Laserfiche WebLink
1187 VANDERBILT CIR. #2 <br /> CALInANIA COOLANT SERYICE MANTECA, CA 95337 <br /> Your California Antifreeze Service Company'" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 <br /> FAX: 209-239-6316 <br /> SERVICE ORDER: 14 5� 1 1 <br /> Customer <br /> roadbase -Jiffy Lube#2322 (SRYKHE 21-792602 00014KHE) MANIFEST# <br /> 00 Kettleman Lane/CHEROKEE <br /> odi, CA 95240 <br /> 09-339-0900 <br /> PA*CAL 000182 045 Customer 1372/22 Contact;,Steven Terms_ Net 30 RV- <br /> 50 F restone Prime 50/50 A/F 3 5• 00 <br /> 50 lasts Antifreeze Pick Up N �G <br /> Tank Serial Numbers: Non Taxable Sub Total I�U�/„ OD <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION l� <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)`NO PLACARDS REQUIRED- STATE CODE 221 <br /> p 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 /> "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 /> -1 5JBTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> r <br /> Customer Signature Date river Signature Date <br /> Print 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 />