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1187 VANDERBILT CIR.#2 <br /> CALIFORNIACOOLANT SERVICE MANTECA, (A 95337 <br /> A Division of Fremouw Environmental Services, Inc. OFFICE: 209-239-5587 <br /> Tronsporler EPA# CAR000171017 FAX: 209-239-6316 <br /> SERVICE ORDER; 0057..!2 <br /> EMANIFEST# <br /> q-1TPnL s'a-mble 92 <br /> Bessiprnerk(m,, I C -.A <br /> CA 1-45316 <br /> FTA TD#f CAT,, X,'M 5 560 C-utwer 9 1111-:6 Coitad:Dail 121 Tenns-A--*PsqukvM- W-. Tr--ffA!A <br /> q. <br /> 0. 6 <br /> Tank Serial Numbers: <br /> Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> —IT <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 /> Z) OTHER: <br /> U DESIGNATEDTSDF: <br /> J EVERGREEN OIL,INC.: 6880 Smith Avenue- Newark,CA -CAD980887418-(510)795-4400 <br /> J THERMO FLUIDS: 655 South Stanford Way- Sparks,NV 89431-NVD982510711-(775)219-7396 <br /> 3 NU-SET WDUSTRIES: 977 South 700 West-Salt Lake City,UT 84104-UTD982589459-(801)977-0220 <br /> D/K DIXON,;,,. O Chevron Way- Dixon,CA 95620-CATO8001 2602-(707)693-6008 <br /> -;I-W.4Md*REEN OIL,INC.-FRESNO: 4139 N.Valentine Avenue-Fresno,CA 93722-CAD982446882-(510)795-4400 <br /> J ALTERNATETSDF: <br /> J BIG SKY ENVIRONMENTAL: 401 W.Channel Road-Benicia,CA 94510-(510)541-2128 <br /> Ioil I A/F .�: i,-- I UOF T Oily D-bri---- 4 <br /> GENERATOR'S CERTIFICATION: I here 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 I 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 heafth 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 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 /> ICollection Station Industrial Agriculture Government Marine Other Industrial Oil Lubricating Oil I I I I 1 1 ifiiOil <br /> All amounts not paid within 30 days of invoice are subject to 1 1h%interest per month,18%annuall1kon unpaid balanm,,, <br /> 1-�47, lm-07 UlDir-06s and or an attorney customer ill be responsible for all collectio nd or atWfney fees., <br /> Print Name Generatorisi6nature -mme-r:'s s- nature <br /> Yde of ttils form, <br /> I hereby certify that I have mad and have the authority to bind the above listed generator to the tell on h reyers <br /> State Law Requires that you keep this ReceipVBIII of Lading on file no less then 9 years. <br />