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1187 VANDERBILT CIR. #2 <br /> IL ALituRNIA 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: 47451 <br /> Customer <br /> MANIFEST# <br /> cannon fiire �SRYKMEA91288 00003 _ � <br /> 905 Claremont Aire./Marsh L ne - `- Z 1 G�7 <br /> ocldon, CA 85207 <br /> 09-177-9000 <br /> _PA#M 000 106 050 Cuot mor* 1260 Contact: Charles baker Terms: Net 30 Rew: Loma Machado <br /> UODE DESCRIPTIONOTY UNIT PRICE AMOUNT <br /> 7 <br /> 50 Prestone-Prime 5 V50 AtF �' ,� <br /> 50 VNaste Arditreers Ick 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,LIQ1 ID(USED OIL/MIXED OIL)-NO PLACARDS REQUIRED- STATE CODE 221 <br /> Q NON-RCRA HAZARDOUS WASTE,LIOL ID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED` STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ BANGO OIL,LLC: 22211 Bango R ad-Fallen,NV 89406-NVR000080655•(775)852-2295 <br /> 1:1D/K DIXON: 7300 Chevron Way ixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1515 .River Road•W.Sacramento,CA 95691 •CAD044003556-(916)371-5747 <br /> ��_NU-SET INDUSTRIES: 977 South 00 West•Salt Lake City,UT 84104•UTD982589459-(801)977-0220 <br /> ❑ 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 qu 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 afford. <br /> HEREBY CERTIFY THAT I HAVE NOT MIXED 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 ANY P.C.B'S. <br /> 'I FURTHEg.AGREE TO ACCE T ADDIT L CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'. <br /> Customer Signal re 1 _ Date Driver Signature ate <br /> Print Name l PriinntD-rriiverr's Name <br /> GJ'� <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 />