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AMERICAN VALLEY 201641 <br /> f WASTE OIL, INC. Invoice Number: <br /> P.O. Box 340 • Delhi, CA 95315 <br /> PH. 1-800-732-4645 • FAX 209-668-3880 <br /> EPA#CAR000272302 <br /> BILL TO: CONVENIENT CAR JOB SITE: CONVENIENT CAR fnvVce Date: <br /> 3250 N.WILSON WAY 32.50 N.WILSON WAY <br /> STOCKTON,CA 95205 STOCKTON,CA 95205 <br /> PhoneCustomer P.O. Terms A# <br /> 209-948-4848 ISSAC C.0.D. CAL000348517 <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITY PRICE AMOUNT <br /> CODE <br /> NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 <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 /> HAZ WASTE PICK UP-PAPER FILTERS \4j2 <br /> FACILITY FJEL SURCHARGE <br /> r l <br /> SALES TAX- <br /> TERMS: Invoices over 30 Days are subject 1. 0 o ge. Customer agrees to pay all legal fees if court action TOTAL �-fl <br /> becomes necessary to collect this invoice. -D <br /> By signing I herby certify that I have not mixed aAvof t<waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the <br /> l 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 generat- <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 /> i 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 generator that their <br /> waste has been tr Asported to a license treatment. r transfer facility. <br /> �G�ENERATOR/DRIVER <br /> UTHORIZED <br /> S GNATUR �� -�. l -/� lr' DATE ` 1 (-SIGNATURE: DATE:IYA <br /> 6 <br /> DISPOSAL / RECYCLING FACILITY <br /> 0 DK-DIXON O ASBURY ENVIRONMENTAL 0 RIVERBANK OIL TRANSFER 0 YUMA YES LLC Q'AMERICAN VALLEY <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. 6500 US HWY 95 ' WASTE OIL, INC. <br /> DIXON,CA 95620 CERES,CA 95358 RIVERBANK, CA 95367 YUMA,AZ 85365 9767 4TH ST.#B <br /> 707-693-6008 209-541-1825 209-863-8181 928-344-9828 DELHI,CA 95315 <br /> EPA#CAT080012602 EPA#CAL000393680 EPA#CAL000190816 EPA#AZR000521146 209-667-8857 <br /> EPA#CAL000469438 <br />