Laserfiche WebLink
, 1187 VANOERBILT CIR. #2 <br /> CALHIRNIA COOLANT SERVICE MANTEDA, CA 95337 <br /> OFFICE: 209-239-5587 <br /> Your California Antifreeze Service Company FAX: 209-239.6316 <br /> — Transporter EPA#CARD00047167 <br /> SERVICE ORDER: >' 7 <br /> s .g <br /> customer <br /> foadbase -AftyLUb@#2322 (GRYKHE 21-792002 00014KHEI MANIFEST# <br /> ')00 Ketttvrrtan Lan*/ CHEROKEE <br /> odl, CA 95240 <br /> 200-330-0.900 <br /> 'SPA#WL 000192 640 CUsfo✓r 1372/22 Corlitact_ StWen Terms: Net 30 R <br /> . . <br /> u q jrestane Prime 50/50 AT j ,OD <br /> X50 !n ste Antifreeze Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total �� <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE ; <br /> WASTE DISPOSAL INFORMATION <br /> r❑ 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 /> J 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 /> ❑ NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> J ALTERNATETSDF: <br /> J 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 /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOYLEGA DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signature i Date er ignature Date <br /> f c q <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 />