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California Coolant ,- <br /> ii is m�.,s <br /> Services N L 8 2000 <br /> 1187 Vanderbilt Cir. #2 pL(N <br /> Manteca, Ca 95337 FWpVAONIM&i" "` <br /> Office: 800-253-2256 PERMIT / SERVICES 6257 <br /> Fax: 209-239-6316 INVOICE NO: <br /> Vame /y O rem 6 Date of Service <br /> 4ddress ! 3 O /V L✓i a .5 o Aj WA y� Rep �5 ? ce., Manifest# <br />,qtySTo CK —71 e Zip 9.� o er irE o Cust# 7 G <br /> phone a p 9 _ yG .2 _ a7 y 6 y Customer P.O. <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUNT <br /> 030 Recycled Antifreeze 610 <br /> 002 Ethylene Glycol/Antifreeze <br /> C4 �� <br /> Non Taxable Sub Total 3 s O <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> • • Comments: <br /> a <br /> IN <br /> OUT 3�1 --- - <br /> CAL EPA# CAL000147713 TRANSPORTATION REGISTRATION#3713 <br />® 8y initialing here er acknowledg at/ e s read and agrees to the Terms and Conditions printed <br /> on the back gMis purch se orde <br /> r <br /> Customer Authorizati`o/n: l X Date: Af _'� a X <br /> Date: _X <br /> Onsite Agreement: ,/6G- ---�"G ./,__" <br />