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NCV-C9-2C1513:44 From: To:12C94r8?a? asgsa(1 <br /> 1187 VANDERBILT(IR.#2 F""c'MOU�V hi4VIRONMENTAL SERVICES' IIP. SERVICE ORDER(INVOICE: l <br /> MANTECA, CA 95337 CA11F0&N1A COOLANT SERY12 f 7n. C1 <br /> Offim 209.239-5587 Transporter EPA# (AR000 11017 <br /> FAx: 209-239.6316 tLS.D.O.T.91484667 D.T.S.C.ft3544 CA#274461 DATE: <br /> SITE ADDRESS T'l�aa'�t34tG ll Auto 11-cpat1, BILLING/MAILING ADPREArC-T Ll11L�4.huto R.��1air <br /> Customer Customer <br /> MaA3t`:cza, CA 95336 iv� 1^,JaAtt ki,C-.,ft}. 95336 <br /> L.P.A.-#k f' 1000 X99 266 r� NOV O 9 Phone 209 2-49 92.50 ' <br /> Additional Contacts: iWo ENVI ®� <br /> MENTAL PAYMENT TERMS:NET 15 <br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 • 14 • 21 • 30 • 45 • 60 - 90 • 180 * 365 w/c WASTE MANIFEST NUMBER 61UANTiTY UNITS PRICE AMOUNT <br /> CODE <br /> 1\40R.-VA-Ki't$dfl7x,r0,DTJFl REI-01 lijt37 i ;pc26 _tea d:F#'F 1 C3 tic+:a e'.aU <br /> IN fR-e4:I l rkt781' r1IM W,7EO»; 111( N Cd 521A- .,�n Nii-: <br /> P-r� <br /> Empty Drums Provide D Remove ❑ 1 Al 1 A2 5g ❑ 109 0 159 0 309 O 55g❑ 5 P F <br /> Clor-D-Tett 94000 Test Kit: Test❑ Pass❑ Fail U Generator Knowledge 0 PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean:'\, Y�j+) A/( uoF ""�— Oily D®brie M .— , <br /> SERVICES REQUESTED BY ,w/ TAX <br /> Accept tom. LIZ P.O. # TOTAL CHARGES: <br /> GENERATOR'S CERTIFIC T N:I hereby declare that the conlcmis of Iris consignment are fully and accurately described aboyo by propor shipping name and ere claseilled,packed,marked,and <br /> labeled,and are In all respects in proper condllioh for tronspori by hlghway according to appllcoue stalo and nailomi[lovomm,-n1 regulations. 11 I am a large quantlry generator,I certlfy lhot 1 Novo <br /> a program in plooe to reduce the volomo and loxLily of waste generated to the deorea I hove delerminad to ho nc.onomir.aBy proclicable and that I have selected tFhe practicobfe method of <br /> treatment,storage,or dtD=l curr00%,available to me which minimized the present and fuluro imoot to human heatlh and the environment,,OR,It I am asmall quanlHy aenorotof,I hove maae a <br /> gow folti)e(fori to rownue my waste generation and select the best wosto management melhod Ihat Is avowable to me and that I can offord.All mcd all from the©enorakx 11sied above will be <br /> irol rted only to a taclNty permNted by the State of California to pt"100 Used as into recycled oil OR a facility that Is required to comply wfih Fcdcrol fogulallons oppllcoble to the management of <br /> used of Imre:event 111f Motion regcrding known of st*pecled hazards g1.loclatee with this waste has been dlsclosod, mo omtomer agrees to pay reasonable costs and attorney tees Incuned Ir"1 ' <br /> col;eetlon of tt is ohllpotlon. vwnua roc purpoaos of the otl9gatlor)=ho11'T 6In Solaro l,o.mty, h derty under penolly of penury mol the forgo ng Is true and oonect. <br /> DISPOSAL/RECYCLING FACILTY: rG`6iloctlan StatlonIndustrlal Agrlcullum 6ovorrl Marine Othor Induallrlal labivaung <br /> �ryexge ! ��: ( )'r�rnn tleicxlenna: <br /> a nv��r i'r9' t,d M�i ss5 ii A"al,llar�V <br /> {1.4rt yr wzo L`u�,F:tL'15616 rYl,4tll:b,IV I1Wl <br /> ('t�r`,a93r,'iS8 t;A'ST,Rfwa?.rrp lslrs�s-ennorxta�zn�6a7 {sn�•ralt{f la tt'v�:r,3yrg11 f ,� <br /> � x�ff����.�• � �<s��F.. �w ys" '"'^�_ �,� ������,,,,qlr' � __�_' �t� 1�.s�a•'�'� <br /> Print Name { Generator's Si�rt6luro prlvgr sSlg�tat lie <br /> ebv terrify that I huvr read curd hluvn II.w..lhority to Lind fhe above li.fed yenerntoY to the+acme an thc_Kcy�rwr ni as of thio term. <br />