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210 S Sacramento St, Lodi, CA 95240 PRO514307 12/07/2021 Program: HW PHOTO 4: 11/30/2021 consolidated manifest receipt for used anti-freeze has an incorrect EPA ID number AMERICAN VALLEY I 195498 WASTE OIL, INC. Invoice Number: P.O.Box 340•Delhi,CA 95315 PH.1-800-732-4645•FAX 209-668-3880 EPA#CAR000272302 eye h'b- BILL TO: AUl G4 Y kkHAUfsT F'FtGS JOB SITE: 11- { 2105ACRAIMNTOST AUTOREXHAI16TPROS Invoice Date: LODI.CA 210 SACRAbEIJTO ST OPENS AT H30 y LODI,CA BII 7 - 9Z Phone 204968-A059 JESUS Customer P.O. Terms EPA# ISMS t C.O.U. CALOW241807 PRODUCT SHIPPING DESCRIPTION MANIFEST QUANTITY PRICE AMOUNT F �I WASTE CODE I NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 NON-RCRA Waste Liquid Used Antifreeze 133 NON-RCRA Waste Liquid Used Oily Water 223 �l Compliant Drained Used Metal Oil Filters OIL COLLECTION FEE n log m TERMS:Invoices over 30 Days are subject to a 1.5%service charge. Customer agrees to a all legal fees if court action • becomes necessary to collect this invoice. pay 9 TOTAL c7 r 7 By signing 1 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 waste does not contain any PCBs. have complied with the requirements of the applicable California used oil management regulation to detennlne this Is 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. a p A 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 general- - - 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 • 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. 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 regulations applicable to management of used oil,but that Is not required to comply with the more stringent requirements applicable to hazardous waste management taclli- ties.California facilities that handle or process used oil are required to meet those more stringent requirement,and some out-of-stela facilities that process used oil also meet 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 that comply only with federal used oil management standards and not these more stringent requireme This nota icallon is for information purposes only. \ By both parties signing this Invoice it w111 serve as an agreement that American Valley Waste OII will submitcon9 fltlon for(certain waste streams)to the generator that their waste has been transported to a licensed treatment or transfer facillty, a GENERATOR/ _ DRIVERltj AUTHORIZED ri I SIGNATURE; DATE: SIGNATURE: ppm; ,J DISPOSAL/REQYQLIINC, FACILITY 0 I O DK-DIXON CLASBURY ENVIRONMENTAL O RIVERBANK OILTRANSFER O YUMAYES LLC O AMERICAN VALLEY WASTE OIL,INC 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. 6500 US HWY 95 521 INDUSTRIAL DR STE M DIXON,CA 95620 CERES,CA 95358 RIVERBANK, CA95367 YUMA,AZ 85365 LIVINGSTON,CA 95334 i I 707-693.6008 209.541-1825 209.863.8181 928-344.9828 209.667.8857 EPA#CAT080012602 EPA#CAL000393680 EPA#CAL000190816 EPA#AZR000521146 EPA#CAL000443004 MPC(72010) VICKY VANG-LEE, REHS Page 4 of 5