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AMERICAN VALLEY <br /> WASTE OIL, INC. Invoice Number: <br /> P. 0. Box 340 • Delhi, CA 95315 75915 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA. CAL000827878 7 <br /> Invoice Date: <br /> BILL TO: JOB SITE: MIR 6 5 1_1 1-1 r';_L& <br /> nyt,a 9 �nlTcac,ul�� <br /> �1 it AF'<Nill'J�� IIfIV i J 313/2 1=ARMINGT0N RIS <br /> STCCKTSA v J152CA <br /> STOCKTON CA 95205 <br /> Ai Hvv1` ysi <br /> Saies hep <br /> Phone Customer P.O. Payment Terms EPA# <br /> 209-942-3131 „ r, ,,AI9X1,121142 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> USED OIL ID 221 <br /> WASTELIQ RCRA HAZARDOUS `Lr" 0/ 5 S M SOS2 <br /> USED AUTOMOTIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> OILY WATER, NON RCRA HAZARDOUS <br /> WASTE LIQUID 221 <br /> TRINITY HEAVY DUTY PREMIX <br /> RECYCLED ANTIFREEZE N/A <br /> NON HAZARDOUS WASTE LIQUID <br /> TRUCK TIME N/A <br /> GREASWEEP N/A <br /> Tf O.Q; FYfpnded L.tfe Premix recycled A.nhfr zP <br /> Fuel Stu r_ilatge a5 ] <br /> I hereby certify that I have not mixed this waste with any other waste,that the total halides are less than 1000 P.P.M.;and that <br /> the waste does not contain any P.C.B.'s.I further agree to accept the additional charges for legal disposal if this viaste is over G' - <br /> 1000 P.P.M.total halides,or contaiinnes an P.C.B.'s. TOTAL <br /> GENERATOR/DRIVER <br /> SIGNATURE / � SIGNATURED <br /> SIGNATURE <br /> TERMS: INVOICES OVER 30 DAYS ARE SUBJECT TO A 1.5% SERVICE CHARGE. CUSTOMER AGR E€S TO PAY ALL LEGAL FEES IF <br /> COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. NN` j , <br /> American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may b-ee'transporied[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�St4l 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 certifications of Ilk 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 informattip/n p es only. (y <br /> Driver signed /-% Date 7� Generator sign / I 1 " - Date <br /> By signing the invoice the ge era r certifies that the generator has established a prograrn to reduce the volume r quantity and toxicity of the In zaFdous <br /> waste to the degree, as determined by the generator, to be economically practicable. <br /> By both parties signing this invoice it will serve as an agreement that American Valley will submit cont rmations for,(certain waste streams)to the generator <br /> that their waste has been transported to a license treatment or transfer facility. <br /> DISPOSAL/ RECYCLING FACILITY <br /> 0 RIVERBANK OIL TRANSFER O RAMOS ENVIRONMENTAL SERVICES <br /> 5300 CLAUS ROAD• RIVERBANK, CA 95367 1515 SOUTH RIVER ROAD•W. SACRAMENTO, CA 95691 <br /> 209-863-8181 • EPA ti CAL000190816 916-371-5747•EPA h CAD044003556 <br /> MPC(1012004) <br />