Laserfiche WebLink
1 187 VANDERBILT CIR.#2 FREMOUVONVIRONMENTAL SERVICE*, C. SERVICE ORDER/INVOICE: <br /> MANTECA, CA 95337 CALIFORNIA COOLANT SERVICE3 4 <br /> OFFICE: 209-239-5587 <br /> FAX: 209-239-6316 Transporter EPA# CAR000171017 <br /> U.S.D.O.T.#1484667 D.T.S.C.#354.1 CA#274461 DATE: 1z, - <br /> SITE ADDRESS BILLING/MAILING ADDRESS <br /> Customer United Auto Repair Customer United Auto Repair <br /> 400 N. El Dora o 400 N. El Dora o <br /> Stockton, CA 95205 Stockton, CA 95205 <br /> NOV is 7 f�. <br /> E.P.A. # CAL 000 224 920 Phone 209 941 8218 ' �, i1 <br /> Additional Contacts: JQe PAYMENT TERMS: NET 15 <br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 180 365 W/C WASTE <br /> CODE MANIFEST NUMBER QUANTTIY UNITS PRICE AMOUNT <br /> Trirlity Heavy Duty 50/50 AF(Green) Batch# 245 Gallons 4.13 <br /> Trinity AMP 50/50 AF(Yellow)Batch# 600Y Gallons <br /> Triray AMP(R)50/50 AF(Red)Batch 60OR Gallons 5.90 {' <br /> Non Ril Hazardous Waste Liquid(Waste Antifreeze) CA 134 1 %/ Gallons N/C <br /> Poly Hand Pump PSP800 <br /> Empty Drums Provide J Remove J 1A1 IA2 5g J IOg J 15g J 30g J 559 J S P F <br /> Clor-D-Teat Q4000 Test Kit: Test -I Pass J Fail J Generator Knowledge :_:1 PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br /> Clean: , , N Labels Oily c, A/F UOF ,� Oily Debris <br /> SERVICES REQUESTED BY TAX 8.00* <br /> We evs' wm Y <br /> Accept _ — i P. O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are bully 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 notional government regulations. If I am a large quantify generator.I certify that I have <br /> a program in p':ace 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 v,,hich minimized the present and future threat to human heolih and the environment:OR.if Iam a small quantity generator.I have made a <br /> good faith ef`ort to minimize my wasfe 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 only to a facility permitted by the State Df California to produce used oil into recycled oil OR o facility that is required to comply with Federal regur tions 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 reasonoble 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 forgo: <br /> ng is true and correct. <br /> DISPOSAL/RECYCLING FACILTY: Collection Station Industrial Agriculture Government Marine Other Industrial Lubricating <br /> Oil Oil <br /> `._ Dara:_.. ( )Erergeen Ql Inc.: ( )Thermo TTuids Inc: <br /> 7300 Ch!won Way 44561 Road 30B 655 S.Sanford Way <br /> D=n,CA 95620 Davq CA 95616 Spahr,MV 89431 <br /> (701 693-LO08 CAT080012602 (510)795-0400 CAD982446" (503)788-461 982510711 <br /> .1- <br /> Print Nbme f / Generafo In <br /> I hereby certify that I have rend and have the auth _ to blind th <br /> _ e aboe listed enertovtcir to_the terms on the eyerse side of this form. <br /> —..r_ erre...__.._—.....—.._.._._ <br /> State Low Requires that you keep this Receipt/Bill of Lading on file no less than 3 years. <br />