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AMERICAN VALLEY 16 4 WASTE OIL, INC. Invoice Number: P.O. Box 340 - Delhi, CA 95315 PH. 1-800-732-4645 - FAX 209-668-3880 EPA#CAR000272302 FLEENOR PAPER C0 4201 1----FREMONT "A' I!-'I-EF NOR PA FIER C'0 BILL TO: JOB SITE: 1201 (-- Fr,EMON-f '31 1 Invoice Date: STC)GKTON, CA 95215 <-Yl 0 C KT(l,CA 95;215 PhonerCustamer P.O. Terms r,, n EPA# 'AL0003180 PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUAN-11-1r PRICE AMOUNT CODE NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 NON-RCRA Waste Liquid Used Antifreeze 133 NON-RQRA Waste Liquid Used Oily Water 223 Drained'Used Oil Filters TERMS: Invoices over 30 Days are subject to a 1.5%service charge. Customer agrees to pay all legal fees if court action TOTAL becomes necessary to collect this invoice. 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 plorn,and the wsa(a does not tontain any ioces.I have complied with the requirements of the applicable California used oil management regulation to determine this is true.I agree to accept the oddiflonal charges for the disposal of this waste if the information I have provided about this waste is IncQrrecl. Generator's Certification:By signing I carilly that If I am a large quRntlly generator,I certify that I have a program in place to reduce the volume and toxicity of waste generat- ed to the degree I have determInad to be economically aff ordobTe and that I have selected the practicable method of treatment,storage,or disposal currently ava)[able to me which minimizes the present and future threat to human life and the environment:Or,if I am a small quantity generator,I have made a Good faith effort to minimize my waste generation and select the waste management method that is available to me that I can afford. American Valley Waste Oil herby advises the above Generator that generatota shipment of used oil may be transported to a facillty that is required to comply with federal regulations applicable to management of vied oil,but that is not required to comply with the more stringent requiremertis applicable to hazardous waste management faclil- ,fog.California Facilities that handle or process used oil are required to meet those more sinngent repulremont,and some out-ol-state larilltlas that process used oil also meet those requirements,ang I nooring ce rl IfIcallo no of tank Itilegrity,and li nanoiai assurances fur closum.and accidental raleaaas.It is lawkil to Send used ell to out Of State ffiCIIM83 that comply only with federal used ell management standards and not these more Stringent requirements. This notification is for information purposes only. By both parties signing this involce it will serve as an agreement that American Valley Waste Oil will submit confirmation for(certain waste streams)to the generator that their waste has been transported to a licensed treatment or transfer facility. GENERATOR! DRIVER AUTHORIZED SIGNATUR E DATE. SIGNATURE: DATE,/,'," L D12S-POS��No ITY f=ACL 0 DK-DIXON 0 AS13URY ENVIRONMENTAL /RIVERBANK OIL TRANSFER 0 CFR 0 GLOBAL MATERIAL MGMT 7300 CHEVRON WAY 1920 MORGAN RD, 5300 CLAUS RD, 2035 E. 15TH ST. 1640 N.BROADWAY DIXON,CA 95620 CERES,CA 95358 RIVERBANK, CA95367 LA,CA 90021 STOCKTON,CA 95205 707-693-6008 209-541-1825 209.863-8181 213-746-0237 818-770-2577 EPA#CAT080012602 EPA#.'CAL000393680 EPA#CAL0001 90816 EPA#CAL000270577 EPA#CAL000417316 MPC(7/2010)