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NOV <br /> 11$7 VAN6ER611.T CIfl. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> ' OFFICE: 209-9-239-55$7 <br /> "Your California Antifreeze Service Company"„ ' FAX: 209.239-6316 <br /> Transporter EPA#CAR000047167jw <br /> % I. SERVICE ORDER: <br /> a. <br /> MANIFEST# <br /> iri13e>! grocers ;7 <br /> 1990 Pi=1i Rd <br /> tockton, CA 95215 <br /> 90- 9907 <br /> PA—.*CAD 9a2 503 251 Customer'*' 1577 <br /> [!1,' n u;?r1�oR rr ,t rl <br /> vplasie Anti#?aze Pick-U <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE - - <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)'NO PLACARDS REQUIRED` STATE CODE 221 <br /> ,.NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ DEMENNO/KERDOON: 2000 N.Alameda Street-Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ D7K DIXON: 7300 Chevron Way•Dixon,CA 95620•CAT0800126D2•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road-W.Sacramento,CA 95691 •CAD044003556-(916)371-5747 <br /> r <br /> .13`NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982589459.(801)977-0220 <br /> ❑ ALTERNATE TSDF: <br /> O CFR: 33210 Western Avenue•Union City,CA 94587•(510)487-9277 <br /> (All Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present and future threat to human <br /> life and the environment; Or,if I am a small quantity generator,I have made a good faith to minimize my waste generation and select the best waste management method that <br /> is available to me that I can afford. <br /> -I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. <br /> 'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signature Dale Driver'Signature Date <br /> j . t _ <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid within 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />