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1 187 VANDERBILT CIR.#2 FREMOUVONVIRONMENTAL SERVICErJ,NC. SERVICE ORDER/INVOICE: <br /> MANTECA, CA 95337 CALIFORNIA COOLANT SERVICE 13409 <br /> OFFICE: 209-239-5587 <br /> FAX: 209-239-6316 Transporter EPA# CAR000171017 <br /> D.S.D.O.T.#1484667 D-T-S.C.43544 CA#274.161 DATE:_ ��— <br /> SITE ADDRESS <br /> United Auto Repair Pay BILLING/MAILING ADDRESS <br /> 400 N. El Icor o Customer United Auto Repair <br /> 400 N. E1 Dorado <br /> Stockton, CA 95205 Stockton, CA 95205 <br /> // MAILED <br /> E.P.A. # CAL 000 074 459Phone_ 0 V R�1 JUN 14 1012 <br /> 941 <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 WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Trirdty Heavy Duty 50/50 AF(Green) Batch# 245 <br /> Gallons 4.13 11Lf <br /> Trimty AMP 50/50 AF(Yellow)Batch# 600Y <br /> Gallons <br /> Trinity AMP(R)50/50 AF(Red)Batch# �� � L 600R ,�'�j <br /> Gallons 5.90 .JC_.(-- 7 <br /> Non RCRA Hazardous Waste Liquid(Waste Antifreeze) CA 134 <br /> Gallons N/C <br /> Poly Hand Pump PSP800 <br /> f <br /> Empty Drums Provide J Remove J IA1 1A2 5g J log J 15g J 30g J 55g J S P F <br /> Clor-D-Tect Q4000 Test Kit: Test J Pass J Fail J Generator Knowledge J PPM <br /> Transportation Charges/Additional T uck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: N Labels Oil G G A/F -�___ UOF Oily Debris. <br /> SERVICES REQUESTED BY TAX 8,00* <br /> We r, �I—M �1 P. O. # <br /> Accept TOTAL CHARGES: ��' L Z_ <br /> GENERATOR'S CERTIFICATION: Ihereby declare that the contents of this consignment ore fully and accurately described above by proper shippingname and are classified,packed,marked,and <br /> labeled,and ore in all respects in proper condition for transport by highway according to applicable state and notional government regulations. If I oma large quantity generator.I certify that I have <br /> a program in place to reduce the volume and foxicdy of waste generated to the degree I have determined to be economically practicable and that 1 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:OR.it I am a small quantity generator,I have made a <br /> good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. All used all 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 cit OR a focWy 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 T'ne customer agrees to pay reasonable costs and attorney fees incurred in the <br /> correction of-,his obrgation. Venue fcr pu-poses of th s obGgotion shall be in clono 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 Industrial Lubricating <br /> Oil Oil <br /> Ymon <br /> )D/K Di : ( )Erergem Ort Inc.: rm6 Ra <br /> c.: ( )7bids Iac: <br /> 73M Chmi;nWay 44561 Road 30B 655 S.aanrffd Wag <br /> Damn,CA 95620 Dara CA 95616 Spadct!`rV 89q�t <br /> (To�6D3-W0a cAT'08001z60z (510)'9S.ggp0 CAD9824468-A (503)788z VD9dz51o7t1 <br /> Print Name Generator's Sig ure Driver's Signature <br /> 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 />