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r <br /> California Coolant <br /> Services <br /> 1187 Vandorbilt Cir. #2 <br /> $may a ti Manteca, Ca 95337 <br /> r f, Office: 209-239-5587 <br /> Fax: 209-239-6316 4272, <br /> ame A4 Y, d S u Tu ate of Service S c/ <br /> ddress ep anifest# <br /> ity G State Zip l�f/O arm$c'E c ust# <br /> hone a L.� _ _ - �� ustomer P.O. <br /> • • - _ DESCRIPTIONCITY UNIT PRICE AMOUNT <br /> 030 Recycled Antifreeze <br /> 002 Ethylene Glycol/Antifreeze <br /> Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE t� c' S <br /> • Comments: <br /> IN _ �c v '—G Tc rT E . .v <br /> OUT — 7y U <br /> CAL EPA#CAL000147713 TRANSPORTATION REGISTRATION#3713 <br /> MM <br /> 8y'tniUaiing..heM"uistomer that he/shs"has read And agroes W the Terms and Conditions printed <br /> onthe back.0-1his purdid e>xder. ' <br /> Customer Authorization _ 1�^r X Date r y y X <br /> Onalte Agreement: X Date: /"� X <br />