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09/18/2014 06:20 19mc3341873 FLAGCITY CHEVRON <br />AmEpicAN VALLEY <br />WASTE OIL., INC. <br />P, O. Box 340 • Deihl, CA 95315 <br />PH. 1-800.732-4645 • FAX 209-668-3880 <br />EPA# CAL000827878 <br />BILL TO: FLAG CITY CHEVRON JOB SITE: FLAG; CITY CHEVRON <br />6421 CAPI TOL AVE K%W 12& "M 5 <br />LODI, CA LODI, CA <br />PAGE 01/02 <br />126916 <br />Invoice Number: <br />Invoice Date: <br />Phone <br />209-334-0975 KAP,EN <br />Customer P.O. <br />Terms <br />G. 0. D. <br />EPA# <br />CAL000153066 <br />PRODUCT SHIPPING DESCRIPTION <br />WASTE MANIFEST <br />QUANTITY PRICE <br />AMOUNT <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed Oils <br />221 <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />NON-RCRA Waste Liquid Used Oily Water <br />7� <br />rs <br />Drained Used Oil Filters <br />/►AJC'✓' <br />I <br />SALES TAX - <br />TERMS: Invoices over 30 Days are %bled to a 1.5% service charge. Customer agrees to Pay all legal fees If court action TOTAL <br />becomes n to foiled this Irnrolce. W <br />Bysignins I henry certify that I have not mixed any of the waste descrlhed above with any other hazardous waste, the total halide content Is LESS than 1,000 ppm, <br />and the waste does not contain any PCBs. I have complied with the requirements of the applicable Callfomla used oil management regulation to determine this Is <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 incorrecL. <br />Generxw's, certification! By signing I certify that If I am a large quantity generator, I certify that I have a program in pine to reduce the votumc and toxicity of waste <br />generated to the degree 1 have determined to be economically affordable and khat (haw selected the practicable method of treatment; storage, or disposal currently <br />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 <br />effort to minimize my waste generation and select the waste management method that Is avalinble to that I can afford. <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 <br />that their waste has been transported to a licensed treatment or transfer facility. <br />OENERATOFV <br />DRIVER ,,y,r AUTHORIZED I <br />SIGNATUR DATE: F 7r SIGNATURE: <br />nikPOS L RECYCLIN F CILITY <br />DK-DIXON O CFR O UNITED ENTERPRISES CORP <br />7300 CHEVRON WAY 2035 E. 15TH ST. 11190 PENROSE ST. i <br />DIXON, CA 95620 LA, CA 90021 SUN VALLEY, CA 91352 <br />707.693.6006 213-746-02$7 818.787.2649 <br />EPA» CAT08001.2802 EPA# CAL000270577 EPA# CAL000379059 <br />t tXfSCA 1r OF RN5lONBn" Von co"UICTMG'C'i�I9'Y'J TMG <br />To feta b9110 41r iM fife etoettiapr�r atilt Isnt�wa mrd '" � <br />r <br />Te1:6niciaatB $i�ttte: •..------------� <br />