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AMERICAN VALLEY <br /> MITE OIL, IkC. 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: f 1,_ w "f'; �,.t',t r.{ . ,..y,-•a S:3 1".'x: � •"f e.-' <br /> OB SITE: <br /> 1. "11)1 f.,r ti I'F,�01" I ;: I J 42D,i F� Invoice Date: <br /> N QA 21 <br /> Phon$y3-3r,^f Customer P.O. Terms EPA .AL(30[)318(�$., <br /> K <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 233 <br /> Drained Used Oil Filters <br /> 0 1 L CCA I.,E C 1 M1a911 i''r-1_` <br /> J <br /> TERMS: Involces over 30 Days are subject to a 1.5%service charge. Customor agrees to pay all legal fees if court action TOTAL <br /> becontas necessary to collect this Invoice, r p <br /> Ay alt3ning I lterhy carfity that I hRve not mixed any of lite waste dascrit'rod above with'any Other Hazardous waste,the total hallcie eOnlent Is LESS!lean 1,000 ppm,and the <br /> wa0a dens not i;ontain any PCBs.I have complled wllh the raqulromerna of the appllCable California usod all manngamaht regulation to detem+ine Shia is true.I agree to <br /> aCrPpt the addltlonal charges for the disposal of thm waste if the lnforrruttlL:n 1 have provided abOut this waste Is lncotract_ <br /> Ganeratnr's Cattlllnallpn:By$10iling I certify that if I am a lafpe quantify generator,I certifythRt I have a program in Placa to fedteca the volume and toxlalty of waato genatst- <br /> ed to the dEgree I have determined to be econernirally affnMahte nrrd that I have selactod The pracl€cable method of treatmefn,storaga,or disposal currently evallahle to me <br /> which Inlnlrrrlxes[tie preeant and tuturn Threat to ftuman life and the envlfonment:Or.If I am a small tluantlly generator.I have rmWe a Good faith effort to minlmite my waste <br /> generation and select t h a waste mat lagement method that Is availa big to me thgt I can afford. <br /> American Valley Waste Oil 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 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 that handle or process used all ere required to meet those more stringent requirement,and some out-of-state facilities that process used oil also most <br /> those requirements,engineering certifications of tank integrity,and financial assurances for closure and accidental releases.It is lawful to send used oil to out of state facilities <br /> that comply only with federal used oil 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 a licensed treatment or transfer facility. <br /> GENERATOR! <br /> DRIVER AUTHORIZED li ' <br /> SIGNATURE: DATE/' err it ,�,IGNATURE: i Rte' �`� DATE; � <br /> DISPOSAL BICYCLING EA &11Y <br /> O DK-DIXON O ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O CFR O GLOBAL MATERIAL MGMT <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. 2035 E. 15TH ST. 1640 N,BROADWAY <br /> DIXON,CA 95620 CERES,CA 95358 RIVERBANK, CA95367 LA,CA 90021 STOCKTON,CA 95205 <br /> 707-693-6008 707-693-6008 209-863-8181 213-746-0237 818-770-2577 <br /> EPA#CAT080012602 EPA#CAL000393680 EPA#CAL000190816 EPA#CAL000270577 EPA#CAL000417316 <br /> -- --- MPC(7/2010) <br />