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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: 64493 <br /> s <br /> Valley le 925%) MANIFEST# <br /> 1019BmsmwAvef G 13 ��,✓ <br /> Mwlem,CA 95336 <br /> 209.823-2168 <br /> FPA U)# CA.R OD0015 560Cuskwner# 1826 C -Dan Smma-1121 Tems IaEt 30R,b ell Jeff AJuI <br /> f <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> ON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)"NO PLACARDS REQUIRED' STATE CODE 221 <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED- STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSOF: <br /> ❑ EVERGREEN OIL,INC.: 6880 Smith Avenue-Newark,CA -CAD980887418-(510)795-440D <br /> ❑ THED—NO ELLIjDS: 655 South Stanford Way-Sparks,NV 89431-NVD982510711-(775)219-7396 <br /> D/ : 7300 Chevv n Way-Dixon,CA 95620•CAT080012602-(707)693-6008 <br /> RAMOS ENVIRONMENTAL: 1515 S.River Road-W.Sacramento,CA 95691-CAD044003556-1916)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 /> (Ail Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator,I certify that f 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 I have selected the practicable method of treatment,storage,or disposal currently vailable to me which minimize the present <br /> and future threat to human life and the environment; Or,if I am a small quantity generator,1 have made a d faith•to ntmize 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 IDES E LESS T A 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. <br /> '1 FURTHER AGREE TO AC PT THE ADDITIONAL CHARGES FOR LEGAL MOSALtTHIS WASTE IS OV 1000 .P.M.TOT L HAL ES,OR CONTAINS ANY P.C.B'S. <br /> �/ ustomer t t e Date Drive Date <br /> P' t�3+ <br /> P'nt DrivAil returned checks are subject to a$15.00 Service Charge, <br /> 3. a 9. I�� � in 30 days of invoice are subject to 11/2%interest per month,18%annually on unpaid balance. <br /> �c s collections and or an attorney customer will be responsible for all collection and or attorney fees. <br />