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1 187 VANDERBILT (IR.#2 FREMOUW L VIRONMENTAL SERVICES, C. SERVICE ORDER/INVOICE: <br /> MANTE(A, (A 95337 CALIFORNIA COOLANT SENYKE 11' 3 71 <br /> OFFICE: 209-239-5581 <br /> Transporter EPA# CAR000111017 <br /> FAz: 209-239-6316 U.S.D.O.T.#1484667 D.T.S.C.#3544 CA#274461 DATE: <br /> SITE ADDRESS Uddill Au10 R,epail � C�I INGADDRE"alaOrB Anto Repailt <br /> RE <br /> CE?029 f�Ct.� �, , C eye 2029 e,e-k4,,, d <br /> StockUm, CA 95205 - y Slutkt>tL ("'ll,95205 <br /> E.P.A. # CAL 000 370 116 ENVIRONMENTREA HEALTH 209-565-5(193 <br /> Additional ContacftIdds .Atulo Repair PAYMENT TERMS: NET 15 <br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 - 14 - 21 - 30 - 45 - 60 - 90 - 180 - 365 W/C WASTE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> CODE <br /> Noa-RCRA Razzdom Waste I.iqutd(Coed Oil) ; T).1 Ciau()IV 151, <br /> Nott-RC'RA Itt"dotse Wage 1-14uitl(118"]A-111i Frear) CA 13.1 <br /> Non-RC'R:'1 Ihmwdono Waste I.1quid(Oil;?Wad T) CA 223 (1al.10ty <br /> Empty Drums Provide ❑ Remove ❑ IAl lA2 5g ❑ 10g ❑ 15g ❑ 30g ❑ 55g ❑ S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ Pass❑ Fail ❑ Generator Knowledge ❑ PPM <br /> Transportation Charges/Additional Truck Time/Additional Labor/LAB Packing/Site Cleaning <br /> Clean: Y N Labels,. Oil A/F UOF Oily Debris <br /> SERVICES REQUESTED BY TAX <br /> Acret VISA 6' I P. O. # <br /> Accept <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmeNtase fJlly and Vctul'blelk described ab ve ing nom re classified,pocked,marked,and <br /> labeled,and are in all respects in proper condition for transport by highway according to applicable state and national government regulations. If I on large quantity generator.I certify that I have <br /> a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of <br /> treatment,storage.or disposal currently available to me which minimized the present and future threat to human health and the environment;OR.if I am e small quantity generator.I have mode a <br /> good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. All used oil from the generator listed above will be <br /> transported only to a facility permitted by the State of California to produce used oil into recycled oil OR a facility that is required to comply with Federal regulations applicable to the management of <br /> used oil. All relevant information regarding known or suspected hazards associated with this waste has been disclosed. The customer agrees to pay reasonable costs and attorney fees incurred in the <br /> collection of this obligation. Venue for purposes of this obligation shall be in Solono)County. I declare under penalty of perjury that the forgoing is true and correct. <br /> DISPOSAL/RECYCLING FACILTY: Collection Station Industrial Agriculture Government Marine Other Indoiilrlal LubrlOoll <br /> 1 r t <br /> Print Name Generator's Signature Driver' hifure-.. , <br /> I hereby certify that I have read and have the authority to bind the above listed generator to the Terms on the reverse side of this form. <br /> -•- r- R- °- •J--• -..r-- •ji=-n- 9 r,.d,,,,. —rrr...,.,r—4,_'2 va _ <br />