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1 187 VANDERBILT (IR.#2 FREMOUW L_ .TRONMENTAL SERVICES, . SERVICE ORDER/INVOICE: <br /> MANTECA, CA 95337 CALIFORNIA COOLANT SERVICE 11690 <br /> OFFICE: 209-239-5587 Transporter EPA# (AR000111011 <br /> FAX: 209-239-6316 U.S.D.O.T.#1484667 D.T.S.C.#3544 CA#274461 DATE: <br /> SITE ADDRESS Baldds Auto Rep:uY BILLING/MAILING ADDRBRaldds Auto Itepatr <br /> Customer Customer 1020 G 1efekil-Rd <br /> Stockton CA 95:7ilti ECEIVEp'tockum, CA 15205 <br /> CAl 000 370 116 MAY 0 9 '2012 709-565-5093 <br /> E.P.A. # EM <br /> nR0WA@Af <br /> .ALTH <br /> Additional ContadfWddw Attto Repair PERMIT/SERVICES PAYMENT TERMS: NET 15 <br /> PRODUCT - SERVICE INFORMATION/PROPER SHIPPING DESCRIPTION <br /> 7 • 14 21 • 30 • 45 • 60 • 90 • 180 • 365 w/C WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT <br /> I fumy 'I At' Kill tViii I LUC It if 7T7--- <br /> t„ ort 1 <br /> I dylity AMP <br /> M k" w •):.,' 171 r)TLi <br /> OXCIVI, 61JUK i n7 <br /> N/C <br /> Poly iland Pullip . <br /> 1 031V <br /> Empty Drums Provide ❑ Remove ,:] 1A1 1A2 5g ❑ IOg ❑ 15g J 30g O 55g J S P F <br /> Clor-D-Tect Q4000 Test Kit: Test❑ Pass❑ Fail J Generator Knowledge 0 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 /> I I <br /> Wer. w D9C VENP. TOTAL CHARGES: <br /> Accept _- s .�=P. O. # <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified.packed,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 am o 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 a small quantity generator,I have made 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 Solano County. I declare under penalty of perjury that the forgoing Is true and correct. <br /> DISPOSAL/RECYCLING FACILTY: Cattection Station Industrial Agriculture Government Marine Other Industrial Lubricating <br /> Oil <br /> (Aim.CA 9$e 10 Dw.s.'AYSM1Ia 10*4Ek Nv 44411 <br /> (711./1 NO} Ct`.f1t10Y r:"W2 (S t9/hY�+trO r'ArA51M'AB'N (Y71 194 4161: N 71[)!A2SI811 I <br /> Print Name Generator's Signature Driver's Signature <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 />