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, . California Coolant <br /> =-- <br /> Services <br /> " 1187 Vanderbilt Cir. #2 <br /> '- Manteca, Ca 95337 <br /> Office: 800-253-2256 <br /> Fax: 20�,-239-6316 INVOICE NO: J0207 <br /> Name ,4 ✓ -�.�c��. Date of�ervice <br /> Address Rep Manifest# <br /> City .v Teat Zip c 7, Terms Cust# <br /> Phone Customer P.O. . <br /> ftODE00 DESCRIPTION CITY UNIT PRICE AMOUNT <br /> 030 Recycled Antifreeze <br /> 002 Ethylene Glycol/Antifreeze , // .�,• <br /> i <br /> r <br /> I <br /> Non Taxable Sub Total <br /> F <br /> f Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> ,; • • <br /> Comments: Gi✓/� '/I `� —/''�/`'� <br /> IN <br /> OUTy <br /> CAL EPA# CAL000147713 TRANSPORTATION REGISTRATION#3713 <br /> By initialing here customer acknowledges that be/she has read and agrees to the Terms and Conditions printed <br /> on the back of this purchase prd r. <br /> Customer Authorization, 1 Date: X <br /> Onsite Agreement: Dater <br /> X <br />