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1187 VANDERBILT CIR. #2 <br /> Alit-dNIA COOLANT SERVICE MANTECA, CA 95337 <br /> Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Fax: 209-239-6316 <br /> Transporter EPA#CAR000047167 <br /> SERVICE ORDER: 46975 <br /> I697t5 <br /> Customer <br /> n.Tln MANIFEST#(SRME991288 00003) _ <br /> 905 Claremont Ave./Marsh L ne <br /> Stockton, CA 95207 <br /> 09.477-900L <br /> PA*CAL 000 196 530 Cust mer* 1260 Contact;Charles Baker Terms: Net 30 � Louie Machado <br /> •DDESCRIPTION QTY UNIT PRICE AMOUNT <br /> 50 Prestone-Prime 5 /50 AIF <br /> 50 Waste Antifreeze I&Up <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQt ID(USED OIL/MIXED OIL)-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 /> ❑ BANGO OIL,LLC: 22211 Bango Road•Fallen,NV 89406•NVR000080655-(775)852-2295 <br /> ❑ D/K DIXON: 7300 Chevron Way xon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515S.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 /> ❑ ALTERAWETSDF: <br /> ❑ CFR: 33210 Western Avenue•Union Ci CA 94587•(510)487-9277 <br /> Lha,r <br /> erators/Customers MUST read the following text.) <br /> If I am a large quantity generator,I certify that ram 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 practid 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 qator,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 /> HEREBY CERTIFY THAT I HAVE NOT MIXED 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 /> FURTHER AGREE TOA CEPTTHEADDITTES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P C.B'S. <br /> D <br /> Custome Signaturea re Date <br /> ame / Print Dnver's Name <br /> lAll 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 />