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1187 VANDERBILT CIR. #2 <br /> 1 CALI, vRNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 <br /> FAx: 209-239-6316 <br /> SERVICE ORDER: 47212 <br /> 'Customer <br /> koadbase -Jffy Lube 222( YKaE 21=792802 00014lfttE) MANIFEST# <br /> 00 Kettleman Lane/CHEROKEE <br /> odi, CA 85240 <br /> 09-339-0000 <br /> Pb*CAL 000182 045 Customer* 1372/22 Contacts Steven Term si Net 30 Reo. ` <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> 50 F restone Prime 50/50 AT <br /> 50 Vlaste ArdiMeeze Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE p D <br /> WASTE DISPOSAL INFORMATION ! W <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 /> ❑ 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 /> ❑'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 R.C.B'S. <br /> 'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> —C stomer Signature D� river Signature Date <br /> �b�Vt�lO <br /> 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 1 112%interest per month,18%annually on unpaid balance. <br />