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AMERICAN VALLEY 133591 <br /> WASTE OIL, INC.. Ir voice Number: <br /> P.O. Box 340 • Delhi, CA 953.15 <br /> PH. 1-600-732-4645 i FAX 209-668-3880 <br /> EPA#CAL000827878 <br /> BILL TO: JOB SITE: I voice Date: <br /> DidJ4-_/, .-01 <br /> %a <br /> Phone /r- Customer P.O. Terms SPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRIG AMOUNT <br /> CODE <br /> NON-RCRA 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 /> Drained Used Oil Filters <br /> TERMS: Invoices over 30 Days are subject to a 1.5`y 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 It LESS han 1,000 ppm, <br /> and the waste does not contain any PCBs.I have complied with the requirements of the applicable California used oli management regulation to d termine 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 waste is 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 ar-toxicity of waste <br /> genen;i to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment,storage,c r 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 m de 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 /> By both parties signing this Invoice it will serve as an agreement that American Valley Waste Oil will submit confirmation for(certain waste stream )to the generator <br /> that their waste has been transported to a licensed treatment or transfer facility. <br /> DRIVER o' GENERATOR/ <br /> AUTHORIZED <br /> SIGNATURE: °�.�,..�-- DATE:C,/f,�,�,r!/f"SIGNATURE: '�l .-��,it-- DATE`r„ "✓,j��, <br /> DISPOSAL/ RECYCLING FACILITYr <br /> O-6k-DIXON O 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 /> 707-693-6008 213-746-0237 818.787-2649 <br /> EPA#CAT080012602 EPA#CAL000270577 EPA#CALo00379059 <br /> MPC(a"de13) <br />