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1187 VANDERBILT CIR. #2 <br /> IL AtiFuRNIA 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: 46921 <br /> Customer <br /> MANIFEST# <br /> rsnnon Tin (SRYKNE991288 00003) <br /> 905 Claremont Ave.I Marsh L ne <br /> toddon, CA 95207 <br /> 09.477-9000 <br /> PA*CAL 000 196 530 Custo or#-. 1260 Contact: Charles Baker Terms_ Not 30 Raw. Louis Machado <br /> �,-ODE DESCRIPTIONOTY UNIT PRICE AMOUNT <br /> 50 Prestone- Prime 5 /50 AIF <br /> 50 Vhste Antifreeze ldt Up ;z <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> 1 <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQl.ID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED- STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQt ID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ BANGO OIL,LLC: 22211 an lo <br /> R ad•Fallen,NV 89406-NVR000080655•(775)852-2295 <br /> ❑ D/K DIXON: 7300 Chevron Way D xon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 .River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> d NU-SET INDUSTRIES: 977 South 0 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> 0 ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union Ci 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 h ve 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 practic ble 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 qua tity 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 affordZE <br /> I HEREBY CERTIFY TD T IS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN A/P.C.B'S.FURTHER,CAION L CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> i <br /> 'i <br /> 6usfo er Signature Date Driver ' eture Da,e <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid wit in 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />