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1187 VANDERBILT SIR. #2 <br /> _ <br /> CALIfuANIA COOLANT SERVICE MANTECA, CA 95337 <br /> Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: 4 A 713 <br /> Customer <br /> foadbaso t Jffyl_ube 2322 (CRYKHE 21-702802 00014KHE) ' MANI4EST# <br /> 00 Kettleman Lana!CHEROKEE , �3Kw✓Vii' v <br /> i6�0�=3�13Q900 a J� <br /> �A 0001 C>r ftetaMor* 1372122 Costa r+ Torma_ Nat 90 Row. t <br /> 50 F restone Prima 50/50 AT �O 0 2 5 2,CSO <br /> 50 eta AcIllfraaze Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total 252 •�XJ <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE 25 2,�V <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)`NO PLACARDS REQUIRED- STATE CODE 221 <br /> ZlON-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 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 DISP6SAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B' <br /> fes/-- ✓�—'1— - <br /> a <br /> tom�Signature, 'Date rover Signature Date <br /> M b��I <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 1/2%interest per month,18%annually on unpaid balance. <br />