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''1187 Vanderbilt Cir. #2 <br /> California Manteca, Ca 95337 <br /> Office: 209-239-5587 <br /> Coolant Services Fax: 209-239-6316 <br /> INVOICE NO :a3 °ay <br /> Name Date of Service <br /> Address <br /> `�1J O -'6r- � �/!"C %a✓/(� Rep !/'G� P.O. # <br /> ity L state <br /> ziplms' �� ust# <br /> Phone r7,v 6 _, e 5-? � Contact Person: <br /> • . DESCRIPTION QTY UNIT PRICE AMOUNT <br /> 110 50/50 Automotive Antifreeze <br /> 120 50/50 Heavy Duty/Phosphate(Free Antifreeze) <br /> 130 Non-Diluted Automotive Antifreeze <br /> 140 50/50 Long Life Antifreeze <br /> {t f� ' �: s*!/r✓ 7""!�"i2ti� E:; �'E" f//C/rv�" �"prea /. c'��a ✓/ � ,+�:� <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> Customer Authorization: \):X Date: ✓ -lr°' c _]{ <br /> CCS Representative: - Gam^-- X Date: X <br /> All returned checks are subject to a s15.0o Service Charge. <br /> All amounts not paid within 30 days of invoice are subject tot Y.% interest per month,18%annually on unpaid balance. <br /> 'INVOICE NO: <br /> HAZARDOUS WASTE RECEIPT MANIFEST DOCUMENT NUMBER <br /> GENERATOR'S NAME&MAILING ADDRESS GENERATOR'S U.S.EPA ID NO. <br /> 1 ,0171 ,91 ;);) 0 0 I f <br /> CONTACT PERSON PHONE NUMBER <br /> TRANSPORTER'S NAME: CALIFORNIA COOLANT SERVICE TRANS PORTER'S U.S.EPA ID NO. <br /> 1187 VANDERBILT CIR#2 CAR 000047167 <br /> MANTECA, CA 95377(209)2395587 <br /> WASTE NAME:...................................................Waste Anti.Freeze AUTHORIZED WASTE FACILITY: THERMO FLOW- <br /> CLASSIFICATION:................................................Non <br /> LOWCLASSIFICATION:................................................Non RCRA Waste 4000 ARCATA WAY <br /> IDN:......................................................................................#342 N.LAS VEGAS,NV 89030 <br /> 702 642-9994 <br /> SIGNATURE AND DATE QUANTITY WASTE FACILITY U.S.EPA ID NO. <br /> NVR000001925 <br />