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Jan. 12. 2012— 9:24AM — - " <br />s Environmental Servicos <br />1515 South River Rd. <br />West Sacramento, CA 95691 <br />(916) 371-5747 <br />CAD044003556 <br />DATE '� , Lk . t o <br />GENERATOR Chase Chevrolet <br />BILLING ADDRESS <br />GENERATOR CONTACT <br />PHONE 1 9-475-6630 <br />JOB SITE ADDRESS 6441 Holltman Dr , S1D kron 5 -12 <br />JOB DESCRIPTION <br />L <br />MATERIALS <br />No. 6103 P. 9 <br />ORDER NO. 121593 <br />JOB NUMBER <br />GENERATOR EPA #CAL 000 117 545 <br />AMOUNT (IF ANY) <br />CHECK NUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />HALIDES <br />(amt.) <br />,C Il, op P.P.M. <br />` COMBUSTIBLE LIQUID, N.O.S., - NA1983,111, (USED OIL) CODE # <br />NON RCRA HAZARDOUS WASTE. SOLID - LIQUID CODE #1 START TIME <br />U.S. DOT DESCRIPTION: END TIME <br />(USED ANTIFREEZE) NON RCRA HAZARDOUS WASTE LIQUID CODE # USED OIL FILTERS �S <br />MANIFEST NO. QU C�C< NO. OF GALLONS J \ o <br />DRIVER'S SIGNATURE TRUCK#� <br />DESIGNATED TSDF: RAMOS ENVIRONMENTAL SERVICES, 1515 SOUTH RIVER RD. WEST SACRAMENTO 95691 CAD 044003556 <br />I HEREBY CERTIFY THAT] HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE, AND THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M. <br />This is to certify that the above named articles are property classified, described, packaged, marked and are in proper condition for <br />transportation, according to the applicable regulations of the Department of Transportation. <br />Generator's Cedilioatlon: I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br />to be economically practicable. Ramos agrees with the generator to send all their hazardous waste to an authorized hazardous waste trealmenl facility <br />via Ramos' standardized permuted storage facility. <br />All used oil collected from the generator listed above will be transported only to a faculty permitted by the State of California to produce used oil Into <br />recycled oil. <br />Terms - net 15 days. <br />After due date, a finance charge of 1.50% per month, 18.00% annual rate, will be <br />costs and attorney fees incurred In the collection of this obligation. Venue for pur <br />I declare, under penalty of perjury that the foregoing Is true and correct. <br />of <br />The customer agrees to pay reasonable <br />igation shall be Yolo County. <br />im <br />GENEF100A SIGNATURE ,_ j jp „ i <br />