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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANTSERYKE MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAx: 209-239-6316 <br /> SERVICE ORDER: 65506 <br /> Valley 11 r (tamble 925%) MANIFEST# <br /> 101913esmner Ave t 1651 <br /> CA 95336 <br /> 209-823-2168 PO <br /> e °G��I <br /> EPA 13D# CAR 000 015 560 Cushmer# 1826 Cimitect_Dan Sia-1121 Terms:P0#Requ&rBMeK Jeff AW4,** <br /> •® ® • • <br /> 120 CQ8_500 AX <br /> 050 7 <br /> 3� <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> i <br /> Tax <br /> TOTAL DUE <br /> —WASTE DISPOSAL INFORMATION <br /> eNfNON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL f MIXED OIL)'NO PLACARDS REQUIRED* STATE CODE221 <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED` STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: 3✓ <br /> ❑ EVERGREEN OIL,INC.: 8880 Smith Avenue-Newark,CA -CAD9W887418-(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South Stanford Way-Sparks,NV 89431-NVO982510711-(775)219-7396 <br /> D!K Chevron Way-Dixon,CA 95620-CAT0800126M-(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road-W.Sacramento,CA 95691-CAD044003556-(916)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 South 700 West-Salt Lake City,UT 84104-UTD982589459-(801)977-0220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue-Union City,CA 94587-(510)487-9277 <br /> (All GeneratoralCustomers MUST read the following text.) <br /> If t am a large quantity generator,I certify that I have 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 1 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 gen4vem <br /> od faith t minimize my waste generation and select the <br /> best waste management method that is available to me that 1 can afford.*1 HEREBY CERTIFY THAT i HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,TARE LES HAN 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 LEGAL SPOS LIF00 P.P.M.T T L HALIDES,OR CONTAINS ANY P.C.e'S. <br /> C. <br /> Ll �r <br /> Zustomer S�ignaturd Dat Drive une Date <br /> /� _! �1l✓V�! T C U <br /> Print l4arrilf Prin e <br /> All returned checks are subject to a$15.00 Service Charge. <br /> 3.43+T°t s 9.2 , 's_rtc}t within 30 days of invoice are subject to 1112%interest per month,18%annually on unpaid balance. <br /> 1; collections and or an attorney customer will be responsible for all collection and or attorney fees. <br />