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i�1�D[6CC <br />Job Site <br />EPA # CALOOD367942 <br />LIt . AND INSURED TRANSPORTER # 3468 <br />I GENER9 OR <br />Site EPA Ili <br />1— <br />i Contact Person <br />Company Name mrtit t <br />Address /(p ' Q /_1 <br />City. State, Zip <br />Site Phonei``� .£ !ti y j <br />Date <br />PRD <br />Non-RCRA Hazardous Wash Liquid (Used Oil <br />PO interval <br />Code <br />121 <br />N'on-RCRA Hazardous Wash Liquid (1 & Water) 1 223 <br />Non-RCRA Hazardous Wash Liquid( Automotive Antifreeze) I 133 <br />Non-RCRA Hazardous Wast! Solids <br />Non-RCRA Hazardous Wasto Solids <br />with Used 01 <br />Send Payment To: , <br />2355 Road 192, Delano CA 93215 <br />Ph: 209-863-0888 - Fax: 209-863-0887 <br />ID # 46-0727047 <br />MGP# CA 130615 <br />Invoice No. Mi ro ' `' <br />Name <br />Address <br />City, State, .Tap <br />Net 30IC.O.D.lCash/Check Dyers Truck/Name7 <br />CA Manifest # Quantity Units Price Amount <br />Gal � <br />Gal <br />Gal <br />Dltun(s} <br />Drained Used Oil Filter Drum (s) Dr�ls(s) <br />Empty Drum (s) Eaal <br />Transportation & Truck Time Washout <br />Hazardous Testirtg <br />We pay ❑ Customer hys ❑ I I <br />Unless otherwise specified on this Consolidated OManifW Receipt (invoice) Terms � Accounts due on the 10th or the montli Wowing <br />month of purchase. Past due; accounts wI be dmrged a FINANCE CHARGE at the PERIODIC RATE of 1-5% par month, which is the Total <br />ANNUAL PERCENTAGE W = OF 1"3 .I <br />I hereby certify that I have r of mixed this waste %Yith any other waste that the total halides are: less than 1000 PPM, and that the waste does not contain <br />any PCB's. I further agree i a accept the additional charges for legal disposal if this, waste is ever 1000 PPM, tal h or contains any PCB's <br />GENERATORor fiylL 1 <br />AUTHORIZED :. -' '� SIGNATURE <br />TERMS: INVOICES OVEF 30 DAYS ARE SUBJEC i_5% SERVICE CHARGE CUSTO AGREED TO PAY ALL LEGAL FEES OF COURT <br />ACTION BECOMES NECESSARY T COLLECT THIS INVOICE. <br />Kern Oil here by advises It ie above erator that Generators shipmont of used oil may be transported to a facility that is required to comply with federal <br />regulations applicable to n tanagern rat of used oil. But that Is net required to comply with the more stringent requirements applicable to hazardous waste <br />management facill6es. Ke n OII Filte r Recycling is authorized tott a request for EPA# from DTSC. California fatalities that handle or process used oil are <br />required to meet those mr re stringe rit requirements, and some out-of-state fadlfies that process used oil & also meet those requkurnenfs, e <br />certi orations of tank Integrity, and firancial assurances for closure an accidental releases. It is lawful to send used oil to out-of-state facirtiies that comply <br />onlywith federal used oil m anagerne it standards and notbu r.,e more stringent requirements Bysigning the invoice the generator certifies that the generator <br />has established a progra n -to reduce the volume or quantify and toxicity of the hazardous waste to the degree, as determined by generator, to be <br />economically practic3bie.13y both parties signing this invoice it will serve as an agreement that Kern Oil will submit confirmations for (certain waste streams j <br />to the generatorthat thairy aste has transported to a licenced treatment or transfer facility. <br />Riverbank Oil Transfer F-1 NAME 7 NAME <br />5300 Claus Rd, Bldg t I <br />Riva E6ank. CA 951137 <br />Ph_209-863-Ot388 Fa:. 209-860887 <br />F_PA# CAL000190616 <br />ADDRESS <br />crTv <br />STATE, ZIP <br />PHONE _ <br />FPA 10 <br />ADDRESS. <br />CiT y <br />STATE, 7J <br />PHONE — <br />EPAID_ <br />