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AMERICAN VALLEY 178418 <br /> WASTE :OIL , INC . Invoice Number . <br /> P. O . Box 340 • Delhi , CA 95315 <br /> PH . 1 -800-7324645 • FAX 209 -668-3880 <br /> EPA# CAR000272302 <br /> BILLT090 JOB SITE: CSA17RAL VALLEY LIFT TRUCK IN nvoice Date : <br /> X080 E - C°REkKkff OT <br /> TCAC¢ :T Nt CA 96213 <br /> � 0Cta i ?K GA 95205 <br /> Phone Customer P. O . Terms EPA# <br /> iruit 16 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON - RCRA Waste Liquid Used Oil/Mixed Oils 221 f <br /> NON - RCRA Waste Liquid Used Antifreeze 133 <br /> NON - RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Metal Oil Filters <br /> (AL COLLFC110N FEE <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 1 4 <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, and the <br /> waste does not contain any PCBs. I have complied with the requirements of the applicable California used oil management regulation to determine this is true. I agree to <br /> 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 generat- <br /> ed to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, or disposal currently available to me <br /> 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 <br /> generation and select the waste management method that is available to me that 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 oil are required to 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 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 /> f GENERATOR/ <br /> DRIVER {) L AUTHORIZEDj. l n. <br /> SIGNATURE DATE : (t` �- s SIGNATURE : }.` ' " �� _ ._ DATE <br /> DISPOSAL / RECYCLING FACILITY <br /> O DK- DIXON QSBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER 0 YUMA YES LLC Q AMERICAN VALLEY WASTE OIL, INC <br /> 7300 CHEVRON WAY 1920 MORGAN RD , 5300 CLAUS RD . 6500 US HWY 95 521 INDUSTRIAL DR STEM <br /> DIXON , CA 95620 CERES , CA 95358 RIVERBANK, CA 95367 YUMA, AZ 85365 LIVINGSTON , CA 95334 <br /> 707-693-6008 209-541 -1825 209-863-8181 928-344-9828 209-667-8857 <br /> EPA# CAT080012602 EPA# CAL000393680 EPA# CAL000190816 EPA# AZR000521146 EPA# CAL000443004 <br /> MPC (7/2016) <br />