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1187 VANDERRIIT (IR.#2 *11onRNIA COOLANT SERVICERVICE ORDER /INVOICE: <br /> MANTECA (A 95337 <br /> OETUE: 209-239-5587 A DiFremouw Environmental Services, Inc. ATE: <br /> a Transporter EPA# (AR000171017 <br /> FAX: 209-239-6316 <br /> SOE ADDR'.55 **�� BILLING/MAILINGADDRESA <br /> Customer Customer <br /> Skx-,ktian. C`a <br /> a.' <br /> E.P.A. # !.00 Phone <br /> Additional Contacts: <br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 14 21 30 45 60 90 180 365 W/C WARE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Empty Drums Provide J Remove J 1A1 IA2 5g J 10g J 15g J 3Dg J 55g J S P F <br /> Clor-D-Tett 614000 Test Kit: Test J Pass J Fail J Generator Knowledge J PPM <br /> Transportation Charges/Additional Truck Time/Addiflonal Labor/LAB Packing/Site Cleaning <br /> Clean: ' Y N labels Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY I TAX <br /> We r , 4 F P. O. # TOTAL CHARGES: <br /> Accept _ <br /> GENERATOR'SCERTIFICATION I hereby declare that the contents of this consignment are fully and accurately desoribetlabove by proper shipping name and are classified.Packed marked.and <br /> labeled.and ore iu all respects in proper condition for transport by highway according to applicable state and naibnal government regulations. If I am a large quantity generator.i cartr y 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 parent and future threat to human health and the environment:OR.if t am a small quantity generate,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 oil from the gonerator 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 it 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 Satanic,County. I declare under Readily of perjury,that the forgoing k true and correct. <br /> DISPOSAL/RECYCLING FACILTY: Collection Station -Industrial Agriculture Government Marine Other Industrial Lubrioil <br /> cating <br /> Oil is <br /> Print Name Generator's Signature Drivers Signature <br /> I her"a 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 />