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Phone ��;��=�� �r�= <br />;�� #� 1:�: � Customer P.O. Terms EPA# <br />i��r� 1 ����`-�'��� <br />PRODUCT SHIPPING DESCRIPTION MANIFEST QUANTITY PRICE AMOUNT <br />WASTE <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />;NON-RCRA Waste Liquid Used Oily Water <br />223 <br />Compliant Drained Used Metal Oil: Filters <br />- �n.,-�a�.t.t,ar-���.i3i., <br />3 <br />, .� <br />��"_ ( � i <br />� <br />t s� <br />�( �.,{� <br />�` <br />i I <br />1.` .fir <br />m <br />��� �� �}t�'�€.��° ti �� t � i .wit � �:�r <br />�! <br />_ <br />r^)'A"^., <br />.�s"� L.s J kn�i.� <br />1k{ to-' ..o <br />f <br />� a�i.�ms � t`...<.^ <br />TERMS: Invoices. over 30 Days are subject to a i.5%service charge. Customer agrees to pay all aegal fees if court action TOTAL �:> <br />:becomes <br />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. Lhave complied with the requirements of the applicable California used oil management regulation to determ(ne his is true: i agree to <br />accept the additional charges forthe disposal of this waste if the information.I have provided about this waste is incorrect. <br />Generator's Certification: By signing lbertify 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 th©degree 1 have determined <br />to;be economically affordable and that I have selected the practicable method of treatment, (storage, or disposai:currentiy available to me <br />which minimizes the present and future threat to human life <br />and the environment: Or, if Lam a small quantitygenerator, I have made a Good faith effort to minimize my waste <br />` generation and select the waste management method that is to shat afford. <br />available me i can <br />American Valley Waste Oil hereby advises the above Generator thatgenerators shipment of used oil may be transported to a facility that is required to comply with federal <br />regulations applicable to <br />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 thaf;handie <br />or process used oil are required o 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 <br />closure and accidental releases. tt is`,lawful to send usedoil to out of state facilities <br />that comply only with federal used oii'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 licensed treatmen�t, <br />a tor transfer facility. <br />j <br />� � <br />..�' rb' �,d"j/ <br />GENERATO <br />DRIVER= *` ,--- �f ,,�"' �,, <br />-� <br />.-- .� r AUTHORIZE _ / P' �` t <br />� <br />SIGNATURE: ,"�,_ p�'°� 1' DATE,-; �"„,, �-nSIONATUREt � '` `a �--DATE-� <br />f r,,: � . ,. ,,.. <br />DISPOSAL /RECYCLING FA ILITY .. <br />O DK-DIXON ' O ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER -(Q UMA YES LLC O AMERICAN VALLEY WASTE OIL, INC <br />7300. CHEVRON WAY 1920 MORGAN RD. l 5300 CLAUS RD. 6500 US HWY 95 521 INDUSTRIAL DR STE M <br />DIXON, CA 95620 CERES, CA 95358 RIVERBANK,`: CA 95367 YUMA, AZ 85365 UVINGSTON, CA 95334 <br />707-.693-6008 209-541-1825 209-863-8181. 928-344-982.8. 209.667-8857 <br />EPA# CAT080012602 EPA# CAL000393680 EPA# CAL000190816 EPA# AZR000521146 EPA# CAL000443004 <br />MPC (-712016) <br />