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A <br /> California Coolant <br /> i Services <br /> 1187 Vandorbilt Cir. #2 1 <br /> Manteca, Ca 95337 <br /> Office: 209-239-5587 n�s <br /> Fax: 209-239-6316 PURCHASE ORDER NO:' 40 <br /> Customer <br /> ame A17- <br /> to of Service <br /> ddressyl4 V. CL/ pTE bv�f ep anifest# <br /> Ity, STococ c�tate Zip 9 .1- a14160 <br /> G arms ust# <br /> honea G cf y J _ y S� uetomer P.O. <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> 030 Recycipi;lAntlfreeze 4f <br /> 002 Ethylene Glycol/Antifreeze <br /> Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> • Comments: <br /> IN _ U <br /> OUT - y <br /> 61 <br /> CAL EPA#CAL000147713 TRANSPORTATION REGISTRATION#3713 <br /> SykiHthat <br /> -Initialing here aanowl®d es ha/shti has read and$grees to the Terms and Conditions printed <br /> Wr,ron the back of this purchase <br /> Customer Authorization: 1 � - i_ Date: 7 '� y X <br /> Onsite Agreement: .t �t/''��^-mac Date: - - X <br /> i <br />