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CALIFORNIA COOLANT SERVICE <br />"Your California Antifreeze Service Company" <br />Transporter EPA# CAR000047167 <br />1187 VANDERBILT CIR. #2 <br />MANTECA, CA 95337 <br />OFFICE: 209-239-5587 <br />Fax: 209-239-6316 <br />SERVICE ORDER: 4. 4 f) F) <br />Customer <br />stir;4 sg, i a®®,3� §.k 12 ��Fiq-20W. 7'i <br />Lodi, CA 95240 <br />09-36h_O8 <br />PAOCAL000300647 ICuatomer* X49 <br />7�ODE DESCRIPTION <br />Contact: °TillafyDennis <br />MANIFEST# <br />ef� <br />Toms: Due on Rep: Louis Machado <br />QTY UNIT PRICE AMOUNT <br />0 <br />fiL' v 9y-•• 1541 619 ctidp <br />-/2 <br />- <br />0 <br />Waste iifffeezePick Up <br />-r--.�?•) ==%rte...-.- "�^�"-,�-�;,-.�=--- <br />Tank Serial Numbers: <br />Non Taxable Sub Total <br />Taxable Sub Total <br />Tax <br />TOTAL DUE <br />c:. <br />WASTE DISPOSAL INFORMATION — <br />HAZARDOUS WASTE, LIQUID (OILY WATER)'NO PLACARDS REQUIRED' <br />HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' <br />❑ OTHER: <br />❑ DESIGNATEDTSDF: <br />❑ DEMENNO/KERDOON: 2000 N. Alameda Street -Compton, CA 90222 • CAT080013352 • (310) 537-7100 <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 />,,- ,X—'_NU-SET INDUSTRIES: 977 South 700 West • Salt Lake City, UT 84104 • UTD982589459 • (801) 977-0220 <br />❑ ALTERNATETSDF: <br />❑ CFR: 33210 Western Avenue -Union City, CA 94587 • (510) 487-9277 <br />STATE CODE 221 <br />STATE CODE 134 <br />(All Generators/Customers MUST read the following text.) <br />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 <br />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 <br />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 <br />is available to me that I can afford. <br />'1 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 T E ADDITIONAL CHARGES FOR LEGAL DI SA THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR CONTAINS ANY P.C. 'S. <br />,914 <br />Customer Signature 1 Date Driver Signature / ate <br />3,25 :' <br />Print Name S (: Print Driver's Name <br />All returned checks are subject to a $15.00 Service Charge. <br />Allan, a not paid within 30 days of invoice are subject to 1 1/2% interest per month, 18% annually on unpaid balance. <br />