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1187 VANDERBILT CIR. #2 <br /> AL1r,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: 4 9 4 4 .3 <br /> mer <br /> • MANIFEST# <br /> rannon lire (SRYKHE991288 00003 <br /> 905 Claremont Ave. I Marsh L ne <br /> toddon, CA 95207 <br /> 09-477-9000 <br /> �PA*CAL 000 196 530 Cust sr*. 1260 Contact:Charles Baker Terms: Net 30 Rep: Louie Machado <br /> �IODE DESCRIPTIONCITY UNIT PRICE AMOUNT <br /> 150 Prestone-Prime 5 /50 AIF <br /> 50Waste Antifreeze idc Up <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE c <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIOL ID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> a NON-RCRA HAZARDOUS WASTE,LID 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-D xon,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 0 West-Salt Lake City,UT 84104-UTD982589459-(801)977-0220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue-Union City 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 le 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 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 /> FURTHER AGREE TO ACCEPT THE ADDITION L CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signature /bate Driver§gnature Date <br /> LAy <br /> nn 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 />