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California Coolant <br /> Services <br /> -` 1187 Vanderbilt Cir. #2 <br /> Manteca, Ca 95337 <br /> Office: 800-253-2256 6252 <br /> Fax: 209-239-6316 INVOICE NO: <br /> Customer <br /> Name Date of Service <br /> Address v _ Rep G GtJ Manifest# <br /> City G / State Zip 95,E y O er v O,,, ust# a S <br /> Phone a G y _ 3 3 y ? 3 Customer P.O. <br /> CODE DESCRIPTIONOTY UNIT PRICE AMOUNT <br /> 030 Recycled Antifreeze <br /> 002 Ethylene Glycol/Antifreeze <br /> i <br /> Non Taxable Sub Total 97 SS <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE ��JJ <br /> =--?y Comments: <br /> CAL EPA# CAL000147713 TRANSPORTATION REGISTRATION#3713 <br /> '$y Initialing here customer acknowledges that he/she has read and agrees to the Terms and Conditions printed <br /> on the back of this purchase order. <br /> Customer Authorization: X Date: <br /> Onsite Agreement: � Date: 7 —O GX <br />