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"y v AMERICAN VALLEY i 51504 <br /> J Irl WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 • Delhi, CA 95315 <br /> f .PH. 1-800-732-4645 • FAX 209-668-3880 <br /> tiIAR <br /> ' EPA. CAL000827878 <br /> 177)� <br /> ENVIRONMELTH -_-._,.✓ ���..,�,°�.,? <br /> PERMIT/" �� < - Invoice Date: <br /> BILL TO: d� JOB SITE: <br /> I I ji >F <br /> `,t I E t VIA..'L{ ; r as i?L't, <br /> 9f <br /> Phone Customer P.O. Payment Terms EPA# <br /> -2 r r. ('At c. <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> USED OIL NON RCRA HAZARDOUS , <br /> WASTE LIQUID 221 ' <br /> USED AUTOMOTIVE ANTIFREEZE, NON <br /> RCRA HAZARDOUS WASTE LIQUID 343 <br /> OILY WATER, NON RCRA HAZARDOUS <br /> WASTE LIQUID 2212 - <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 /> 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 TOTAL <br /> 1000 P.P.M.total halides,or containes any,P.G:B.'s. <br /> DRIVER � ,, r ,� GENERATOR/AUTHORIZED + <br /> SIGNATURE _« SIGNATURE SIGNATURE I " ' <br /> TERMS: INVOICES 9VI=R 30 DAYS ARE SUBJECT TO A 1.5%SERVICE CHARGE. CUSTOMER AGREES TO PAY ALL LEGAL FEES 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. <br /> This notification is fdCinformat!on purposesoniy. - z i <br /> Driver signe¢' �y a Date °- ` Generator signed i " ' Date <br /> By signing Ov invoice the generator certifies that the generator has established a program to reduce the volume or quantity and toxicity 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 /> 0, 1VERBANK OIL TRANSFER O RAMOS ENVIRONMENTAL SERVICES <br /> y 55300 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(10/2004 <br />