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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Anfifreeze Service Company- OFFICE: 209.239.5587 <br /> Transporter EPA#CAR000047167 FAx: 209.239.6316 <br /> SERVICE ORDER: 44 ,130 <br /> a ti Auto Tech (SRDHH 97-090620) MANIFEST# <br /> 20 E. Hammer Lane D-10 <br /> toddon, CA 95210 <br /> 09-951-1100 <br /> PAIR CW. 000 318 708 Customer f 2283 Contact: Deng Terms: Due on Rep. Jeff Pull <br /> CODE DESCRIPTION QTY UNIT PRICE AMOUNT <br /> 12n prq-SWIM AJF <br /> 50 Waste Antifreeze Pick U <br /> j i <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCFtA HAZARDOUS WASTE,LIQUID(OILY WATER)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> ON-RCRA HAZARDOUS WASTE,❑QUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REOUIRED' STATE CODE 134 - <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ DEMENNO/KERDOON: 2000 N.Alameda Street-Compton,CA 90222-CAT080013352-(310)537-7100 <br /> ❑ DM DIXON: 7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road•W.Sacramento,CA 95691•CADD44DO3556•(916)371-5747 <br /> 4 NU-SET INDUSTRIES: 977 South 700 West-Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union City,CA 94587•(510)487-9277 <br /> (All Generators/Customers MUST read the following text.) <br /> If I am a large quwt ty generator,I certify that I have a program in place to reduce one volume and toxicity of waste generated to the degree I have determined to be ecowmically <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,M I am a Small quarnity,generator,I have made a good faith to minimize my waste generation and Select the best Waste managemem method that <br /> is available to me that I can afford. <br /> 'I HEREBY CERTIF THAT i 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 /> NOTCONTAINAN P.C.B'S. <br /> '1 F FITHEO , TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Irl ..,; / /, <br /> Cuslgm9r Signetljre Date _DriGer SlgrletdFe Date <br /> JJ h i <br /> 3.25`_1 I P 1 � n E r. <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamouma not paid within 30 days of Invoice are subject to 1 112%Interest per month,16%annually on unpaid balance. <br />