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1 0 <br />FROM :• <br />• FAX NO. :2099574314 <br />BILL TO: <br />ULTRACARE <br />4629 N WEST LANE STE- A D <br />STOCKTON, CA 95202 <br />an. 25 2010 05:50PM P3 <br />i <br />AMERICAN VALLEY f 91213 <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 />JOB SITE: I I <br />ULTRA CARE Invoice Date: <br />4629 N. WEST LN. -TE, 10 <br />i <br />e X: BIANCHI <br />STOCKTON, CA 95202 <br />IMC OIL <br />Customer P -O.`"- Terms EPA '�'""' <br />Phone Custom <br />_7 W. G <br />PRODUCT SHIPPING DESCRIPTION WASTE MANIFEST Q TITY PRICE AM T <br />CODE <br />NON-RCRA Waste Liquid Used OiVMixed Oils <br />221 <br />NON-RCRA Waste Liquid Used Antifreeze <br />133 <br />C <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />NON Hazardous Waste Liquid <br />Trinity Heavy Duty premixed, Recycled Antifreeze <br />51Q <br />q J <br />Trinity Extended Life premixed Recycled Antifreeze <br />Trinity Case Goods <br />Truck Wash Out <br />Truck Time <br />TERMS: Invoices over 30 Days are subject to a 1.36% service charge. Customer agrees to pay all legal fees it court action <br />TOTAL <br />(D <br />becomes necessary to collect this invoice. <br />((p <br />ay ing I herbyy certify that I have not mixed this waste with any other waste, that the total halides are less than 1000 P.P.M; and that me waste does not <br />conte n any PC. B's- further agree to accept the additional charges for legal disposal if the waste is over 1000 P,RM, total halides, or contains any P.C.B's <br />Generator's Certification: By signing I certify that I have a program in.place to reduce the volume and toxicity of hazardous waste generated to the degree I <br />have determined to be economically practicable. <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 <br />generator that their waste has been transported to a licensed treatment or transfer facility. <br />American Valley Waste Oil hereby advises the above Generator the Generators shipment of used oil may 69 transported to a Wility that is required to comply <br />with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous <br />waste management facilities. California facilities that handle or process used oil are required to meet those more stringent requirements, and some out-of- <br />state facilities that process used oil also meet those requirements, engineenng certifications of tank integrity, and financial assurances for closure and <br />accidental releases. It is lawful to send used oil to out-of-state faclll;es that comply only with federal used oil management standards and not these more <br />stringent requirements. r' <br />This notification is io r tion purposes on> <br />DRIVER GENERATOR AUTHORIZED . <br />GENERATOR/ <br />SIGNATURE SIGNATURE --..--. <br />DISPOSAL / R CLING FACILITY NAME: <br />DK-DIXON O RAMOS ENVIRONMENTAL SERVICE ADDRESS: <br />7300 CHEVRON WAY 1515 SOUTH RIVER ROAD CITY/ST.- <br />ITY/ST: <br />DIXON, <br />DIXON, CA 95520 W. SACRAMENTO, CA 95691 PHONE: <br />707-6936006 916-371-5747 <br />EPA # CAT080012602 EPA # CAD0,14003556 EPA#: <br />moo ('o2ooe) <br />