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Ertvironmentai Services Division \ rMETROLEUM 4RGE INC. Malling:P.O.Box 176,Salida,CA 95368 -ow Consolidated Manifest 4612Kiernan Court,Sallda,CA95368 PROCUC'rS COMPANY Phone;209-645.0791 FAX 209-545.2241 / invoice EPA#CAR008047099 CA Transporter Number 3844 GENERATOR: CA License#758518 Site EPA ID#: Invoice No 40zW,== Contact Person: Invoice Date: Name: Driver Printed Signature: Address: Truck#: City,State,Zip: PO# Site Phone: TERMS: Product Shipping Name Waste CA Manifest#0 Coda Quantity Units Price Non-RCRA Hazardous Waste Liquid(Used Oil);Lubricating 221 Amount Non,,,RCRA Hazardous Waste Liquid(Used Oil): Industrial 221 cal Non RCRA Hazardous Waste Liquid(Used Automotive Antifreeze) 134 Gal Non-RCRA Hazardous Waste Liquid(oil&Water) 423 Gal Non-RCRA Hazardous Waste Solids Contaminated with Used Oii 352 Gal Paper andlor plastic Oil Filter Drums) 352 Drums) Drained Used Oii(Metal)Filter Drum(s) Drum(s) Empty Drum(s) Each Transportation&Truck Time Each Manifest Fee HR. Unless otherwise specified on this Consolidated Manifest Receipt(Invoice)Tenns: Accounts due on the t Oth of the month following month of purchase. Past due at the PERIODIC accounts will be charged a FINANCE CHARGE RATE of 1-112%per month,which is the ANNUAL PERCENTAGE RATE of 18%. Total By signing I hereby certify that I have not mixed any of the waste described above with any nthor hazardous waste,the total halide content is LESS than 1,000 ppm,and the waste does not contain a y Pce's.�have complied with the requirements of the applicable California used oil management regulation to determine this is true. I agree to accept the additional charges for the disposal of the waste if the information I have provided about this waste is incorrect. Generator's Certification; By signing I certify that If I am a large quantity generator, ume and toxicity of waste minimize my waste generation and select the waste management method that is available to me that I can afford.I certify that I have program in place to reduce the vol generated to the degree I have determined to be economically affordable and that I have selected the practicable method of treatment, storage, 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 George W.Lowry,Inc.hereby advises the above Generator that generators shipment of Used Oil and Oily0ater may be transported to a facility that is required to comply with federal regulations applicable to management of Used Oil and Oily/Water, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process Used Oil and OilylWater are required to meet those more stringent requirements,and some out-of-state facilities that process Used Oil and Oily/Water also meet those requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases,it is lawful to send Used Oil and Oily/Water to out of state facilities that comply only with federal Used Oil and Oity/Water management standards and not these more stringent requirements. This notification is for the informational purposes only. By both parties signing this invoice it will serve as an agreement that George W.Lowry,Inc. will submit confirmation for(certain waste streams)to the generator that their waste has been transported to a permitted transfer facility or permitted treatment,storage or disposal facility. Lowry Driver Signature X Date Signature of Generator,Representative or Agent of Generator: X Date Recycling,Transfer,Treatment, Storage, Disposal Facilities Name: ❑ Address: 21st Century Environmental California oil Transfer LLC Ramos Environmental US Ecology Management of Nevada 5300 Claus Road 2095 Newlands Or 1515 S.River Road Highway 95,11 miles 8 of Beatty City,State,zip: .East Riverbank,CA 95367 West Sacramento,CA 95691 Beatty,NV 89003 Fernley,NV 89400 209.863-8181 91fi 371-5747 775.553-2203 Phone: NVD98 CALDOD7908i6 CAD044003556 NVT {775)57595338.2760 33001DOCO EPA ID: