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u <br /> AMERICAN VALLEY <br /> WASTE OIL' INC . Invoice Number: <br /> \ P.O . Box 340 • Delhi , CA 95315 <br /> PH . 1 -800-732-4645 • FAX 209-668-3880 <br /> 7 EPA# CAR000272302 77 <br /> BILL TO: JOB SITE: <br /> r Invoice Date: <br /> Phone _ Customer P. O. Terms u _ EPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 r ' <br /> I Lm <br /> NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Metal Oil Filters <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 action TOTAL <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 content is LESS than 1 ,000 ppm, and the <br /> waste 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 <br /> 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 quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste general- <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 /> generation and select the waste management method that is available to me that I can afford. <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, but 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 also meet <br /> 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 <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 generatorthat their <br /> waste has been transported to a licensed treatment or transfer facility. <br /> GENERAT <br /> DRIVER AUTHDR Z�Df �= _ <br /> SIGNATURE: DATE SIGNATURE. <br /> i. DATE. <br /> DISPOSAL / RECYCLING FACILITY <br /> DK-DIXON ,U ASBURY ENVIRONMENTAL O RIVERBANK OILTRANSFER O YUMA YES LLC Q AMERICAN VALLEY WASTE OIL, INC <br /> 7300 CHEVRON WAY 1920 MORGAN RD. - 5300 CLAUS RD. 6500 US HWY 95 521 INDUSTRIAL DR STEM <br /> DIXON, CA 95620 CERES, CA 95358 RIVERBANK, CA 95367 YUMA, AZ 85365 LIVINGSTON, CA 95334 <br /> 707-693-6008 209-541 -1825 209-863-8181 928-3449828 209-667-8857 <br /> EPA# CAT080012602 EPA# CAL000393680 EPA# CAL000190816 EPA# AZR000521146 EPA# CAL000443004 <br /> MPC ( 12016) <br />