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1187 ANOERBILT <br /> R. <br /> CAARNIA COOLANT SERVICE MTECA, CA 953137#2 <br /> "Your California Antifreeze Service Company OFFICE: 209-239-5587 <br /> P y <br /> Transporter EPA#CAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: q <br /> � <br /> Customer *J <br /> rz t i� pr .d Tz�a t 7 n 5'} a _? MAKIFE,S # <br /> French Camp,CA 95231 <br /> Zig-?�Z-]ii74 <br /> EPA M#. CAI-.Y;,^� 5C439 Customer# 27 11 Contact:Bpi Terms: _-7.,0,D <br /> • • <br /> 3 i rite Antifreeze Pick T.Tt <br /> TT»i TSS, <br /> 0/ 1 s <br /> o f °"A 603 C b --- <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> F <br /> Taxable Sub Total <br /> J7 ( Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)*NO PLACARDS REQUIRED* STATE CODE 221 <br /> ❑ NON-RCRA HAZARDOUS W SSE,,LIQUID(ETHYLENE GLYCOL SOLUTIONS)* O PLAI'(ARDS REQUIRED* STATE CODE 134 <br /> 0..--OTHER: 3'* 'I1� �-►Lt+t 4ti '7f11 °- W� s 4`4 i <br /> ❑ DESIGNATEDTSDF: C)'' � V�u" <br /> ❑ EVERGREEN OIL,INC.: 6880 Smith Avenue•Newark,CA •CAD980887418•(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South Stanford Way•Sparks,NV 89431 •NVD982510711•(775)219-7396 <br /> ❑ D/K DIXON: 7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road•W.Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> LJ,...ALTERNATE TSDF: U <br /> ❑ CFR: 33210 Western Avenue•Union City,CA 94587•(510)487-9277L <br /> (All Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present <br /> and future threat to human life and the environment; Or,if I am a small quantity generator,I have made a good faith to minimize my waste generation and select the <br /> best waste management method that is available to me that I can afford. <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PP M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. ^'^d <br /> *1 FURT ER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DIS OSAL IF THIS WASTEOVE P.P.M.TOTAL HAkN7ES,OR CONTAINS ANY P.C.B'S. <br /> I A, ��� <br /> p <br /> Custo#ter Sig ature ate Drier Signature Date <br /> Pnnt Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> All amounts not paid within 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br /> If account is forwarded to collections and or an attorney customer will be responsible for all collection and or attorney fees. <br />