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Environmental Services Division qGEORGEINC. Mailing : P.O. Box 176, Salida, CA 95368 Consolidated Manifest 4612 Kiernan Court, Salida, CA 95368 L9YV!t Y Phone: 209-545-0791 FAX 209-545.2241 019 EUUCTCOMPANY invoice EPA # CAorter Number CA Transporter Number 3844 CA License # 758518 GENERATOR : Invoice N2 40 Site EPA ID M Invoice Date: Contact Person : Driver Printed Signature : Name: Truck #: Address : PO # City, State, Zip : Site Phone : TERMS : Product Shipping Name E221 CA Manifest #0 Quantity units Price Amount Non-RCRA Hazardous Waste Liquid (Used Oil): Lubricating Gal Non-RCRA Hazardous Waste Liquid (Used Oil): Industrial Gal Non RCRA Hazardous Waste Liquid (Used Automotive Antifreeze) 134 Gal Non-RCRA Hazardous Waste Liquid (Oil & Water) 223 Gal Non-RCRA Hazardous Waste Solids Contaminated with Used Oil 352 Drum(s) Drained Used Oil Filter Drum(s) Drum(s) Empty Drum(s) Each Transportation & Truck Time HR. Unless otherwise specified on this Consolidated Manifest Receipt (Invoice) Terms: Accounts due on the 10th of the month folloWing month of purphase. Past due I j Total accounts will be charged a FINANCE CHARGE at the PERIODIC RATE of 1 -1 /2% per month, which is the ANNUAL PERCENTAGE RATE of 180/6. By signing I hereby 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 waste does not contain any PCB's. I have complied with the requirements of the applicable California used oil management regulation to determine this is true. I agree to accept the additional charges for the disposal of the waste if the information I have provided about this waste is incorrect. Generators Certification : By signing I certify that If I am a large quantity generator, I certify that I have program in place to reduce the volume and toxicity of waste 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 available 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 . George W. Lowry, Inc. hereby advises the above Generator that generators shipment of Used Oil and Oily/Water may be transported to a facility that is required to comply with federal regulations applicable to management of Used Oil and Oily/Water, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process Used Oil and Oiiy/Water are required to meet those more stringent requirements, and some out-of-state facilities that process Used Oil and Oily/Water also meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases, it is lawful to send Used Oil and Oily/Water to out of state facilities that comply only with federal Used Oil and Oily/Water management standards and not these more stringent requirements . This notification is for the informational purposes only. By both parties signing this invoice it will serve as an agreement that George W. Lowry, Inc. will submit confirmation for (certain waste streams) to the generator that their waste has been transported to a permitted transfer facility or permitted treatment, storage or disposal facility. Lowry Driver Signature X Date Signature of Generator, Representative or Agent of Generator: X Date Recycling , Transfer, Treatment, Storage, Disposal Facilities Name: ® ❑ ❑ ❑ Address: Bakersfield Transfer California Oil Recycling Ramos Environmental Yuma Environmental City, State, Zip : 1620 E. Brundage Lane 5300 Claus Road 1515 S. River Road 2730 E. 13th Bakersfield, CA 93307 Riverbank, CA 96367 West Sacramento, CA 95691 Yuma, AZ, 85365 Phone: 661 -322-8258 209-863-8181 916.371 -5747 928-344-9826 CAL00028258 CAL0000190817 CAD004003556 AZR000515924 EPA ID: