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1187 VANDERBILT CIR. #2 <br /> ALIFU�NIA COOLANT SERVIC MANTECA, CA 95337 <br /> I' 1 OEFl(E: 209-239-5581 <br /> A Division of Eremouw Environmental Services, I FAX: 209-239-6316 <br /> �� Transporter EPA# CAR000171017 <br /> SERVICE ORDER: 0054 0 8 <br /> r <br /> Customer <br /> MANIFEST# <br /> 4 'I C SC k a c c � ti o r��- pJ IF- <br /> S+c)co 4 C q--e, --L C) 4f 7 7- ,q 0 o 0 <br /> 7=E DESCRIPTION QTY UNIT PRICE AMOUNT <br /> DR P-ak - u)3 PIss0/2um i Av c. <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> J NON-RCRA HAZARDOUS WASTE,LIOL ID(USED OIL/MIXED OIL)*NO PLACARDS REQUIRED` STATE CODE 221 <br /> J NON-RCRA HAZARDOUS WASTE,LIOL ID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED' STATE CODE 134 <br /> J OTHER: <br /> J DESIGNATEDTSDF: <br /> J EVERGREEN OIL,INC.: 6880 Smi Avenue• Newark,CA • CAD980887418•(510)795-4400 <br /> J THERMO FLUIDS: 655 South Sta ord Way• Sparks,NV 89431 • NVD982510711 •(775)219-7396 <br /> J NU-SET INDUSTRIES: 977 South 00 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> J D/K DIXON: 7300 Chevron Way• ixon,CA 95620•CAT080012602•(707)693-6008 <br /> J EVERGREEN OIL,INC.-FRESNO: 4139 N.Valentine Avenue•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> J ALTERNATETSDF: <br /> J BIG SKY ENVIRONMENTAL: 401 W.Chi nnel Road•Benicia,CA 94510•(510)541-2128 <br /> Clean: Y N I Labels Oil A/F UOF Oily Debris <br /> GENERATOR'S CERTIFICATION: I hereby declare th the contents of this consignment are fully and accurately described above by the proper shipping name and are classified,packed,marked,and <br /> labeled,and are in all respects in proper condition for tra port by highway according to applicable state and national government regulations. It I am a large quantity generator,I certify that I have a program <br /> in place to reduce the volume and toxicity of waste gen rated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or <br /> disposal currently available to me which minimized the pi asent and future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my <br /> waste generation and select the best waste manageme method that is available to me and that I can afford. All used oil from the generator listed above will be transported only to a facility permitted by <br /> the State of California to produce used oil into recycled of OR a lacility that is required to comply with Federal regulations applicable to the management of used oil.All relevant information regarding known <br /> or suspected hazards associated with this waste has bee disclosed. The customer agrees to pay reasonable costs and attorney fees incurred in the collection of this obligation. Venue for purposes of this <br /> obligation shall be in Solano County. I declare under pe ally of perjury that the forgoing is true and correct. <br /> Collection Station Industrial Agriculture Government Marine Other Industrial Oil Lubricating Oil <br /> All amounts not paid wi hin 30 days of invoice are subject to 11/2%interest per month,18%annually on unpaid balance. 1 <br /> If account is forwarded t collections and or an attorney customer will be responsible for all collection and or attorney fees. �)Xz <br /> Print Name Generator's Signature Dri is Signature <br /> I hereby rti I have reaq and have the u h ri to bind the above listed generator to the terms h reverse sideform, <br /> S le Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br />