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1 187 VANDERBILT CIR,#2 FRENIOUW EWRONNIENTAL ll� <br /> SERVICES, A. SERVICE ORDER/INVOICE: <br /> MANTECA, CA 95337 1 <br /> OFFICE: 209-239-5587 C.4tIfORN1A Coot.ahr SERVICE 1 4 119 <br /> FAX: 209-239-6316 Transporter EPA# CAR000171017 !, I <br /> t.S.D.O.T'.#1484667 D.-F.S.C.43,44 CA#274461 DATE: <br /> SITE ADDRESS <br /> United Auto RepairBILLING/MAILING ADDRESS <br /> Customer17 Dorado �Customer United Auto Re it <br /> Stockton, CA 95205 400 N. El Dorado <br /> Stockton, CA 95205 1 A I L E D <br /> E.P.A. #, CAL 000 074 459JUN 1 t `2012 <br /> Phone209941 8218 <br /> Additional Contacts: Joe PAYMENT TERMS: NET 15 <br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 180 365 W/C WASTCODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Trinity Heavy Duty 50150 AF(Green) Bach# 245121 / <br /> Gallons 4.13 { t <br /> Trinity AMP 50!50 AF(Yellow)Batch# 600Y <br /> _ Gallons <br /> Trinity AMP(R)50/50 AF(Red)Batch# i'� 60OR <br /> Gallons 5.90 J <br /> Non RCRA Hazardous Waste Liquid(Waste Antifreeze) CA 134 <br /> Gallons N/C <br /> Poly Hand Pump PSP800 <br /> i <br /> 1 <br /> Empty Drums Provide J Remove J 1A1 lA2 5g J 10g J 15g J 30g J 55g J S P F <br /> Clor-D-Teat Q4000 Test Kit: Test -1 Pass J Fail J Generator Knowledge J PPM <br /> Transportation Charges/Additional T uck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: C N Labels OilG�i�� A/F �_ UOF Oily Debris_____ _ <br /> SERVICES REQUESTED BY TAX 8,00* <br /> Wer <br /> ,.-0 <br /> Accept "S� P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION I rerbcy declare That the conten*.....s of'his Corsiarnmenf o'e futy and accurately aescr:bed above by proper sh aping name and are c <br /> labeled,and are in all respects in proper condition for transport by highway a- cbng to cplassified,pecked,marked,and <br /> plicoble state and national government regulations. If am a large quantity generator, certify that have <br /> a program in oloce to reduce the volume and toxicity of waste generated to the degree I have determined to be ecorcmica!ly procticalc e and that 1 have selected the cracticob',e method of <br /> treatment,storage,or disposal currently availcb!e to me e hich minimized the present and future threat tc human health and the environment:or?,if I cm a small quantity generator,I have mode a <br /> goodfaith <br /> effort <br /> to to a lac€ize my waste generation a7d select the best waste management method that is avclbk:Ae to me and that I can afford All used oil from the generator listed above will be <br /> Irons } ty permlYed by the State of California to produce used oil into recycled oil OR a facility that is required to comoty with Federal regulations applicable <br /> used oil. All relevant Information regarding known or suspected hazards assockoted with this waste has been disclosed T'ne customer agrees to pay raasanoble costs and atorney femanagement incurred <br /> urdhe <br /> Collection of this obltgatian. Venue to,,pun is of i..Ps ob gatiGr�5ha'I b„ill S,I,,'10 GCu^ir I aecic"R i,rder penalty ct perjury that thio forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILTY: Collection Station Industrial Agriculture Government Marine Other Industrial Lubricating <br /> V <br /> Oil Oil <br /> Y )LYY.i ( )EvuWiicn CC rnc.: <br /> 73M chawoo W ( )'Thnnn Fluids Inc: <br /> �' 44:6t P.Cad 655 S Stanfrrd Wap <br /> Thmq CA 95920 Darin,CA 9561561 6 spades,NV 89131 <br /> (707)943-urns CA 1080012902 (510)'9$-4 00 CAD982:998?i (503)7as z VD9s25111711 <br /> Print Name Generator's Si —---_— <br /> g ure (r Driver's Signature <br /> hereb�.,Iify that I have read and have.the authorM to bind the abo..ve listed pienctratpir 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—ye-ars. — <br />