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1187 VANDER6aT CIR. #2 <br /> CALI HNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAx: 209.239-6316 <br /> SERVICE ORDER: <br /> r MANIFEST# <br /> am Auto Repair (SR KH 100-889228) <br /> 031 VV Yosemite Ave <br /> anteca, CA 95337 <br /> 9-239-8900 <br /> PA*CAL 000 303 724 Customer* 2482 Contact;Brent Terms; Due on Rep; Louie '.. <br /> CODE DESCRIPTION <br /> WA_ nox coal AX <br /> 50 Waste Antifreeze Pict U <br /> Tank Serial Numbers: -- Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <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 •NVDDMI0711•(775)2194396 <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•CAD044003556•(916)371-5747 <br /> NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982589459•(601)977-0220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union City,CA 94587•(510)487-9277 <br /> (All GeneratorstCustomers MUST read the following text.) <br /> It I am a large quantity generator,1 certify that 1 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,1 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 I 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 /> 'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> fN/' � �. � • .'. <br /> Customer Signature Date Driver Signature ��l/ J�� Date <br /> Print Name Print Driver's Name <br /> 5.20. 5.90 Ne uo All returned checks are subject to a$15.00 Service Charge. <br /> Allamoums not paid within 30 days of Invoice are subject to 1 1/2%Interest per month,18%annually on unpaid balance. <br />