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ARNIA <br /> 1187 VANDERBILT CIR. #2 <br /> CALCOOLANT SERVICE MANTECA, CA 95337 <br /> X" <br /> Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAx: 209-239-6316 <br /> RDER: � <br /> SERVI� p 8 5 ✓/ <br /> Customer <br /> roadhato -Jffy Lube 0 2322 (SRYKHE 21-792002 00014KHE) MANIFEST# <br /> 00 Kettlernan Lane/CHEROKEE <br /> odd CA 90240 <br /> 000 142 640 CUOtOMOf 9372;22 Contac Jamie Toirm: Not 30 fey: <br /> CODE DESCRIPTION QTY UNIT PRICE AMOUNT <br /> 150 F restone Prime 50150 AT 5, (00 +Cq to,DD <br /> ka sla Antifreeze Pick Up r1 1\�!G <br /> Tank Serial Numbers: ,,`'ti` Non Taxable Sub Total Q t I o , 0W0 <br /> Taxable Sub Total 1 t <br /> Tax <br /> TOTAL DUE iq�. otl <br /> WASTE DISPOSAL INFORMATION <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 /> :1 RAMOS ENVIRONMENTAL: 1515 S.River Road-W.Sacramento,CA 95691 -CAD044003556-(916)371-5747 <br /> /�U-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, ATE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. q I­ <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 Y PP..C.B'S. <br /> Customer Signature f Date Driver Signature Date <br /> _ n <br /> Print Name l { 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 />