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1187 VANDERBILT CIR. #2 <br /> CALF VRNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" OFFICE: 209 23 <br /> P Y Fax: 209-239-6316316 <br /> 9-5587 <br /> IL— <br /> Transporter EPA#CAR000047167 <br /> SERVICE ORDER: 45995 <br /> ✓ <br /> Customer <br /> roadbace -J yLuba#2322 (SRYKHE 21-792802 00014KHE) MANIFEST# <br /> 00 Kettieman lane/CHEROKEE . <br /> odi, CA 85240 <br /> 09-339-0900 <br /> PA*CAL 000182 845 Customer*: 1372!22 Contact:Steven Terms: Net 30 Ren: <br /> CODE DESCRIPTION QTY UNIT PRICE AMOUNT <br /> 50 F restone Prime 50150 AIF -7�' 20, DD <br /> 50 IiA 4ste Antiteoze Pick Up +✓ <br /> Tank Serial Numbers: Non Taxable Sub Total L41x.1 <br /> Taxable Sub Total I <br /> Tax <br /> TOTAL DUE I, , <br /> WASTE DISPOSAL INFORMATION V <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)-NO PLACARDS REQUIRED- STATE CODE 221 <br /> -B�410N-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 /> U-SET INDUSTRIES: 977 South 700 West-Salt Lake City,UT 84104-UTD982589459-(801)977-0220 <br /> f' <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 CCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF� 11S WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S:, <br /> stomer Signature Date,/'' er Signature npte <br /> VV <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 1 112%interest per month,18%annually on unpaid balance. <br />