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1 187 VANDERBILT CIR.#2 FREMOUW E*IRONMENTAL SERVICES, A. SERVICE ORDER/INVOICE: <br /> MANTECA, CA 95337 CALIFORNIA COOLANT SERYKE <br /> OFFICE: 209-239-5587 17314 <br /> FAX: 209-239-6316 Transporter EPA# (AR000171017 <br /> U.S.D.O.T.#1484667 D.T.S.C.#3544 CA9 274461 DATE: Z <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer United Auto Repair Customer United Auto Repair <br /> 400 N. El Dorado 400 N. El Dora o <br /> Stockton, CA 95205 Stockton, CA 95205 A . <br /> gk <br /> V// <br /> E.P.A. # CAL 000 224 920 v p 209 941 <br /> Phone 8218 <br /> Additional Contacts: Joe PAYMENT TERMS: NET 15 <br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 1 14 21 30 45 60 90 180 365 W/G WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Trinity Heavy Duty 50/50 AF(Green) Batch# 245 Gallons 4.13 . ' 'S <br /> '6-�12 / <br /> Trinity AMP 50150 AF(Yellow)Balch# 600Y Gallons <br /> Trinity AMP(R)50/50 AF(Red)Batch# 60OR Gallons 5.90 <br /> Non RCRA Hazardous Waste Liquid(Waste Antifreeze) CA 134 / Gallons NIC <br /> 31 <br /> Poly Hand Pump PSP800 <br /> Empty Drums Provide J Remove J I A 1 1A2 5g _.1 10g J 15g J 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 /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: N Labels Oil� A/F` UOF4' Oily Debris <br /> SERVICES REQUESTED BY TAX 8.00* <br /> Accept P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: I hereby declare that the <br /> of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and <br /> labeled.and a,e in cll respects in proper condition for transport by highway according to applicable state and national government regulations. If I am a large quantify generator.I certify that I hove <br /> a program in place to reduce the volume and toxioty of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of <br /> treatment,storage.or disposal currently available to me which minimized the present and future threat to human health and the environment;Ofd,if I am a small quantity generator, have mode a <br /> good faith of ort to minimize my woste generation and select the best waste management method that is available to me and that I can afford. All used oil from the generator listed above will be <br /> transported cnly to a facility permitted by the State:)f California to produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the management of <br /> used oil. All relevant information regarding known or suspected hazards associoted with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney fees incurred in the <br /> collection of this obligation. venue for purposes of this obligation shall be in Solana County. I declare under penelty of perjury that the forgoling is true and corect. <br /> DISPOSAL/RECYCLING FACILTY: Collection Station Industrial Agriculture Government Marine Other Industrial Lubrlcatfng <br /> --- - oil Oil <br /> �__,1-1� = ( )Evergreen Ql Inc.: ( )Thermo Fkrids Inc: <br /> 7300 Ch!msWay 445611308 655 S.Sanford Wag <br /> Di3m CA 95620 Da,*CA 95616 Spadcs,NV 89431 <br /> (707)693-6008 CAT080012602 (5 1111)795-4400 CAD982446874 (503)788-"l 982510711 <br /> i <br /> Print Nlme f / Generato a <br /> I hereby certify that 1 have read and have the auth to bind the_abov_..e 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 />