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AMERICAN VALLEY 144708 <br /> WASTE OIL, INC. Invoice Number: <br /> P O. Box 340 a Delhi, CA 95315 <br /> PH. 1-800-732-4645 9 FAX 209-668-3880 <br /> EPA# CAL000827878 <br /> BILL TO: BROOKgDE COUNTRY CLUB JOB SITE: BROOKSIDE COUNTRY CLUB <br /> 3603 ST,ANDREWS DR 3131 BROOKSIDE RD. Invoice Date: <br /> STOCKTON,CA 95219 STOCKTON,CA 95219 <br /> X- MARCH LANE <br /> Phone209-478-9963 ROBIN Customer P.O. Terms EPA# <br /> Net 30 Days I CALOOO 205437 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE �`�,� �►1 ,+f <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 -y� /� �/ V `� <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Drained Used Oil Fitters <br /> OIL COLLECTION FEE l I ck-`-�, <br /> ales Tax <br /> TERMS- Invorces over 30 Days are subject to a 1.5%service charge. Customer agrees to pay all legal fees it court action TOTAL � — <br /> becomes neCessa to Coliect 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, <br /> and the waste does not contain any PCBs.1 have complied with the requirements of the applicable California used oil management regulation to determine this is <br /> true.-I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect. <br /> Generators 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 <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 <br /> effort to minimize mywaste generation and select the waste management method that is available to me that I can afford. <br /> By troth 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 <br /> that their waste has been transported to a licensed treatment or transfer facility. <br /> GENERATOR/ <br /> DRIVER ¢ / THOR12ED <br /> SIGNATU. - DATE U// SIGNAT DATE <br /> POSAL/ RECYCLING FAC14ITY � <br /> DK-DIXON O CFR O UNITED ENTERPRISES CORP <br /> 7300 CHEVRON WAY 2035 E 15TH ST. 11190 PENROSE ST. <br /> DIXON CA 95620 LA,CA 90021 SUN VALLEY,CA 91352 <br /> 707-693-6008 213-746.0237 818-787-2649 <br /> EPA#CATOW012602 SPAN CAL000270577 EPA#CAL000379059 <br /> LWC.5.2'1 13, <br />