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111C Is 5. AMERICAN VALLEY 148597 <br /> WASTE OIL, INC. Invoice Number: <br /> P.O. Box 340 - Delhi, CA 95315 <br /> PH. 1-800-732-4645- FAX 209-668-3880 <br /> EPA#CAL000416714 <br /> BILL TO: BROOKSIDE COUNTRY CLUB JOB SITE: BRWKSIDE C;UUN1RY CLu6 livoice Date: <br /> 3603 ST.ANDREWS OR 3131 BRUOK5IUE RD. <br /> STOCKTON,GA 95219 Si UGKTUN,CA 95119 <br /> X MARCH LANE <br /> Phone I�'� `" Customer P.O. Terms EPA# <br /> 209-47&Jd 63 R084 N Net 30 Days ('At OW?01.9437 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANT(TY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 3t Gj r 2 <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 233 <br /> Drained Used Oil Filters <br /> OIL COLLECTION FEE m ! n 35,Cx <br /> Sales Tax <br /> TERMS: Invoices over 30 Days are subject to a 1.5%service charge. Customer agrees to pay all legal fees it court action TOTAL <br /> becomes necessary to collect this invoice. <br /> By signing I herby certify that 1 have not mixed any of the waste described above with any other hazardous waste,the total halide content b LESS Twan 1.000 PPm,and the <br /> waste does not contain any PCBs.I have complied with the requirements 01 the applicable California used oil management regulation to determine th4.s la true.I agree to <br /> accept the additional charges for the d4aposai of this waste if the information 1 have provided about this waste is incorrect <br /> (ieneratohs CeNficaton:By signing I�Ky that if I am a large quantity generator,I certify that I have a program In plaoe 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 cwrenuY avai'abie to me <br /> which minimizes the present end future threat to human life and the environment:Or,if I am a small quantity generator,l have made a Good faith~to rninknize my waste <br /> generation and select the waste management method that is available to me that I can afford. <br /> American Valley Waste CA 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 managernerrt of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous waste used rre& <br /> ties.California facilities that handle or process used oil are required to meet those more stringent requirement,end some out-of-stilts ss <br /> te facilities that proce <br /> those requwements,engineering certification of tank Integnty,and financial assurances for closure and accidental releases.It is lawful to send used al to out of state facilities <br /> that comply only with federal used oil management standards and not these more stringent requirements. <br /> This notticaton Is for Information purposes only. for that Heir <br /> By both parties s4gning this Invoice it wil serve as an agreement that American Valley Waste 011 will submit confirmation for(certain waste streams)to the genera <br /> waste has been u to a Iioensed treatment or transfer facility. <br /> 1*1 QENERATM / <br /> AUTHORIZED / <br /> S GNARUR DATE: SIGNATURE: k✓ GATE: <br /> F730OC4HEVRON <br /> O ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O CFR O GLOBAL MATERIAL MGMT <br /> WAY 1920 MORGAN R0. 5300 CLAUS RD. 2035 E.15TH ST. 1640 N.BROADWAY <br /> 5620 CERES,CA 95358 RIVERBANK, CA 95387 LA,CA 90021 3TOCKTON,CA 95205 <br /> 707-693-6008 209-863-8181 213 748-0237 81&770-2577 <br /> 0012802 EPA#CAL000393680 EPAdC CAL000190818 EPA#CAL000270577 EPA#CAL000417318 <br /> APC(7/tots) <br />