Laserfiche WebLink
LT <br /> CALIMNIA COOLANT SERVIP0 F=( �YE MATVA, CA195337#2 <br /> YourCaiifornia Antifreeze Service Company" Oil'- A 2 2010 OFFICE: 209-239.5587 <br /> Transporter EPA#CAR000047167 ENVIf�IlI_VM-ENT HEALTRX, 209-239.6316 <br /> PE YID@PWfM: 5 q,Customer <br /> &C Auto Motor Repair(SRDHH 87-075422) MANIFEST# <br /> 1870 N. Wilson Way/ L <br /> oddon, CA 85205 <br /> 09-482-8484 <br /> PAO CAL 000138 851 It- Paz Terms_ Due on ReD. Louie <br /> 20 CCS-50.050 AT sq <br /> � Z Z <br /> 50 Ill <br /> ; <br /> Tank Serial Numbers: Non Taxable Sub Total 22 <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE .; ZZ <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL!MIXED OIL)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE 134 <br /> OTHER: <br /> ❑ DESIGNATEDTSDF: <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•CAD044OD3556•(916)371-5747 <br /> NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982569459•(801)977-0220 <br /> ❑ AATETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union City,CA 94587•(510)487-9277 <br /> (All GeneratorstCustomers MUST read the following text.) <br /> If I am a large quantity generator,1 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 /> 'I HEREBY CERTIFY THAT 1 HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. <br /> 4 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WAST IS 1 c VE 1000 P.P OTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> t III f 4 <br /> t _ <br /> Customer Signature,, Date Driv Si 1 one, _ p Date <br /> PriDYName ?~ Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid within 30 days of invoice are subject to 1 112%interest per month,18%annually on unpaid balance. <br />