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CALIFORNIA COOLANT SERVICE Your California Antifreeze Service Company" Transporter EPA# CAR000047167 SERVICE ORDER 1187 VANDERBILT CIR. #2 MANTECA, CA 95337 OFFICE: 209-239-5587 Fax: 209-239-6316 4 7 ' ) u1i,V"t1L:831&*1.1.17-1 WU11610IT, Ir_rI I1! ❑ NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/ MIXED OIL) `NO PLACARDS REQUIRED- STATE CODE 221 ,3U_ NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) *NO PLACARDS REQUIRED' STATE CODE 134 ❑ OTHER: ❑ DESIGNATEDTSDF: ❑ 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 d -NU -SET INDUSTRIES: 977 South 700 West • Salt Lake City, UT 84104 • UTD982589459 • (801) 977-0220 ❑ dLTERNATE TSDF: ❑ CFR: 33210 Western Avenue • Union City, CA 94587 • (510) 487-9277 (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 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 affoid. I I HEREBY CERTIFY THAT I }(AVE NOT MIXED THIS 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'y .. 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. Customer Signature ,x,43 Print Name Date <__Miuer-Signatur Date Print Driver's Name All returned checks are subject to a $15.00 Service Charge. Allamounts not paid within 30 days of invoice are subject to 1 1 /2% interest per month, 18% annually on unpaid balance. ?Edi e_k�g `�; '+ , 'herckee Lane ve '��yy6C ryry�$ .s$ppyd' y, yy��. '05.y240 PA CAL 000 300 64 .i Customer*: 2"O Conkad. T`illaryDentis CODE DESCRIPTIONCITY MANIFEST # Teras„ Du� ou t¢ x4 Louie ndachaeo UNIT PRICE AMOUNT 50 Waste Antifreeze Dick U Tank Serial Numbers: / Non Taxable Sub Total lJ Taxable Sub Total Tax TOTAL DUE u1i,V"t1L:831&*1.1.17-1 WU11610IT, Ir_rI I1! ❑ NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/ MIXED OIL) `NO PLACARDS REQUIRED- STATE CODE 221 ,3U_ NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) *NO PLACARDS REQUIRED' STATE CODE 134 ❑ OTHER: ❑ DESIGNATEDTSDF: ❑ 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 d -NU -SET INDUSTRIES: 977 South 700 West • Salt Lake City, UT 84104 • UTD982589459 • (801) 977-0220 ❑ dLTERNATE TSDF: ❑ CFR: 33210 Western Avenue • Union City, CA 94587 • (510) 487-9277 (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 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 affoid. I I HEREBY CERTIFY THAT I }(AVE NOT MIXED THIS 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'y .. 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. Customer Signature ,x,43 Print Name Date <__Miuer-Signatur Date 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.