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FROM • FAX NO. :2099574314 an. <br />AMERICAN VALLEY.' <br />WASTE OIL,INC. <br />P. O.. Box 340 • Delhi, CA 95315 <br />PH. 1-800-732-4645 • FAX 209-668-3880 <br />BILL TO: <br />ULTRACARE <br />4629N WEST LANESTE.10 <br />STOCKTON, CA 95202 <br />25 2010 05:50PM P4 <br />,(OB SITE: <br />ULTRACARE <br />4629 N. WVEST LN. STE.10 <br />X BIANCHI <br />STOCKTON, GA 95202 <br />100011. <br />91374 <br />Invoice Number: <br />i -0•-10 <br />Invoice Date: <br />Phone Safes e2eo: EaVJARD <br />Customer P.O. Terms EPA# <br />209-567-7841 RICK C.O.D. CAL000285394 <br />PRODUCT SHIPPING DESCRIPTION MANIFEST QUANTITY PRICE AMOUNT <br />WASTE <br />CODE <br />NON-RCRA Waste Liquid Used Oil/Mixed'Oils 221 <br />Lt <br />NON-RCRA Waste Liquid Used Antifreeie 133 <br />NON-RCRA Waste Liquid Used Oily Water <br />223 <br />NON Hazardous Waste Liquid <br />Trinity Heavy Duty premixed Recycled Antifreeze <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 1.5% service charge. Customer agrees to pay all, legal fees if court action <br />TOTAL <br />becomes necessary to collect this invoice. <br />^^- <br />ay signing I herby certify that I have not mixed this waste with any other waste, that the total halides are less than 1000 P.RmM and that the waste does not <br />contain any RCZs. I further agree to accept the additional charges for legal disposal if the waste is over 1000 P.P.M. 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 hoardoue 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 be transported to a facility 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, engineering certifications of tank integrity, and financial assurances for closure and <br />accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these more <br />stringent requirements. �.. . <br />This notification is for information purposes only. <br />DRIVER r` GENERATOR/AUTHORIZED r" <br />r� <br />SIGNATURE _ �--� �` SIGNATURE /SIGNATURE �� f <br />DISPOSAL / RECYCLING FACILITY d NAME: <br />DK-DIXON O RAMOS ENVIRONMENTAL SERVICE ADDRESS: <br />7300 CHEVRON WAY 1515 SOUTH RIVER ROAD CITY/ST: <br />DIXON, CA 95620 W. SACRAMENTO, CA '95691 PHONE: <br />707-693.6008 916-377-5747 - <br />EPA # CATDWO12602 EPA # CAD044003555 EPA#: <br />MPC 00/2009) <br />