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RECEIVED , <br /> AMERICAN VALLEY 127495 <br /> WASTE OIL , INC . MAR 0 2 2016 Invoice Number : <br /> P. O. Box 340 Delhi , CA 95315ENVIRONMENTAL <br /> PH . 1 - 800-732 -4645 • FAX 209 - 66 & 38ff,;t" 4Ty M:P�4kiZTkCNIT <br /> EPA# CAL000827878 <br /> J , M EGtUEPPaECNT � dill` <br /> BILL TO : J . M EQUIPIVEENT JOB SITE : 321 SPRECKELSAVF Invoice Date : <br /> 321 SPRErCKELS AVE MANTECA, CA 953'36 <br /> ;1AN'i' EvCA, CA 95336 30D OIL 60D SUM <br /> Sales Rep: <br /> Phone Customer P. O. Terms EPA#CAL000350320 <br /> 209 -275-6265 SCOTT Net 3013arys <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON - RCRA Waste Liquid Used Oil/Mixed Oils 221 <br /> NON- RCRA Waste Liquid Used Antifreeze 133 <br /> NON- RCRA Waste Liquid Used Oily Water 223 <br /> Drained Used Oil Filters <br /> HAZARDOUS VVASTE PICK UP- ABSORBENT S AND OIL , ( " I ", }? , { 4 .j 0 �) <br /> 56 (3A L OaOP U A CE RT STEE L R ECON <br /> Sales Tax <br /> TERMS: Invoices over 30 Days are subject to a 1 . 5% service charge. Customer agrees to pay all legal fees if court action TOTAL `( , <br /> becomes 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, <br /> and the waste does not contain any PCBs. I have complied with the requirements of the applicable California used oil management regulation to determine this is <br /> true. l agree to accept the additional charges for the disposal of this 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 a program in place to reduce the volume and toxicity of waste <br /> generated to the degree 1 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 1 am a small quantity generator, l have made a good faith <br /> effort to minimize my. waste generation and select the waste management method that is available to me that I can afford . <br /> By both parties signing this invoice it will serve as an agreement that American Valley Waste Oil will sub r it confirmation for (certain waste streams) to the generator <br /> that their waste has been Transported to a licensed treatment or transfer facility. <br /> i <br /> GENERATOR/ <br /> DRIVER 4^ 2 `l . � , I rL AUTHORIZED ^ , j � <br /> SIGNATURE: �- DATE: t SIGNATUFif pi ' DATE: <br /> DISPOSAL / RECYCLING FACILITY <br /> O 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# CAT080012602 EPA# CAL000270577 EPA# CAL000379059 <br /> MPC (6/2013) <br />