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California Coolant <br /> Services <br /> 1187 Vanderbilt Cir. #2 <br /> Manteca, Ca 95337 <br /> Office: 800-253-2256 <br /> Fax: 209-239-6316 INVOICE NO: <br /> Customer <br /> Name Date of Service <br /> Address RepManifest# <br /> -;'_7' <br /> City State Zip Terms-11 ust# <br /> Phonea Customer P.O. <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUNT <br /> 030 Recycled Antifreeze r n <br /> ,✓ewri�n r%o ,�' d <br /> 002 Ethylene Glycol/Antifreeze <br /> rl <br /> Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTA D E <br /> :41AMIL611011111 Comments: <br /> IN <br /> OUT <br /> CAL EPA# CAL000147713 TRANSPORTATION REGISTRATION#3713 <br /> on <br /> By initialing here customer acknowledges that he/she has read and agrees to the Terms and Conditions printed <br /> on the back of this purchase order,.,,;, <br /> Customer Authorization: +w._. X Date: X <br /> Onsite Agreement: _ x �s dlft� RX Date: 'cr Z X <br />