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1187 VANDERBILT CIR. #2 <br /> CALANIA 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: 4,9012 <br /> Customer <br /> toAdbar-b -JW Lube 0 23 2 (9RYK _ 21492602 g2602 00 MANIFEST# <br /> 00 Kettleman lane/CHEROKEE <br /> di, CA 85240 <br /> 09-339-0900 <br /> rPAO CAL 000182"0 Customer* 1372/22 Contact: Jamie Tama_ Not 30 Rets: t <br /> •D E DESCRIPTIONQTY UNIT PRICE AMOUNT <br /> :77 _(IL -- <br /> 50 F restone Prime 50/50 AT �/r` <br /> � 5•coo 252.00 <br /> 50 Ste Antlfreeze Pick Up <br /> 1� V <br /> Tank Serial Numbers: Non Taxable Sub Total 252 -W <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE /}5�7•oo <br /> WASTE DISPOSAL INFORMATION L ,G <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)'NO PLACARDS REQUIRED` STATE CODE 221 <br /> ON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ DEMENNOXERDOON: 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 /> O RAMOS ENVIRONMENTAL: 1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> 60�"U-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 AG E TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL 91SPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS NY P .B'S. <br /> intmer Signature Date Driver Signature ' Date <br /> / 1 <br /> 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 />