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I <br /> CALIFORNIA COOLANT SERYICE MANTECACA,1167 RILT 33 #2 <br /> 4 C CA 95337 <br /> "Your California Antifreeze Service Company` OFFICE: 209.239.5587 <br /> Transporter EPA#CAR000047167 Fax: 209-239-6316 <br /> SERVICE ORDER: ;� n 9 <br /> I <br /> & H Auto Tach (SRDHH 97-090920) MANIFEST# <br /> 20 E. Hammer Lane 0-10! <br /> tockton, CA 95210 <br /> 09-951-1100 <br /> RACAL 000 518 108 Custemerlk 2293 Contact_: Dw, JefAul <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> 20 CCS- 501150 AIF <br /> 50 ante Antifreeze 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 /> ZI DESIGNATEDTSDF; <br /> ❑ EVERGREEN OIL,INC.: 5580 Smith Avenue•Newark,CA •CADg8o8S?41S•(510)7954400 <br /> ❑ BANGO OIL,LLC: 22211 Bango Road•Fallen,NV 89406•NVR000080655•(775)852-2295 <br /> ❑ DIX DIXON: 7300 Chevron Way•Dixon,CA 95620•CAT060012602•(707)693$008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road•W.Sacramento,CA asset•CAD044003556•(916)371-5747 <br /> 0 NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982589459•(601)9T7-0220 <br /> ❑ ALTERNATETSOF: <br /> ❑ CRI: 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 quantity generator.I certify that 1 have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present <br /> and future threat to human life and the environment; Or,It I am a small quantity generator,l have made a good faith to minimize my waste generation and select the <br /> best waste management method that is available to me that I can afford. <br /> 'I 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 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> A l lamounts not paid within 30 days of invoice are subject to 1 112%Interest per month,18%annually on unpaid balance. <br />