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<br />0 0 1187 VANDERBILT CIR. #2
<br />CALIFORNIA COOLANT SERVICE MANTECA, CA 95337
<br />87
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<br />CE: 209-2-55
<br />"Your California Antifreeze Service Company" OFFICE:
<br />209-239-6316-2-55
<br />Transporter EPA# CAR000047167
<br />SERVICE ORDER:
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<br />WASTE DISPOSAL INFORMATION —
<br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL / MIXED OIL) -NO PLACARDS REQUIRED"
<br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) "NO PLACARDS REQUIRED*
<br />U OTHER:_____ _
<br />U DESIGNATEDTSDF:
<br />U EVERGREEN OIL, INC.: 6880 Smith Avenue • Newark, CA • CAD980887418 • (510) 795-4400
<br />L] THERMO FLUIDS: 655 South Stanford Way • Sparks, NV 89431 • NVD982510711 • (775) 219-7396
<br />U D/K DIXON: 7300 Chevron Way • Dixon, CA 95620 • CAT080012602 • (707) 693-6008
<br />U RAMOS ENVIRONMENTAL: 1515 S. River Road • W. Sacramento, CA 95691 • CAD044003556 • (916) 371-5747
<br />LJ :NU -SET INDUSTRIES: 977 South 700 West • Salt Lake City, UT 84104 • UTD982589459 • (801) 977-0220
<br />U ACTERNATETSDF:_ —_
<br />U 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
<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, I have made a good faith to minimize my waste generation and select the
<br />best waste management method that is available to me that 1 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 PC.B'S.
<br />'1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE 1$ OVER 1000 P.P.M. TOTAL HALIDES, OR CONTAINS ANY PC B'S.
<br />Customef Signature Date Driver Signature Date
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<br />Print Name Print Driver's Name
<br />All returned checks are subject to a $15.00 Service Charge.
<br />4 it jA 30 days of invoice are subject to 1 1/2% interest per month, 18% annually on unpaid balance.
<br />MANIFEST #
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<br />10 19 Pp1—w3enaef' Ave ,/
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<br />Tank Serial Numbers:
<br />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"
<br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) "NO PLACARDS REQUIRED*
<br />U OTHER:_____ _
<br />U DESIGNATEDTSDF:
<br />U EVERGREEN OIL, INC.: 6880 Smith Avenue • Newark, CA • CAD980887418 • (510) 795-4400
<br />L] THERMO FLUIDS: 655 South Stanford Way • Sparks, NV 89431 • NVD982510711 • (775) 219-7396
<br />U D/K DIXON: 7300 Chevron Way • Dixon, CA 95620 • CAT080012602 • (707) 693-6008
<br />U RAMOS ENVIRONMENTAL: 1515 S. River Road • W. Sacramento, CA 95691 • CAD044003556 • (916) 371-5747
<br />LJ :NU -SET INDUSTRIES: 977 South 700 West • Salt Lake City, UT 84104 • UTD982589459 • (801) 977-0220
<br />U ACTERNATETSDF:_ —_
<br />U 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
<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, I have made a good faith to minimize my waste generation and select the
<br />best waste management method that is available to me that 1 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 PC.B'S.
<br />'1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE 1$ OVER 1000 P.P.M. TOTAL HALIDES, OR CONTAINS ANY PC B'S.
<br />Customef Signature Date Driver Signature Date
<br />r r Ct(
<br />Print Name Print Driver's Name
<br />All returned checks are subject to a $15.00 Service Charge.
<br />4 it jA 30 days of invoice are subject to 1 1/2% interest per month, 18% annually on unpaid balance.
<br />
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