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1167 VANDERBILT CIR. #2 ' <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "YourCafiforrlie Anti veze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047197 FAX: 209.239.6316 <br /> SERVICE ORDER: 4 8 n 4'2 <br /> & H Auto Tech (SRDHH 97-080620) MANIFEST p <br /> 20 E. Hammer lane D-101 <br /> toddon, CA 85210 <br /> 09-951-1100 <br /> PA#CAL 000 318 708 Customer* 2263 Contact_Dang Terms_ Due Jen ANI <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUNT <br /> 20 CCS- Su.jO A <br /> 50 Waste Ardifireeze Pick Up <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(USED OIL/MIXED OIL)-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 /> ❑ BANGO OIL,LLC: 22211 Bango Road•Fallen,NV 89406•NVR000080655-(775)852-2295 <br /> ❑ D/K DIXON: 7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road•W.Sacramento,CA 95691•CAD044003556-(916)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 South 700 West-San Lake City,UT 84104•UTD982589459-(601)9770220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union City,CA 94587•(510)467-9277 <br /> (All Generators/Customers MUST read the following text.) <br /> If 1 am a large quantity generator,I candy 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,R I am a small quantity generator,I have made a good faith to minimize my waste generation and select the test waste management method that <br /> Is available to me that I can afford. <br /> 'f HEREBY CERTIFY THAT 1 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 logo P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S..' <br /> f <br /> Customer Signature Date Signature /� Date <br /> 343 <br /> Print Name Print Driver's Name <br /> An returned checks are subject to a$16.00 Service Charge. <br /> Allamoums not paid Within 30 days of imroloe are subject to 1 1/2%Interest per month,18%annually on unpaid balance. <br />