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RECE <br /> IVE AMERICAN VALLEY <br /> WA$TE. OIL, INC . Invoice Nlunber: <br /> CIE 0 5 Z01Z P. O. Box 340 • - Delhi, CA 95315 . <br /> PH. 1 -800-732-4645 • FAX 209-668-3880 <br /> iNVIKONMENTALHEALTA CAL000827878 <br /> PERMITISERVICES <br /> BILL TO: JOB SITE: Invoice Date: <br /> JIM THORPE OIL INC COUNTRY MARKET <br /> P.O. BOX 357 10476 LiNNE RD <br /> LODE, CA 95241 (RACY, CA 95376 <br /> CAC002678870 161U ( A <br /> Sales ftp : Steve <br /> Phone Customer P.O. Terms EPA# "Cyj�2 (p7V -2r?O <br /> 209-462-.4581 Net 30 bays ' <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used OiI/MIXed. Ol's 221 <br /> NQN R'CRA Waste Liquid Used Antifreeze -133 <br /> NON-RCRA Waste Liquid Used Oily Water � y W, 00 39 <br /> NON H+ZardeuS Waste Liquid <br /> Trinity Heavy . Duty premixed Antifreeze <br /> Trinity Extended Life premixed Antifreeze <br /> Trinity Case Goods <br /> Truck Wash Out <br /> Truck Time <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 - <br /> becomes necessary to collect this invoice. + - <br /> By signing I herby certify that I have- not mixed this wastewithany other waste, that the total halides are less than 1000 P. P,M; and that the waste does not <br /> contain any P.C.B's. I further agree to accept the additional charges for legal disposal if the waste is over 1000 P.P.M . total halides, or contains any P.C.B's <br /> Generator's Certification: By signing I certify'that I have a program in place to reduce the volume and toxicity of hazardous waste generated to the degree I - <br /> have determined to be economically practicable. I - - <br /> By both parties signing this invoice it willserve as an agreement that American Valley Waste Oil will submit confirmation for (certain waste streams) to the <br /> generator that their waste has been transported to a licensed treatment or transfer facility. - - <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 thatcomplyonly with federal used oil management standards and not these more <br /> stringent requirements. _ <br /> This notification Is for Information purposes only. - <br /> _ / -y GENERATOR/ <br /> SIGVERNATURE: rf - DATE: / C_.- AUTHOR SIGNATURE: V�. E:�J ✓/ 3 y — <br /> O NAME: DISPOSAL / RECYCLING FACILITY <br /> - ADDRESS: ©"&DIXON O RAMOS ENVIRONMENTAL SERVICE <br /> CITY/ST: 7300 CHEVRON WAY - 1515 SOUTH RIVER ROAD <br /> DIXON , CA 95620 W. SACRAMENTO, CA - 95691 <br /> PHONE: 707-693-6008 916-371 =5747 - <br /> EPA#: - EPA ff CAT080012602 EPA If CAD044003556 <br />