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<br /> AMERICA►IALL
<br /> �., ° , 34300.4
<br /> I,III I'�-.4,-I,�n4A-41A-n1-I!-EI2_1-,,Iin-.I�;II&�,�.nTAII,I 7-%�l�A.I_�e"n,-,-VII'_jjImlFm.wIA,�I-XI II 1-M4 C,,1,m,A&IFI,1.��I 1AI II t-:FO,�V,I7;N%n 1n A:I
<br /> WASTE ® IL; INC.
<br /> Invoice Number .
<br /> MSR 4 2 2016
<br /> 1 I P, O. Bok 340 • : Delhi , CA 953,1 5, ; '
<br /> PH . 1 -800 -732 -4645 • n FAX 209-66 ; AL
<br /> EPA# CAL000827878 � � � ,�. .
<br /> JIM N QUIp�AENT r, I°l ; .
<br /> 321 SPRIrGfCEL:SAitE I M EQUIPMENT f�An
<br /> BILL TO : ' . JOB SITE : 1 BPFdEGKELSAVE ! ' Invoice Date .
<br /> MAN1 ECA, CA 96 .36
<br /> MANTA, GA 953;16 1
<br /> C9NL 6UD SUM
<br /> Sales Rep
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<br /> PI I hon, e ?7ISTT7 Customer P. O. TermVat30, Daya EPA#f ►Lt)t)(335E}320 y
<br /> PRODUCT SHIPPING DESCR1 . MANIFEST QUANTITY PRICE AMOt)NTIIII
<br /> WASTE
<br /> CODE
<br /> Ote Pd- RCRA WanI steIT IllLiquid Used OIIfMix11 ed Oils 221
<br /> NON RCRn1 A2 Waste LiquIr id UsII ed Antifreeze 133 ' � In _ 66nI
<br /> NON RCCA Wasteliquld Used Oily Water I2A 23
<br /> Drained Used IIOil n F- iltenII rsITn
<br /> I�tJfti TCI THE CLASTIC; FALN, IN CRUDE OIL
<br /> CES,WE HAVE- AS.
<br /> EEN FORCE© TC3 _
<br /> CHANGE PRICING FOR WASTE OILAND tAn
<br /> . . "
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<br /> TERMS; Invoices1 over 30-11DayIll s are" subject It_A,Am�
<br /> o a" 1 .5% smFervice charge. Customer agrees to pay all legal fees if. court actionFAA%m. TOTAL . :- , y
<br /> " becomes necessary to collect this Involce. " nAAmI
<br /> mI
<br /> By signing f herby certify that I 'have "not mixed any of the waste described above with, any other hazardous waste,'the total hallde content is LESS than 1,000 ppm,
<br /> end FIithe waste doAI es nA. ot contaitrany PCBs:I haveAr complied with" theAreIT quieI remenII ts ofI the applicableII CalI.ifornia used oil manI 4-agement regulation to`determine ths'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 incorrectAt
<br /> Ir�lA7.IIFS�n��IAAnA.iAn�nI�I�.�N�IA!��4I"n%�.I-nIn III,.,.I-'-.IlnI-i IA,FI n,-IA,4�.L-I—'-F�niI,--t,IA��_AI-i1.,"t-jnl,A,v--I..I�-I In nI111I--l I�n,4AeI in,I.,In"An�—n1 A 1 A-I11 I II,1. 7In:IA.A IlImF-m1F,IImI:AI,-Ie,AlA4e^:ITI�,nAA,+,,,IInn K�+I F,I AI--. 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 teduce the frI lume 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 /> III%-,)II,�-�I A1;I1II A.1m-n1,IdII
<br /> 1 IIA
<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,;) have"made a good faith ;; ;
<br /> effort to minimize my waste generationand select the waste management method that is available to me that I can afford.
<br /> By both parties signing this invoice it it 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 /> - 1 }: - _ -
<br /> Y n 4 ' �4 _. I, _ . _ —,_A ___ : -_ _ . • GENERATORt f —
<br /> DRIVER AUTHORIZED —,
<br /> SIGNATURE:' DATE: SIGNATU�Et / - DATE:
<br /> DISPOSAL / RECYCLING FACILITY
<br /> DK=DIXON" m _ O ' CFR .. 7 —O UNITED ENTERPRISES CORP nt
<br /> 7300 CHEVRON WAY . ' 2035 E . 15TH ST. 11190, PENROSE ST, x
<br /> .DIXON CA 95620 LA, CA 90021 SUN VALLEY; CA 91352
<br /> 707=693i6008 213 746 0237 818 787;2849
<br /> EPA# CAT080012602 EPA# CAL000270577 EPA# CAL0003,79059
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<br /> 7 � ,! ` MPC (6/2013)
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