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1187 VANDERBILT CIR. #2 <br /> CALadRNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Antifreeze Service y <br /> Com an OFFICE: 209-239-5587 <br /> Company" <br /> Transporter EPA#CAR000047167 FAx: 209-239-6316 <br /> IL SERVICE ORDER: 4 .54 <br /> 'Customer <br /> ran <br /> - <br /> randbase -^Lube 0 2322(SRYKHE 21-702602 000WHE) M EST# <br /> 00 Kettiernan Lane/CHEROKEE12� W <br /> I odi, CA 95240 <br /> 100-330-0000 <br /> PAA CA 0001829Wb Customer* 1372/22 Centad: Jamie Terms: Net 30 Raw. <br /> CODE . DESCRIPTION OTY UNIT PRICE AMOUNT <br /> 150 F restone Prime 50/50 XF �7 S, (D Q 1 q(9,0D <br /> 50 Vfiioe Antifreeze !Fick Up <br /> Tank Serial Numbers: Non Taxable Sub Total I�1 J CD <br /> Taxable Sub Total 115 <br /> Tax <br /> TOTAL DUE 1 q b,Cb <br /> WASTE DISPOSAL INFORMATION "I W <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)'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 /> ❑ DEMENNO/KERDOON: 2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <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 /> ❑ ALTERNATE TSDF: <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 IF THIS WASTE ISOVEN"1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signature �! Die -- +verSig urrt� aDate <br /> 7N All <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 />