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1187 VANDERBILT CIR. #2 <br /> ALIfURNIA COOLANT SERVICE MANTECA, CA 95337 <br /> Y"Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#ILCAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: 47979 <br /> Customer <br /> TIn 4sRYKHE�9t'1800003) <br /> MANIFEST# <br /> cannon . <br /> 905 Claremord Aare./Marsh Lone <br /> toddon, CA 95207 <br /> 09-477-9000 <br /> PA#CAL 000 198 530 Cust I <br /> mer 1280 Contact_Charles Baker Terms: Net 30 Rep. Louie Machado <br /> CODE DESCRIPTIONQTY UNIT PRICE AMOUNT <br /> 150 Prestone-Prime 0/50 AIF <br /> 30 Wablu Antifreeze F4ck Up <br /> Tank Serial Numbers: Non Taxable Sub Total vU <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE I yU <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIO JID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED- STATE CODE 221 <br /> ,..b. 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 R ad-Fallen,NV 89406-NVR000080655•(775)852-2295 <br /> ❑ D/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 Cl ,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 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 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 ntity generator,1 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 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 <br /> I FURTHER AGREE TO ACCEPT THFDDITIO L CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> r , <br /> Customer Signature Date TJKM s Ignature Date <br /> rint 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 />