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I0 <br /> 1187 VANDERBILT [IR.#2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> A Division of fremouw Environmental Services, Inc. OFFI(E: 209-239-5587 <br /> Transporter EPA# CAR000171017 FAX: 209-239-6316 <br /> SERVICE ORDER: 007174 <br /> s <br /> ly`lrarull flit Valley Express(taxabie 9.25%) MANIFEST# <br /> 1019 tlesserller Ave 1 0c) o o <br /> EPA I4)4:CAR OW 015 5W V Vii: 11326 Cenlade Dan S4:►uzA-1 121 Temliq.K)#Kegthredj�t�� <br /> 0 7 1-nu',V kIm4Vy I Aity-,U/JV AfF <br /> U-01.1 Used Oil&c'usoliate Filtins <br /> 1;0 von-R? RA Hazaret w Waste Lith td <br /> Tank Serial Numbers: Non Taxable Sub Total �~ <br /> Taxable Sub Total <br /> Tax <br /> _T4EKft1DtMJ/ <br /> WASTE DISPOSAL INFORMATION <br /> • NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)-NO PLACARDS REQUIRED' STATE CODE 221 <br /> s <br /> P J NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE 134 <br /> J OTHER: <br /> J DESIGNATEDTSDF: <br /> J EVERGREEN OIL,INC.: 6880 Smith Avenue- Newark,CA •CADS80887418•(510)795.4400 <br /> J THERMO FLUIDS: 655 South Stanford Way-Sparks,NV 89431-NVD982510711 -(775)219-7396 <br /> J <br /> NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104-UTD982589459•(601)977-0220 <br /> J,D/K WYZN: 7300 Chevron Way• Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> 'J EVERGREEN OIL,INC.-FRESNO: 4139 N.Valentine Avenue•Fresno,CA 93722-CAD982446882•(510)795-4400 <br /> J ALTERNATETSDF: <br /> J BIG SK-f ENVIRONMENTAL: 401 W.Channel Road•Benicia,CA 94510•(510)541-2128 <br /> Clear'r.^--re_N I Labels`° Oil " A/F €�,k UOF E, Oily Debris <br /> GENERATOR'S CERTIFICATION: I hjfreby declare that the contents of this consignment are fully and accurately described above by the p r shipping name and are classed,packed,marked,and <br /> labeled,and are in all respects in propef condition for transport by highway according to applicable state and national government regulations. If I am a large quantity generator,I certify that t have a program <br /> 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 treatment,storage,or <br /> 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 good faith effortto minimize my <br /> 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 transported only to a facility permitted by <br /> 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 used oil.All relevant information regarding known <br /> or suspected hazards associated with this waste has been disclosed.The customer agrees to pay reasonable costs and attorney fees incurred in the collection of this obligation.Venue for purposes of this <br /> obligation shall be in Solano County. I declare under penalty of perjury that the forgoing is true and correct. <br /> Collection Station Industrial Agriculture Government Marine - Wet , Industrial Oil Lubricating�ik�" <br /> All amounts not paid within 30 days of invoice are subject to 11/2%Interest per month,18%annually on unpaid balance. <br /> If account is forwarded to collections and or an attorney customer will be responsible for all collection and or aftorne�fePs.. <br /> Print Name Generator's Signature Driver' igna tire <br /> " irvnr+r <br /> listedof this f In. <br /> I he WM qd h, -a bind the above <br /> .4.43't S : . /e uS16111iWPWAA&Areftat you keep this Receipt/Bill of Lading on file no less than 3 years. <br />