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1187 VANDERBILT CIR. #2 <br /> MANTECA, cA95337 <br /> CAL1tURNIA COOLANT SERVICE _ <br /> IL "Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAx: 209-239-6316 <br /> ,�►, SERVICE ORDER: 44, 077 <br /> f <br /> .A <br /> Customer MANIFEST# <br /> roadbase -Jf y Lube 0 2322 (SRYKH E 21-792602 00014KH I.\ <br /> 00 Kettleman Lane/CHEROKEE V-6 <br /> lod0913 -0900 0 <br /> 912- <br /> PA*CAL 000 182 845 Customer* 1372/22 C"jrihct: Jamie mss_ Net 30 Rets: <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUNT <br /> ISO cestane Prime 501450.AX (0o ?)('04 <br /> so V\4ste Ardifreeze Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total 21 „I f. <br /> / Taxable Sub Total Jl�`i <br /> ' Tax <br /> TOTAL DUE co <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 /> ❑ 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 ava]able to me that I can afford. <br /> 'I 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 /> �Of 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. S. <br /> stomer Signa e f Date Driver Signature Date <br /> rint 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 1 172%interest per month,18%annually on unpaid balance. <br />