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BILL TO: <br />eaw <br />AMERICAN VALLEY C) <br />WASTE OIL, INC. <br />P. O. BOX 340 • Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />EPA# CAL000827878 (� <br />ce Datee <br />22.381 <br />Invoice Number: <br />JOB SITE: <br />yoM t D� �� irvoi <br />�oC�7Z 15" <br />v <br />Phone `"'� <br />MPC ( <br />Customer P.O. <br />Terms <br />EPA# <br />PRODUCT SHIPPING DESCRIPTION <br />MANIFEST <br />QUANTITY <br />PRICE <br />AMOUNT <br />WASTE <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />00i<I79:) <br />/) <br />Z� <br />I OQ - <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />Drained Used Oil Filters <br />he <br />�J <br />f <br />TERMS: Invoices over 30 Days are subject to a 1.5% service charge. Customer agrees to pay all legal fees if court actiol <br />TOTAL <br />JUI <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 convent is(LE55 /tlan�,00 ppm; — - <br />and the waste does not contain any PCBs. I have compiled with <br />the requirements of the applicable California used oil management regu ation to det isifsl <br />true. I agree to 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 <br />quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste <br />generated to the degree I have determined to be economically <br />affordable and that I have selected the practicable method of treatment, storage, or disposal currently <br />available to me which minimizes the present and future threat <br />to human life and the environment; Or, if I am a small quantity generator, I have made a good faith <br />effort to minimize my waste generation and select the waste management method that is available to me that I can afford. <br />By both parties signing this Invoice It will serve as an agreement <br />that American Valley Waste Oil will submit confirmation for (certain waste streams) to the generator <br />that their waste has been transported to a licensed treatment or transfer facility. <br />t <br />GENERATOR/ <br />IZED ' <br />/� AIG / u <br />5 GDRIVER <br />NA URE: ��J—�" DATE <br />ATURE: <br />DATE: <br />DISPOSAL / RECYCLING FACILITY <br />'Q DK•DIXON O CFR <br />O UNITED ENTERPRISES CORP <br />7300 CHEVRON WAY 2035 E. 15TH ST, <br />11190 PENROSE ST, <br />DIXON, CA 95620 LA, CA 90021 <br />SUN VALLEY, CA 91352 <br />707-693.6008 213-746-0237 <br />61B•787-2649 <br />EPA# CAT080012602 EPA# CAL000270577 <br />EPA# CAL000379059 <br />HI2013) <br />