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�}T7'lV AMERICAN VALLE 006 <br /> �L � 4&/,Z 0 WASTE OIL, INC. ECEIAVNumber: <br /> P. O. BOX 340 • Delhi, CA 95315 2 6 2 0 14 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> Y�7 <br /> EPA#cAL000827878 ENVIRONME � � <br /> BILL TO: ARCO AMPM JOB SITE: ARCO AMPM HEA TH DEPART f <br /> 1100S.-MAIN 1'100$:MAIN lav.ice Date: <br /> MANTECA.CA 953,17 MANTECA,CA 95337 <br /> Sales Rep: <br /> Phone stomer.P,O, Terms EPA# <br /> 209-825-6784 JESSIECuC.0.D. CAL000313907 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-MCRA Waste liquid Used Oil/Mixed Oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water ,. 3 �' ,/ �, , 1 <br /> 4 In- <br /> Drained Used Oil Filters <br /> -------------------------- <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 Y' <br /> becomes necessary to collect this invoioe. ar(; <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 LE55 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 add ltlonal charges for the disposal of this waste if the information I have provided about this waste is incorrect. <br /> Generator's Certlflcation: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)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 throat to human life and the environment:Or,if i 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 /> Ay both parties signing this invoice It will serve as an agreement that American valley Waste Oil w]II'submit confirmation for(Certain waste streams)to the'generator <br /> that their waste has been transported to a licensed treatment or transfer facility. <br /> ,l GENERATOR/ <br /> DRIVER /� J y �; AUTHORIZED "e r <br /> SIGNATURF; ' G� per �j` DATE: ,' SIGNATURE: ' �./ DATA: '7.�C' <br /> DISPOSAL / RECYCLING FACILITY <br /> 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 /> 707-699-6008 213-746.0237 818.787-2649 <br /> EPA#GAT080012602 : EPA#CALOOM70577 EPA#CAL000379059 <br /> MPC(0/2013) <br />