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AMERICAN VALLEY 197188 <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 /> EPA# CAR000272302 <br /> BILL TO: " - JOB SITE: Invoice Date: <br /> Phone Customer P.O. Terms EPA# <br /> PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST QUANTITYPRICE AMOUNT <br /> CODE <br /> .,k NON-RCRA Waste Liquid Used Oil/Mixed Oils 221 <br /> s NON-RCRA Waste Liquid Used Antifreeze 133 <br /> NON-RCRA Waste Liquid Used Oily Water 223 <br /> Compliant Drained Used Metal Oil Filters <br /> K,5� <br /> f , <br /> TERS Invoices over 33 Days are subject to a l_5 service charge. Customer agrees to pay all legal fees if court action TOTAL <br /> M <br /> becomes necessary to collect this invoice. <br /> By signing I herby certify that 1 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 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 /> 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 O 1 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 tr at 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 transposed to a licensed treatment or transfer facility. <br /> GENERATOR/ <br /> DRIVER AUTHORIZED <br /> SIGNATURE DATE: SIGNATURE: DATE: <br /> DISPOSAL / RECYCLING FACILITY <br /> O RIVERBANK OIL TRANSFER Q YUMA YES LLC <br /> AMERICAN VALLEY WASTE OIL,INC <br /> O DK-DIXON O ASBURY ENVIRONMENTAL <br /> 521 INDUSTRIAL DR STEM <br /> 7300 CHEVRON WAY 1920 MORGAN RD. 5300 CLAUS RD. UMA.AZ 8 85500 US 95 LIVINGSTON,CA 95334 <br /> DIXON.CA 95620 CERES,CA 95358 RIVERBANK, CA 95367 YUM209-667-8857 <br /> EP <br /> 707-693-6008 209-541-1825 209-863-8181 344-98288 <br /> EPA#CAT080012602 EPA#CAL000393680 EPA#CAL000190816 A#AZR000521146 EPA#CAL000443004 <br /> MPC(7/2016) <br />