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AMERICAN VALLEY -` D i �4. <br /> WASTE OIL, INC. hivoice Number: <br /> P.O. Sox 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-568-3880 <br /> EPA# CAR000272302 <br /> BILL TO: JOB SITE: Invoice Date: <br /> Phone Customer P.O. Terms EPA# <br /> C,�L wo- ��3 �� <br /> PRODUCT SHIPPING DESCRIPTIONC WASTE MANIFEST QUANTITY! PRICE AMOUNT <br /> I CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 I <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Me Oil 1=liters <br /> r <br /> I � <br /> I, <br /> is 1 2 019 <br /> I <br /> I3y:: ....................... <br /> l i <br /> TERMS: Invoices over 30 Days are subject to a 1.5°b service charge. Customer agrees to pay all legal fees if court action IJOTAL 1 <br /> becomes necessary to collect this invoice. i i <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 1,0Q0 ppm,and the <br /> wade 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 k <br /> accept the addilienal charges for the disposal of this waste if the information I have provided aboul this.,aste is incorrect. <br /> Generator's Certification.By sighing l 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 vraste 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 /> geoeralon and select the waste management method that is available to me that I can afford. i <br /> I � <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,bill 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 atso meet <br /> those requirements,engineering certifications of tank integrity,and financial assurances for closure and accidental releases.It is lavrful to send used oil to out of state€aciNies <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 /> l DRIVER GENERATOR! <br /> AVTH(�RIZED <br /> S1Gl'IATURE: DATE- SIGNATTURE: DATE: <br /> DISPOSAL / RECYCLING FACILITY <br /> O DK-DIXON Q ASBURY ENVIRONMENTAL O RIVERBANK OIL TRANSFER O YUMAYES LLC Q %`iERICnr:VALLEY Vrasr-E OIL %C <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. 5500 US HWY 95 521 INDUSTRIAL DR STE Mj <br /> DIXON,CA 95620 CERES, CA 95358 RIVERBANK, CA 95367 YUMA.AZ 85365 LIVINGSTON.CA95334 <br /> 707-693.6008 209-541-1825 209-863-8181 928-344-9828 209-667-8857 i <br /> EPA"CAT080012602 EPA#CAL000393680 EPAr CAL000190816 EPA"AZR000521146 EPA"CAL000443004 <br /> } <br /> �� .. .--- --- -- taPc sPza,si <br />