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1187 VANDERBILT GR. #2 LIFORNIA COOLANT SERVICEiRVICE ORDER /INVOICE <br />MANTRA, CA 95337 <br />A Division of Fremouw Environmental Services, Inc. DATE: <br />,Rgh- <br />OFFICE: 209-239-5587 fremorler EEn Envir71017 <br />onmental <br />FAx: 209-239-6316 <br />SITE ADDRESS BILLING/MAILING ADDRESS <br />Customer Customer <br />63"3 !N' V"'i6son, VVY 1630 Ntl"Idliisoll Wy <br />,Sto&ton, CA Q152f15 Stockton, CA 95255 <br />E.P.A. # <br />SAL € 00139 851 <br />Phone <br />Additional Contacts: <br />2+39 462 94614 <br />Jose <br />PRODUCT -SERVICE INFORMATION/PROPER SHIPPING nFSCaIPTInM <br />7 14 21 30 45 60 90 • 180 • <br />365 W/C <br />WASTE <br />CODE <br />MANIFEST NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />imardaust Taste DgUid(USedlk-&eexe <br />CY, <br />. r <br />.54S' V O'7' <br />I <br />Empty Drums Provide J Remove 7 1A1 <br />IA2 Sg [r 1 O ❑ 15g 7 30g ❑ 55g -3 S P F <br />Clor-D-Tect 94000 Test Kit: Test 7 Pass _j <br />Fail ❑ Generator Knowledge J PPM <br />Transportation Charges/Additional Truck Time/Additional Labor/ LAB Packing/Site Cleaning <br />Clean: Y N <br />I Labels <br />Oil <br />A/F UOF <br />Oily Debris <br />SERVICES REQUESTED BY <br />I <br />TAXI <br />I <br />Accept v m <br />P. O. # TOTAL CHARGES: <br />_.._._..-_-_...._...._.-. , ,,,o e,,,,.,,.,.....,.y.mn�ie iunvartau"x.p.ry oescnoeaaoove oyproper shipping name and are classifed. pocked, marked. and <br />bbeled, antl 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 />0 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 human 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 and select the best waste management method that is available to me and that I can afford. All used oil from the generator Ikted above will be <br />transported only to a facility permined by the State of California to produce used oil into recycled oil OR a facility that ts 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 tees Incurred in the <br />cdlection of has oblgation. Venue for purposes of this obliation shall bla <br />ge in Sono 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 IndOIIust lal Lubricating <br />.. OR <br />Print Name - Generator's Signature Driver's Signature <br />I 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 />