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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" <br /> OFFICE: 209-239.5587 <br /> Transporter EPA#CAR000047167 FAx: 209.239-6316 <br /> SERVICE ORDER: -0108 <br /> '4 Auto Tech (SRDHH 97-090820) MANIFEST# <br /> Hammer Lane D-10 ; <br /> aton, CA 95210 <br /> 251-1100 <br /> 318 708 Cu>3±.. <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> J NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)'NO PLACARDS REOUIRED' STATE CODE 221 <br /> ZI NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED- STATE CODE 134 <br /> J OTHER: <br /> J DESIGNATEOTSDF: <br /> J BANGO OIL,LLC: 22211 Bango Road•Fallen,NV 89406-NVRDD0080655-(775)852-2295 <br /> J D/K DIXON: 7300 Chevron Way-Dixon,CA 95620•CAT080012602-(707)693-6008 <br /> J RAMOS ENVIRONMENTAL: 1515 S.River Road-W.Sacramento,CA 95691 -CA0044003556-(916)371-5747 <br /> A NUSET INDUSTRIES: 977 South 700 West•Salt Lake City,LIT 84104•UTD982589459•(801)977-0220 <br /> J ALTERNATETSDF: <br /> J 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 quantity generator,I canny 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 p2cticable 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,d 1 am a small quantity generator,I have made a good faith to minimize my waste generation and select the best waste management method that <br /> is available to me that 1 can afford. <br /> 'I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THATTHE 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.e s. <br /> i LI y <br /> Customer Signature Date Driver Signature Date <br /> 43 <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid within 30 days of Invoice are subject to 1 112%Interest per month,18%annually on unpaid balance. <br />