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v CALIFORNIA COOLANT SERVICE LI ""Your California Antifreeze Service Company" Transporter EPA# CAR000047167 1187 VANDERBILT CIR. #2 MANTECA, CA 95337 OFFICE: 209-239-5587 FAX: 209-239-6316 SERVICE ORDER: 3i'' ' 1 ❑ WASTE DISPOSAL INFORMATION — NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL / MIXED OIL)'NO PLACARDS REQUIRED' NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) -NO PLACARDS REQUIRED' ❑ OTHER: ❑ DESIGNATEDTSDF: ❑ EVERGREEN OIL, INC.: 6880 Smith Avenue • Newark, CA • CAD980887418 • (510) 795-4400 ❑ BANGO OIL, LLC: 22211 Bango Road • Fallen, NV 89406 • NVR000080655 • (775) 852-2295 ❑ D/K DIXON: 7300 Chevron Way • Dixon, CA 95620 • CAT080012602 • (707) 693-6008 ❑ RAMOS ENVIRONMENTAL: 1515 S. River Road • W. Sacramento, CA 95691 • CAD044003556 • (916) 371-5747 NU -SET INDUSTRIES: 977 South 700 West • Salt Lake City, UT 84104 • UTD982589459 • (801) 977-0220 _J AL ERNATE TSDF: CFR: 33210 Western Avenue • Union City, CA 94587 • (510) 487-9277 STATE CODE 221 STATE CODE 134 (All Generators/Customers MUST read the following text.) If I am a large quantity generator, I 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 economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimize the present 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 best waste management method that is available to me that I can afford. 'I HEREBY CERTIFY THAT I HAVE NOT MIXED" WASTE WITH ANY OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S. I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHAR ES FOR LEGAL DISPOSAL IF THIS WA� TE IS OVER 1Q00 P.P. NI TOTAL HALIDES, OR CONTAINS ANY P.C.B'S. Customer Signature Date Driver Signaturm Date 3.43t Print Name Print Driver's Name All returned checks are subject to a $15.00 Service Charge. Allamounts not paid within 30'days of invoice are subject to 1 1/2% interest per month, 18 annually on unpaid balance. MANIFEST f•^y�#^ (/ C1_ (¢# ,odIi, Co'; 91,5240 209-365-983.4, rpA# 04 .'100 300 6A j�m Rt 0m, 4:A- A s�`.440 CtjIntack 91I8a ky Do finiq Tom tzH N4 nh'S ./C�c @..o1.�1e A4fAtagA42 ,(,F : •DE DESCRIPTION QTY UNIT PRICE AMOUNT L\)? 1, 0/ C vc mmr r i C7(.C. � 1 3 �r F Tank Serial Numbers: Non Taxable Sub Total, Taxable Sub Total Tax TOTAL DUE-'~ -• ❑ WASTE DISPOSAL INFORMATION — NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL / MIXED OIL)'NO PLACARDS REQUIRED' NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) -NO PLACARDS REQUIRED' ❑ OTHER: ❑ DESIGNATEDTSDF: ❑ EVERGREEN OIL, INC.: 6880 Smith Avenue • Newark, CA • CAD980887418 • (510) 795-4400 ❑ BANGO OIL, LLC: 22211 Bango Road • Fallen, NV 89406 • NVR000080655 • (775) 852-2295 ❑ D/K DIXON: 7300 Chevron Way • Dixon, CA 95620 • CAT080012602 • (707) 693-6008 ❑ RAMOS ENVIRONMENTAL: 1515 S. River Road • W. Sacramento, CA 95691 • CAD044003556 • (916) 371-5747 NU -SET INDUSTRIES: 977 South 700 West • Salt Lake City, UT 84104 • UTD982589459 • (801) 977-0220 _J AL ERNATE TSDF: CFR: 33210 Western Avenue • Union City, CA 94587 • (510) 487-9277 STATE CODE 221 STATE CODE 134 (All Generators/Customers MUST read the following text.) If I am a large quantity generator, I 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 economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimize the present 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 best waste management method that is available to me that I can afford. 'I HEREBY CERTIFY THAT I HAVE NOT MIXED" WASTE WITH ANY OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S. I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHAR ES FOR LEGAL DISPOSAL IF THIS WA� TE IS OVER 1Q00 P.P. NI TOTAL HALIDES, OR CONTAINS ANY P.C.B'S. Customer Signature Date Driver Signaturm Date 3.43t Print Name Print Driver's Name All returned checks are subject to a $15.00 Service Charge. Allamounts not paid within 30'days of invoice are subject to 1 1/2% interest per month, 18 annually on unpaid balance.