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' AMERICAN VALLEY <br /> WASTE OIL, INC. Invoice Number <br /> RECYCLi <br /> P O Box 340 - Delhi, CA 95315 <br /> PH 1-800-732-4645 a FAX 209-668-3880 <br /> • EPA CAL000827878 <br /> Invoice Date <br /> BILL TO: JOB SITE: <br /> F + <br />' Phoneu t <br /> C s omen P O Payment Terms EPA# <br /> - <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 221 <br /> UNITY HEAVY DUTY 50/50 <br /> YCLED ANTIFREEZE N/A <br /> NON HAZARDOUS WASTE LIQUID <br /> TRUCK TIME N/A <br /> IGREASWEEP N/A <br /> TERMS INVOICES 30 DAYS ARE I <br /> TO A 1 5% SERVICE CHARGE <br /> TO PAY ALL L GALOVER FEES IF COURT ACTION J BEECT COMES NECESSARY TO COLLECT THIS O NMER VQ CE AGREES TOTAL <br /> I' DRIVER -f�. GEN16 ATl7R <br /> SIGNATURE SIGNATURE <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 acci- <br /> dental <br /> ccrdental releases Itis lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these more strin- <br /> gent requirements <br /> This notification is for information purposes only r - <br /> _ r� rj j <br /> Driver signed_ +�t Date - y,. Gen gator signed � r fir° �'�' �� •_�> Date I <br /> By signing the 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 /> B 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 /> their waste has been transported to a license treatment or transfer facility <br /> I <br /> DISPOSAL/ RECYCLING FACILITY <br /> O RIVERBANK OIL TRANSFER O RAMOs ENVIRONMENTAL SERVICES <br /> 5300 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 /> we m1 <br />