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.AMERICAN VALLEY <br />WASTE OIL, INC. Invoice Number: <br />P. O. Box 340 - Delhi, CA 95315 <br />I,xA I'h e 0� PH. 1-800-732-4645 v FAX 209-668-3880 <br />cEPA. CAL000827878 <br />Invoice Date: <br />11111, TO:: JOB SITE:' <br />Phone Customer P.O. Payment Terms EPA# <br />PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br />CODE <br />USED OIL NON RCRA HAZARDOUS <br />WASTE LIQUID 221 <br />USED AUTOMOTIVE ANTIFREEZE, NON <br />RCRA HAZARDOUS WASTE LIQUID 343 <br />OILY WATER, NON RCRA HAZARDOUS <br />221 <br />WASTE LIQUID <br />TRINITY HEAVY DUTY PREMIX <br />RECYCLED ANTIFREEZE N/A <br />NON HAZARDOUS WASTE LIQUID <br />TRUCK TIME N/A <br />GREASWEEP N/A <br />I hereby certify that I have not mixed this waste with any other waste, that the total halides are less than 1000 P.P.M.; and that <br />the waste does not contain any p.C.B.'s. I further agree to accept the additional charges for legal disposal if this waste is over <br />;TOTAL <br />1000 P. RM. total halides, or contains any RC.B.'s. <br />DRIVER <br />GENERATOR/ AUTHORIZED <br />SIGNATURE SIGNATURE/ SIGNATURE <br />, <br />TERMS: INVOICES OVER 30 DAYS ARE SUBJECT TO A 1.5% SERVICE CHARGE. CUSTOMER AGREESTO PAY ALLEGAL SEES IF <br />COURT ACTION BECOMES NECESSARY TO COLLECT THIS INVOICE. <br />American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may be transported to. a'facilitY that is required to comply <br />with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous <br />waste management facilities. California facilities that handle or process used oil are required to meet those more stringent requirements, and some out-of- <br />state facilities that process used oil also meet those requirements, engineering certifications of tank integrity, and financial ancial assurances for closure and <br />. <br />accidental releases. it is lawful to send used oil to out-of-state facilities that comply only with federal used oil managementstandards and not these more <br />stringent requirements. <br />This notification is for informati64 p.4rposes only. <br />2' <br />Generator signed Date <br />Driver signed Date — a 9 hazardous <br />By signing the invoice the generator certifies that the generator has established a program to reduce the volume or quantity and toxicity of th h <br />waste to the degree, as determined by the generator, to be economically practicable. <br />By both parties signing this invoice it will serve as an agreement that American Valley will submit confirmations for (certain waste streams) to the generator <br />that their waste has been transported to a license treatment or transfer facility. <br />DISPOSAL /RECYCLING FACILITY <br />0 RIVERBANK OIL TRANSFER 0 RAMOS ENVIRONMENTAL SERVICES <br />5300 CLAUS ROAD • RIVERBANK. CA 95367 1515 SOUTH RIVER ROAD - W. SACRAMENTO, CA 95691 <br />FPA rAt nno19nni6 916.371-5747 - EPA # CADD44003556 <br />MPC (10=04) <br />T -d 911P6029117 jiedaN ojnU R4TIenb eSS:60 LO L2 Int: <br />