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California Coolant <br /> Services <br /> 1187 Vanderbilt Cir. #2 <br /> il!�— <br /> Manteca, Ca 95337 <br /> Office: 800-253-2256 <br /> Fax: 209-239-6316' INVOICE NO:customer <br /> Name Date of Service _ / G <br /> Xa7e "V Lo <br /> ddress Rep TCti Manifest# <br /> ity Lao/ scat Tip 9Sa y ermsust# S <br /> Phone Gq _ y _ C 33 Customer P.O. <br /> loon OD • CITY UNIT PRICE AMOUNT <br /> 030 Recycled Antifreeze L�/g /, <br /> 002 Ethylene Glycol/Antifreeze (0 3 <br /> Non Taxable Sub Total 74 <br /> p EN Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> • Comments: <br /> IN — s <br /> OUT <br /> CAL EPA# CAL000147713 TRANSPORTATION REGISTRATION#3713 <br /> By 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: G -I r/—O 6{ <br /> Onsite Agreement: � v—'� "'^ Date: CGX <br /> A Division of San)o:quin Coinry He Ith Care Services <br />