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1187 VANDERBILT-GIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA,GA 95337 <br /> 'Your California Antifreeze Service Company' OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: 3034 <br /> Almffftsin Valley R3igiren( ble9.250/4) MANIFEST# <br /> 101PEemenwAve/ 3 <br /> Z - CA.95336 <br /> -823-21158 <br /> EPA ED Ilk W0015560CUdGliner# 1 O •Dan Stoma-1121 Temm Mo.Jeff Aul° <br /> •® ® ® �, <br /> r &Bme up 7 <br /> UOF I TSW Oil&Gawline Filtus <br /> UO N -RCRA HEIZOrdous'4T1Fa Liquid(used oil 37 <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> i <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION �•A <br /> NON-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 /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880 Smith Avenue-Newark,CA.CAD980887418-(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South Stanford Way-Sparks NV;89431-NVD982510711-(775)219-7396 <br /> ❑ D/K DIXON: 00 Chevron Way-Dixon,CA 95620-CAT086012602-(707)693-6008 <br /> ENVIRONMENTAL: 1515 S.River Road-W.Sacramento,CA 95691-CAD044003656-(916)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 South 700 West-Salt Lake City,UT 84104-UT0982589459-(801)977-0220 <br /> ❑ ALTERNATETSOF: <br /> ❑ CFR: 33210 Western Avenue-Union City,CA 94587-(510)487-9277 <br /> (All Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator,I certify that i have a program in place to reduce the volume and toxicity of waste enerated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal cu y 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 e a good faith 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 1 HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,THAT THE To. <br /> O LH LIDES ARE LESS 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 DIS P IS WASTE IS R 1000 P.P.M.T TA HALIDES,OR CONTAINS ANY P.C.B'S. <br /> f - <br /> �. _Customer i�_ D_4 Dae atu e ` D to <br /> v <br /> i_ A_Name int s eats <br /> 3.43 Tom: 2_W1 All returned checks are subject to a$15.00 Service Charge. <br /> A91 b is rTo-t pi3fd W hin 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />