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AMERICAN VALLE16 52782 <br /> WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> j ,if r EPA. CAL000827878 r o z— <br /> fy �G <br /> Invoice Date` <br /> BILL TO: JOB SITE: <br /> GOLDEN STATE I RRIGIITION '� GOLDEN STATE IRRIGATION <br /> 16x98 SHAW IIIc Z, 11tI8 SHAW RD. <br /> STOCUON, CA 952:1.3 ! STOC:IKTON, CA 95213 <br /> Phone Customer P.O. Payment Terms V .. , PA# <br /> 7 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> USED OIL NON RCRA HAZARDOUS . py <br /> WASTE LIQUID 221 x� 3� `f 3� ✓ � I <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 /> r <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 waste is over - <br /> 1000 P.P.M.total halides,or container any P.Q:B.$__ TOTAL <br /> DRIVER ri GENERATOR AUTHORIZED <br /> SIGNATURE ; � ' - SIGNATURE/GENERATOR/ <br /> %f _GAJ--. <br /> TERMS: INVOICESCUSTOMERAGREES OVER 30 DAYS ARE SUBJECT TO A 1.5%SERVICE CHARGE.CUSTOMEAGREES TO PAY ALL LEGAL FffES IF <br /> COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. <br /> American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may be 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 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 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. 9 <br /> This notification is for-inP mat�ion ores only. / j: f <br /> Driver signed l� Date enerator signed 'lCr'ir`�2 ✓n.,,. T�,�✓'SS tA_ <br /> By signing the invoice the generator certifies that the generator has established a program to reduce the volume or quan Ity and tgxiciCy of the hazardous <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 confirmations 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 /> IVERBANK 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#CAL000190816 916-371-5747• EPA#CAD044003556 <br /> MPC(10/200, <br />