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1187VANDERBILTCIR.#2 41ALIFORNIA COOLANT SERVICESISERVICEORDER /INVOICE: <br /> MANTE(A, CA 95331 <br /> - A Division of Fremouw Environmental Services, Inc. DATE: l8 <br /> OFFI(E: 209-239-5587 <br /> FA%: 209-239-6316 Transporter EPA# CAR000171017 <br /> 009804 <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer United Auto Repair Customer United Auto Repair <br /> 400 N. El Dorado MA!1w F f) 400 N. El Dorado <br /> Stockton, CA 95205 Stockton, CA 95205 <br /> MAR tl Yi i <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 • 90 • 180 • 365 W/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Trinity Heavy Duty 50/50 AF(Green) Batch# t 245 Gallons 4.13 <br /> Trinity AMP 50/50 AF(Yellow)Batch# 600Y Gallons <br /> Trirlity AMP(R)50/50 AF(Red)Batch# 60OR S3 Gallons 5.90 <br /> Non RCRAHazardowWaste Liquid(Waste Antifreeze) CA 134 S -�� Gallons NIC <br /> Poly Hand Pump PSP800 <br /> Empty Drums Provide J Remove J 1A1 lA2 5g J 10g J 15g J 30g J 55g J S P F If saq <br /> Clor-D-Tect 94000 Test Kit: Test J Pass J Fail J Generator Knowledge J PPM <br /> Transport�yo <br /> n Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: N Label Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX 8.00* <br /> AcceptwR TP-0. # TOTAL CHARGES: S ` <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,pocked.marked.and <br /> labeled,and are in all respects in proper condition for transport by highway according to applicable state and national government regulations. If I am a large quantity generator,I certify that I have <br /> a program in place to reduce the volume and toxicity 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 hu on health and the environment;OR.if I am a small quantity generator,I have made a <br /> good faith effort to minimize my waste generation cnd 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 only to a facility permitted by the State of 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 associated 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 penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILTY: Collection Station Industrial Agriculture Government Marine Other <br /> TIndustrial Lubricating <br /> oil oil <br /> LYg Damn: ( )Lvergem QT Inc.: ( )Tlwrw Plaids Inc: <br /> Chevron Way 44561 Road 30B 655 S Stan Trd Way <br /> Di—CA 95610 D-iR CA 95616 - Spada.PRr S904- <br /> 07)693-6008 CAT980012602 (510)7954400 CAD982446874 (503)788 982510711 <br /> PrinGenerator's Signure Driver's Signature <br /> I_hgreby 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 /> Stafe Law Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br />