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1187 VANDERBILT CIR. #2 <br /> CAUt►RNIA COOLANT SERVICE MANTECA, CA 95337 <br /> 87 <br /> 39 <br /> OFFICE: 209-2 -55 <br /> '"Your California Antifreeze Service Company"" FAX: 209-2-2 6-55 <br /> Transporter EPA#CAR000047167 <br /> IL <br /> SERVICE OR316 <br /> : 49, 485 <br /> customer <br /> �F'1ST <br /> roa+dbato -My Lube 2322 (SRYKHE 21-702002 00014KHE) # <br /> 00 Kettlemen Lane f CHEROKEElod - <br /> CA <br /> 00-39-0000 0 ►�'� <br /> PA#CAL 000 1821845 Customer* 1372122 Costa 1Steuen 'Terms;. Net 30 R <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> -, <br /> 50 Prestone Prime 50/50 A/F 45, (pp 22,3,00 <br /> 50 Wact@ Antltreeze Pick Up Gi'l/ I& <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> �d <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE O <br /> WASTE DISPOSAL INFORMATION t�J <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 available 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 /> )URTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS A�PC. <br /> ustomer Signature / Date nver SignatuDate <br /> int 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 />