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1187 VANDERBILT(IR.#2 <br /> CALIFORIA COOLANT ERYICE MANTE(A, (A 95337 <br /> -5587 <br /> A Division of fremouw Environmental Services, Inc. OFFICE: 9-239- 316 <br /> Transporter EPA# CAR000171017 FAX: 209 239 6316 <br /> SERVICE ORDER: 00 "4A <br /> Motlsttwilt Valley 1.vFrress(taxable 9.250A) MANIN � �i i <br /> 1019 Bessemer Ave,' ° <br /> 00 <br /> Manteca,CA 9S33b <br /> 209-723-2108 <br /> F,PA,ID#:CAR 000 015 X10 Cusu er If#: 11326 Centwr Uan Som-1121`I ermss:POO' Ke earedl3 :3ett r1�:1"°�" <br /> 120 CCS-50150 AIF <br /> 030 Waste Antifreeze Pick <br /> UOF IJ-;ed(lit& '.sol' a Filters <br /> LIC? loon-RCRA Liazardous Waste L,i-utd <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> — WASTE DISPOSAL INFORMATION <br /> • NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> J NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED' STATE CODE 134 <br /> OTHER: <br /> J DESIGNATEDTSDF: <br /> J EVERGREEN OIL,INC.: 6880 Smith Avenue-Newark,CA -CA0980887418-(510)795-4400 <br /> J THERMO FLUIDS: 655 South Stanford Way-Sparks,NV 89431-NVO982510711-(775)219-7396 <br /> l NU-SET INDUSTRIES: 977 South 700 West-Salt Lake City,UT 84104-UTD982589459-(801)977-0220 <br /> • DM DIXON: 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 /> ZI ALTERNATETSDF: <br /> O BIG SIl1.ENVIRONMENTAL: 401 W.Channel Road-Benicia,CA 94510-(510)541-2128 <br /> Cleary Y.214 I Labels'*yl Oil o A/F r`, UOF C;111 Oily Debris <br /> GENERA"R'§CERTIFICATION: I he by declare that the contents of this consignment are fully and accurately described above by the 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 a large quantity generator,I certify that 1 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 effort to 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 he transported only to a tability 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 _Other l Industrial Oil w.Lubricatin <br /> g <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 collectt and or attorney fees. <br /> 41k< A <br /> Print Name Generator's St6n�„u�e er's tgnature <br /> p C, .. �- <br /> I herft certify that I have read and �v t 'n listedv i I <br /> NJ$3.4 3-t TP.X 9.2,5%55.001 UOf W�J(}ir14,at you keep this Receipt/Bill of Lading on file no less than 3 years. <br />