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__N1187 VAtiOER37 <br /> 95 <br /> MAIITE(A, CA 95331 WFORNIA COOLANT SERVICERVICE ORDER /INVOICE: <br /> OFFICE: 209-239-5587 A Division of Fremouw Environmental Services, Inc. DATE: lD' <br /> FAX: 209-239.6316 Transporter EPA;# CAR000171017 <br /> -- ` <br /> SITE ADDRESS <br /> 009804 <br /> BILLING/MAILING ADDRESS <br /> Customer_ United Auto Repair Customer United Auto Repair <br /> 400 N. El Dorado IWA f 1,.E p, 400 N. El Dorado <br /> Stockton, CA 95205 Stockton, CA 95205 <br /> MAR tl rri � <br /> E.P.A. # CAL 000 074 459 Phone 209 941 8218 <br /> Additional Contacts: <br /> Joe <br /> PRODUCT . SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 20 180 365 W/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Trinity Heavy Duty 50/50 AF(Green) Batch# 245 Gallons 4.13 5, <br /> Trinity AMP 50/50 AF(Yellow)Batch At 600Y Gallons <br /> Trinity AMP(R)50/50 AF(Red)Batch# t 60OR 3 Gallons 5.90 N <br /> Non RCRAHazardousWaste Liquid(Waste Antifreeze) CA 134 aS -�1C Gallons NIC r (' <br /> Poly Hand Pump PSP800 <br /> Empty Drums Provide J Remove J lAl lA2 5g J 10g J 15g _I 30g J 55g J S P F <br /> Clor-D-Tect 94000 Test Kit: Test J Pass J Fail J Generator Knowledge J PPM <br /> Transporta 'on Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: Y N Label Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX 8.00* <br /> Accept "� P. O. # TOTAL CHARGES: L- 5th L>l <br /> GENERATOR'S CERTIFICATION I hereby oec are Thai the contents of this consignment are fully and accurately described above by proper shipping name and ore classified,pocked.marked.and <br /> loceled,and are in all re>pecfs in proper condition for transport by highway according to applicable state and notional government regulations. If I am a lar <br /> a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economical) 9e quantity generator,I certify that I have <br /> treatment,storage,or disposal currently available to me which minimized the present and future threat fo human health and the environment;OR,if I am a mallllqted the practicable method of <br /> quantity generator, have made a <br /> good ate effort to minimize er waste generation cod select the best produce <br /> used <br /> management method that is available to ma and that I can afford. All used oil from the generator listed above will be <br /> iransoorted only to o facility permitted by the State of California to produces used oil into recycled oil OR o fociiity that is required to comply with Federal regulations applicable to the management of <br /> used oil. All relevant information regarding known or suspected hazards associated with this wosie has been disclosed. The customer agrees to pay reasonable Costs and attorney fees incurred in the <br /> collection cf-his obligation. Venue for purposes of this obligation shod be in Solana County. I declare under penalty of perjury thot the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILTY: Collection Station Industrial Agriculture Government Marine Other Industrial Lubricating <br /> Oil Oil <br /> )D1K Dvon ( )Ever Orem QI'me: ( )Th7an F`uils Inc.: <br /> 7 <br /> IMIK <br /> Way 44561 Road 30B 655 S.Stanford Wasr <br /> Dietz.CA 95620 Dave CA 95616 <br /> 2 (510)795-4400 CAD98244687t sv�x.Civ 83 <br /> 693-6008 CAT09001260 - <br /> /] (503)788 982510711 <br /> Prin (� <br /> Generator's Sign ure Driver's Signature <br /> I hereby certify that I have read and have the authority to bind the above listed.generator to the terms on the reverse side of this form. <br /> State Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br />