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AMERICAN VALLEY <br /> WASTE OIL, INC. Invoice Number: <br /> P. O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> CAL000827878 <br /> BILL TO: JOB SITE• r Invoice Date: <br /> Phone Customer PO. Terms r EPA# <br /> ! '/ <br /> PRODUCT SHIPPING DESCRIPTION MANIFEST QUANTITY1 PRICE AMOUNT <br /> WASTE <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 72- 7�ZCC <br /> J <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> NON Hazardous 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 J <br /> becomes necessary to collect this invoice. / <br /> By signing I herby certify that I have not mixed this waste with any other waste,that the total halides are less than 1000 RPM;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. <br /> By both parties signing this invoice it will serve 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 1e 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 for information purposes only. <br /> GENERATOR/ f <br /> DRIVER I — AUTH0192ED <br /> DATE, <br /> SIGNATURE: SIGNATURE: DATE: S . <br /> o NAME: ,, <br /> DISPOSAL / RECYCLING FACILITY <br /> ADDRESS: '&DK-DIXON <br /> O RAMOS ENVIRONMENTAL SERVICE <br /> CITY/ST: 7300 CHEVRON WAY 1515 SOUTH RIVER ROAD <br /> PHONE: DIXON, CA 95620 W.SACRAMENTO, CA 95691 <br /> 707-693-6008 916-371-5747 <br /> EPA#: EPA# CAT080012602 EPA#CAD044003556 <br /> MPC(412010) <br />