(612013) <br />