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ICA <br /> WASTEIL , INC ® Invoice Number : <br /> P. O . Box 340 ® Delhi , CA 95315 <br /> PH . 1 -800-7324645 ® FAX 209-668-3880 <br /> EPA# CAR000272302 <br /> BILL TO . �I � <br /> IvIf F, . JOB SITE � ? a � � ' I Invoice Date : <br /> PhoneCustomer P. O . Terms " l `" l ; - ` EPA# <br /> 4 -y t � �, a ., , � , I . <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON - RCRA Waste Liquid Used Oil/Mixed Oils 221 <br /> NON - RCRA Waste Liquid Used Antifreeze 133 <br /> NON - RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Metal Oil Filters <br /> } ` ;_ ; <br /> IF <br /> } <br /> I 5..,. <br /> IF <br /> IF <br /> IF <br /> IF <br /> 5 c <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 any of the waste described above with any other hazardous waste, the total halide content is LESS than 1 ,000 ppm, and the <br /> waste does not contain any PCBs. I have complied with the requirements of the applicable California used oil management regulation to determine this is true. I agree to <br /> accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect. <br /> Generator's Certification : By signing I certify that if I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generat- <br /> ed to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, or disposal currently available to me <br /> which minimizes the present and future threat to human life and the environment: Or, if I am a small quantity generator, I have made a Good faith effort to minimize my waste <br /> generation and select the waste management method that is available to me that I can afford . <br /> American Valley Waste Oil hereby advises the above Generator that generators shipment of used oil may be transported to a facility that is required to comply with federal <br /> regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facili- <br /> ties. California facilities that handle or process used oil are required to meet those more stringent requirement, and some out-of-state facilities that process used oil also meet <br /> those requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out of state facilities <br /> that comply only with federal used oil management standards and not these-more stringent requirements. <br /> This notification is for information purposes only. <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 generator that their <br /> waste has been transported to a licensed treatment or transfer facility. <br /> GENERATOR/ ` <br /> DRIVER AUTHORIZED ; <br /> SIGNATURE: DATE ` �x , , ),SIGNATURE r t DATE <br /> s <br /> DISPOSAL / _RECYCLING FACILITY <br /> O DK-DIXON , O ASBURY ENVIRONMENTAL 0 RIVERBANK OIL TRANSFER O YUMA YES LLC '' � AMERICAN VALLEY WASTE OIL, INC <br /> 7300 CHEVRON WAY 1920 MORGAN RD, 5300 CLAUS RD , 6500 US HWY 95 "" 52.1 INDUSTRIAL DR STE M <br /> DIXON , CA 95620 CERES , CA 95358 RIVERBANK, CA 95367 YUMA, AZ 85365 LIVINGSTON , CA 95334 <br /> 707-693-6008 209-541 - 1825 209-863-8181 928-344-9828 209-667-8857 <br /> EPA# CAT080012602 EPA# CAL000393680 EPA# CAL000190816 EPA# AZR000521146 EPA# CAL000443004 <br /> MPC (7/2016) <br />