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r Environmental Services Division Mailing: P.O. Box 176, Salida, CA 95368 4612 Kiernan Court, Salida, CA 95368 Consolidated Manifest Phone: 209-545-0791 FAX209-545.2241 . LOWRY ' H "o I ^ e EPA # CAR000047019 OGEORGEINC , ROLEUM PRODUCTSCOMPANY , E V , v CA Transporter Nurriber3844 CA License # 758518 GENERATOR: Invoice N ° 40 Site EPA ID #: _ Invoice Date : Contact Person : Driver Printed Signature: Name: Truck #: Address: PO # City, State, Zip: ; Site Phone: TERMS : Product Shipping Name waste CA Manifest #0 Quantity Units Price Amount Code Non-RCRA Hazardous Waste Liquid (Used .010: Lubricating 221 IF Gal Non-RCRA Hazardous Waste Liquid (Used Oil): Industrial 221 Gal Non RCRA Hazardous Waste Liquid (Used 'Automotive Antifreeze) 134 Gal Non-RCRA Hazardous Waste Liquid (Oil & Water) 223 cal Non-RCRA Hazardous Waste Solids Contaminated with Used Oil ' 352 Drum(s) Drained Used Oil Filter Drum(s) Drum(s) Emptybrum(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 purchase. Past due 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 18%. ! By signing I hereby certify that I have not mixed any ofthe 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. Generator's Certification: By signing I certify,that if I am a large quantity generator, ' I certify that I have program in rplace to reduce the volume and toxicity of waste generated to the degree I ' have determined to be economically affordable and that 1 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 wenvironment, 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 ) 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 Oily/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 �� . ^ 57 '1 6 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 CAL00001908W,, CAD004003556 AZR000515924 EPA ID;