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Jan, 12, 2012 9.23AM <br />1515 South River Rd. <br />West Sacramento, CA 95691 <br />(916) 371-5747 <br />CAD044003566 <br />DATE " � + 10 <br />GENERATOR Chase Cheyrlet <br />BILLING ADDRESS <br />GENERATOR CONTACT &A* Gay <br />PHONE 209-475-6630 <br />JOB SITE ADDRESS 6+41 Holman Dr. Stockton 95212 <br />JOB DESCRIPTION <br />MATERIALS <br />_%[:]R] COMBUSTIBLE LIQUID, N.O.S., - NA1993, tit, (USED OIL) CODE #— 2-1— <br />[:]NON <br />NON RCRA HAZARDOUS WASTE. SOLID - LIQUID CODE # <br />U.S, DOT DESCRIPTION: <br />(USED ANTI -FREEZE) NON RCRA HAZARDOUSI} WASTE LIQUID CODE # <br />MANIFEST NO, <br />DRIVER'S SIGNATURE <br />No, 6 10 3 P, 6 <br />oA®ERN®. 1212 0 7 <br />JOB NUMBER <br />GENERATOR EPA # CAL 000 117 545 <br />AMOUNT (IF ANY) <br />CHECK NUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />(amt.) <br />HALIDES 4,40a-9— P.P.M. <br />START TIME <br />END TIME <br />USED OIL FILTERS DRUMS <br />NO. OF GALLONS <br />TRUCK # _ ---- <br />DESIGNATED TSDF RAMOS ENVIRONMENTAL. SERVICES. 1615 SOUTH RIVER RD, WEST SACRAMENTO 85681 CAD 044003656 <br />1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE, AND THE TOTAL HALIDES ARE LESS THAN 9000 P.P.M. <br />This Is to cenily that the above named. articles are properly classified, described, packaged, marked and are in proper condition for <br />lransportallon, according to the applicable regulations of the Department of Transportation. <br />Generator's Certification: I certify that I have a program in place to reduce the volume and toxicity of Waste generated to the degree I have determined <br />to be economically practicable. Ramos agrees with the generator to send all their hazardous waste to an authorized hazardous waste treatment facility <br />via Ramos' standardized permitted storage lacility. <br />All used oil collected from the generator listed above will be transported only to a facility permitted by the State of California to produce used oil into <br />recycled olk <br />Terms - net 15 days. <br />After due date, a finance charge of 1,50% par month,18.00% annual rate, will be charged on the unpaid balance. The customer agrees to pay reasonable <br />costs' and attorney fees Incurred in the collection of this obligation. Venue for purposes of enforcement of this obligation shall be Yolo County. <br />I declare, under penalty of perjury that the foregoing Is true and correct. <br />X <br />GENERATOR SIGNATURE n <br />