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p 1187 VANDERBILT CIR. #>E2 <br /> ALIT uRNIA 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: 45625 <br /> Customer <br /> MANIFEST# <br /> Brannon 11n(SRYKHE991286 00003) _ <br /> 905 CTkremoW Aim.[Mash LW* S��'''S 16—ockton, CA 95207 <br /> 09-477-9000 <br /> PA*CAL 000 198 530 Cust msr* 1280 Contact_Charles Baker Terms_ Net 30 61p. Louis Machado <br /> �,-ODE DESCRIPTIONQTY UNIT PRICE AMOUNT <br /> 150 Prestone-Prime 0/50 AIF <br /> 50 Waste Antifreeze Pick Up , <br /> Tank Serial Numbers: 4� <br /> Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> >U <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQ JID(OILY WATER)'NO PLACARDS REQUIRED- STATE CODE 221 <br /> _NON-RCRA HAZARDOUS WASTE,LIQ ID(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 WayDixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556-(916)371-5747 <br /> 0 NU-SET INDUSTRIES: 977 South 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union Ciiy,CA 94587•(510)487-9277 <br /> (All Generators/Customers MUST read the following text.) <br /> If I am a large�4antity generator,I certify that I ave 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 i11e 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 rHIS 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 ACC PT THE ADDITIO 4AL CHARGES FOR/LEG/3ALISPAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS Y P.C. 'S. <br /> Customer ignature D' 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 w thin 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />