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' 1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> `Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: 68351 <br /> e <br /> MANIFEST# <br /> A ft ' Valley �•�(tz�ble 9.25°/'0) ..-� ,... <br /> 101PBess erAve! <br /> 1ec%CA 95336 <br /> 2013-823-21& <br /> 9 C 5 !? a l e Coma&-Dsn 1121�' 1$. 'r ;71FAu1'� <br /> •• I • • • <br /> fwd Oft easdinemita s <br /> ME Is VIEW etm <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOT <br /> WASTE DISPOSAL INFORMATION <br /> ON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)-NO PLACARDS REQUIRED' STATE CODE 221 <br /> NOWRCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880 Smith Avenue.•Newark,CA a CAD980887418 a(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South Stanford Way•Sparks,NV 89431 a NVD982510711 a(775)219-7396 <br /> DIXON: 73 Chevron Way a Dixon,CA 95620 a CAT080012602 a(707)693-6008 <br /> A4Vl ENVIRONMENTAL: 1515 S.River Road a W.Sacramento,CA 95691 a CADD44003556 a(916)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 South 700 West a SaR Lake City,UT 84104•UTD9825SM59 a(801)977-0220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union City,CA 94587 a(510)487-9277 <br /> (All Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator,l certify that Mave a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present <br /> and future threat to human life and the environment;Or,if i am a small quantity generator,I have made a good faith to minimize my waste generation and select the <br /> best waste management method that is available to me that I can afford. <br /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL H LI ES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. <br /> '1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LE ALDIS SAL IF E IS OV 000 P.P.M.TOT L HALIDES,OR CONTAINS ANY B'S. <br /> 17-1 <br /> Customer S net a ate Driv a re Dat <br /> Pri Na a er's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> All amounts not paid within 30 days of invoice are subject to 11/2%interest per month,18%annually on unpaid balance. <br /> 3.43+T 9.2 p i is and or an attorney customer will be responsible for all collection and or attorney fees. <br />