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1187 VANDERBILT CIR. #2 <br /> MANTECA, CA 95337 <br /> OFFICE: 209-239-5587 <br /> "Your California Antifreeze Service Company" FAX: 209-239-6316 <br /> Transporter EPA#CAR000047167 <br /> SERVICE ORDER: d 6 8 6 8 f <br /> CALItuflNIA COOLANT SERVICE <br /> 'Customer <br /> f'oadb=ase -Jiffy Lube 2322 (SRYKHE 21-702602 00014KHE) MANIFEST# <br /> 600 Ketileman Lane/(CHEROKEE <br /> adi,CA 95240 <br /> 00-339-0000 - <br /> PA*CAL 000192 645 Customer* 4372/22 Contact: Steven Terms_ Not 30 Raw. <br /> CODE DESCRIPTIONCITY UNIT PRICE AMOUNT <br /> 50 F restone Prime 50/50 A/F <br /> 50 ste Ardltree2e hick Up 7 � <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE i I <br /> WASTE DISPOSAL INFORMATION I" <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED` STATE CODE 221 <br /> ON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED" STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ BANGO OIL,LLC: 22211 Bango Road-Fallen,NV 89406-NVR000080655-(775)852-2295 <br /> ❑ D/K DIXON: 7300 Chevron Way-Dixon,CA 95620-CAT080012602-(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road.-W.Sacramento,CA 95691 -CAD044003556-(916)371-5747 <br /> ,.8.-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 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 generated to the degree I have determined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present and future threat to human <br /> 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 best waste management method that <br /> 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 HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. <br /> 'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL I THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B' / <br /> Dustomer Signature Dae Driver Signature Date <br /> / 1 <br /> ` Jv <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid within 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />