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1187 VANOERBILT CIR. #2 <br /> CALi, vRNIA COOLANT SERVICE - MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" OFFICE: 209-239-5587FAX: 209-239-6316 <br /> t Transporter EPA#CAR000047167 <br /> SERVICE ORDER: <br /> Customer <br /> 5raadbaso -Jiffy l.t�be�2322 (SRYKHE 21-7026102 0001AKHE) MANIFEST# { <br /> 500 Kettleman Lane/CHEROKEE <br /> Lodi, OA 05240 <br /> 00-339-0000 <br /> Pa#6X 000 182 6145 CUStomer* 1372/22 2 Contact_Jamie Torms= Net 30 <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> 50 F restone Prime 50/50 A/l` d/H <br /> 50 Wasle 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 /> ❑ 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 /> AL-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 1 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 IS OVER 1000 P P.M.TOTAL HALIDES,OR CONTAINS ANY f <br /> oe <br /> Customer Signature —E3rtGe'rignafure Date <br /> Print Name` Print Driver's Name 77// <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 />