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qGEORGEINC.
<br />LOWRY
<br />EUM PRODUCTS COMPANY
<br />GENERATOR:
<br />Site EPA ID #:
<br />Contact Person:
<br />Name:
<br />Address:
<br />City, State, Zip:
<br />Site Phone:
<br />Consolidated Manifest
<br />Invoice
<br />Environmental Services Division
<br />Mailing: P.O. Box 176, Salida, CA 95368
<br />4612 Kiernan Court, Salida, CA 95368
<br />Phone: 209-545.0791 FAX 209-545.2241
<br />EPA # CAR000047019
<br />CA Transporter Number 3844
<br />CA License # 758518
<br />Invoice N° 40
<br />Invoice Date:
<br />Driver Printed Signature:
<br />Truck #:
<br />PO #
<br />TERMS:
<br />By signing I hereby 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 PCB's. 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 the 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 program in place to reduce the volume and toxicity of waste
<br />generated to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, or disposal currently
<br />available to me 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
<br />minimize my waste generation and select the waste management method that is available to me that I can afford.
<br />George W. Lowry, Inc. hereby advises the above Generator that generators shipment of Used Oil and Oily/Water may be transported to a facility that is required to comply
<br />with federal regulations applicable to management of Used Oil and Oily/Water, but that is not required to comply with the more stringent requirements applicable to
<br />hazardous waste management facilities. California facilities that handle or process Used Oil and Oily/Water are required to meet those more stringent requirements, and
<br />some out-of-state facilities that process Used Oil and Oily/Water also meet those requirements, engineering certifications of tank integrity, and financial assurances for
<br />closure and accidental releases, it is lawful to send Used Oil and Oily/Water to out of state facilities that comply only with federal Used Oil and Oily/Water management
<br />standards and not these more stringent requirements.
<br />This notification is for the informational purposes only.
<br />By both parties signing this invoice it will serve as an agreement that George W. Lowry, Inc. will submit confirmation for (certain waste streams) to the generator that their
<br />waste has been transported to a permitted transfer facility or permitted treatment, storage or disposal facility.
<br />Lowry Driver Signature
<br />Signature of Generator, Representative or Agent of Generator:
<br />Date
<br />Product Shipping Name
<br />waste
<br />Code
<br />CA Manifest #0
<br />Quantity
<br />units
<br />Price
<br />Amount
<br />1620 E. Brundage Lane 5300 Claus Road
<br />Non-RCRA Hazardous Waste Liquid (Used Oil): Lubricating
<br />221
<br />Bakersfield, CA 93307 Riverbank, CA 96367
<br />West Sacramento, CA 95691
<br />Gal
<br />661-322.8258 209-863-8181
<br />916-371.5747
<br />928-344-9826
<br />Non-RCRA Hazardous Waste Liquid (Used Oil): Industrial
<br />221
<br />AZR000515924
<br />Gal
<br />Non RCRA Hazardous Waste Liquid (Used Automotive Antifreeze)
<br />134
<br />Gal
<br />Non-RCRA Hazardous Waste Liquid (Oil & Water)
<br />223
<br />Gal
<br />Non-RCRA Hazardous Waste Solids Contaminated with Used Oil
<br />352
<br />Drum(s)
<br />Drained Used Oil Filter Drum(s)
<br />Drum(s)
<br />Empty Drum(s)
<br />Each
<br />Transportation & Truck Time
<br />HR.
<br />Unless otherwise specified on this Consolidated Manifest Receipt (Invoice) Terms: Accounts due on the 10th of the month following month of purchase. Past due
<br />accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1-1/2% per month, which is the ANNUAL PERCENTAGE RATE of 18%.
<br />Total
<br />By signing I hereby 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 PCB's. 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 the 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 program in place to reduce the volume and toxicity of waste
<br />generated to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, or disposal currently
<br />available to me 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
<br />minimize my waste generation and select the waste management method that is available to me that I can afford.
<br />George W. Lowry, Inc. hereby advises the above Generator that generators shipment of Used Oil and Oily/Water may be transported to a facility that is required to comply
<br />with federal regulations applicable to management of Used Oil and Oily/Water, but that is not required to comply with the more stringent requirements applicable to
<br />hazardous waste management facilities. California facilities that handle or process Used Oil and Oily/Water are required to meet those more stringent requirements, and
<br />some out-of-state facilities that process Used Oil and Oily/Water also meet those requirements, engineering certifications of tank integrity, and financial assurances for
<br />closure and accidental releases, it is lawful to send Used Oil and Oily/Water to out of state facilities that comply only with federal Used Oil and Oily/Water management
<br />standards and not these more stringent requirements.
<br />This notification is for the informational purposes only.
<br />By both parties signing this invoice it will serve as an agreement that George W. Lowry, Inc. will submit confirmation for (certain waste streams) to the generator that their
<br />waste has been transported to a permitted transfer facility or permitted treatment, storage or disposal facility.
<br />Lowry Driver Signature
<br />Signature of Generator, Representative or Agent of Generator:
<br />Date
<br />Name:
<br />Address:
<br />City, State, Zip:
<br />Phone:
<br />EPA ID:
<br />Date
<br />Recycling, Transfer, Treatment, Storage, Disposal Facilities
<br />❑ ❑
<br />❑
<br />❑
<br />Bakersfield Transfer California Oil Recycling Ramos Environmental
<br />Yuma Environmental
<br />1620 E. Brundage Lane 5300 Claus Road
<br />1515 S. River Road
<br />2730 E. 13th
<br />Bakersfield, CA 93307 Riverbank, CA 96367
<br />West Sacramento, CA 95691
<br />Yuma, AZ, 85365
<br />661-322.8258 209-863-8181
<br />916-371.5747
<br />928-344-9826
<br />CAL00028258 CAL0000190817
<br />CAD004003556
<br />AZR000515924
<br />Name:
<br />Address:
<br />City, State, Zip:
<br />Phone:
<br />EPA ID:
<br />Date
<br />
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