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AMERICAN VALLEY 4 <br /> WASTE OIL, INC.1 It Lvoice Numbed: <br /> P.O.Box 340 • Delhi, CA 95315 <br /> PH.1-800-732-464.5 • FAX 209-668-3880 <br /> EPA#CAL000827878 f <br /> BILL TO: JOB SITE: ,: 'voice Date: <br /> 7--40-1 4 fi %1 tai 01� <br /> Phone Customer P.O. Twms EPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 a 73 g )C116 <br /> p �j <br /> NON-RCRA Waste Liquid Used Oily Water 993 <br /> Drained Used Oil Filters <br /> r <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 1 /f <br /> becomes necessary to collect this involca. £. <br /> By signing I herby certify that I have not mixed any of the waste described above with any other hazardous waste,the total hallde content is LESS Pan 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 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 a 'd 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,cr 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 l 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 /> j <br /> ✓% GENERATOR/ <br /> DRi r <br /> NER %` j% AUTHORIZED ,{----Y--- .-. <br /> SIGNATURE' ATE.! v �•.� SIGNATURE <br /> DISPOSAL/ RECYCLING FACILITY <br /> /I DK-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#CALOOD379059 <br /> MPC(620131 <br />