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r SIT ��T 1187 VANDERBILT DR. #2 <br /> CALIFORNIA CHU:'1 i SERYKE MAf1TECl1, GA 96337 <br /> 0r-ic,: 21,9 238 5587 <br /> '' "Ye7ur California Antifreeze Serviee enmaanY' FAX. 299-239-6316 <br /> Tfansparter EPA*CARD00047167 <br /> SERVICE ORDER: 47595 <br /> Fremont Shell t) <br /> 4144 E. Fremont <br /> �]L <br /> Fremont Sts eet <br /> ccM <br /> 205 <br /> 00-k 1-8 4 <br /> P'A#CAL 000 403 863 Cust�ln)t r 1: 1 FW ��a �_�{: �r6s��e113omirt�l�er. �����; C 1~• J) LOW9 <br /> � e <br /> ' eu � <br /> fastc A1tlal ;r" <br /> i <br /> ._....�._:Non FCt;:PcA I•iwarrkwg V44strl ',_i;aij�r; _ -- —._....._. � (•`, C '�" <br /> �C3i1y1�4�tii�r) - � <br /> t Tank`,erial Numbers: — Nen Taxable Sub Total 1 ! <br /> _r ,,.. �-- � Taxabie Sub Total <br /> TOTAL DQE <br /> I r <br /> WASTE DISP SAIL MFORMAT,ICN — - <br /> �X NCN•PCRA HAZARDOUS WASTE,LIQUID(USED OIL/MixED OIL)`PJC•PLACARDS rknUiREU' STATE CODE 221 <br /> J NCIN-RCRA HAZARDOUS WASTE.LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS RF00IRED' STATE CODE 134 <br /> _i OTHER: - --- -- --------- ----.._.._—.. <br /> ! CESIGNATEDTSDF: <br /> J BANGO OIL,LLC: 22.211 Bango Row•Faller,NV 89406-NVRO00080655-(775)852-2295 <br /> I, D r,/K DIXOK 7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ! C1 RAMOS ENVIRONMENTAL: 1515 S.River Road,W.Sacramento,CA 95691 ,CAD044003556,(916)371-6747 <br /> A SIU-SET INDUSTRIES: 977 South 700 West•Salt Lake City.UT 84104•UTD982589459•(801)977-02220 <br /> J ALTERNATETSDF:._ _V _----- -- ----- --- <br /> J CFR: A3210',Nestern Avenue•Union City,CA 94587•(510)497-9277 <br /> (All uenerators!Customers FAUST read the iollowinn text.) <br /> If I am a large quantity generator,i certify that I have a program in rlace to reduce the volume and toxicity of waste gane,ated to the degree i have determined to be economically <br /> practicable ano that i nave selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present and future threat to human <br /> lite and the environment; Or,if t am a small quantity generator,I have made a good faith to minimize m�waste gnrleration and select the best waste management method that <br /> is a,:ailable to me that I can afford. <br /> 'I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH A14v OTHER HASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.:AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.P.'S. <br /> 'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR t.EGA:.DISPCISAL THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OF.CONTAINS ANY p.C.B'S� <br /> Cu%omer Signature Date driver Signature r Sate <br /> Fr nt Name Print Driver's Name <br /> A!I returned checks are subject to a 515.00 Service Charge. <br /> i %`• Allamounts not paid within 30 days of Invoice are sub ect to 1 112%interest per month.18%annually on unpaid balance. <br />