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1187 VANBERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE A MANTECA, CA 95337 <br /> OFFICE: 209-239-5587 <br /> Your California Antifreeze Service Company" FAX: 209-239-6316 <br /> Transporter EPA#CAR000047167 <br /> SERVICE ORDER: 49206 <br /> Customer <br /> r"Tin(BRYXHEl119 5400003) MANIFEST# <br /> Claremord Ave./Marsh ane % %� S <br /> on, CA 85207 <br /> 77-9000 <br /> PA#CAL 000 198 530 Cust mar* 1280 Contact: Charles Baker Terms: Not 30 Rw. Loins Machado <br /> �$ �fEt8A8=Pile 0/50 AIF <br /> Big MOO ARtifrme Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total - C <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> J NON-RCRA HAZARDOUS WASTE,LI UID(USED OIL/MIXED OIL)-NO PLACARDS REQUIRED- STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LI UID(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 Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> J RAMOS ENVIRONMENTAL: 151 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> (TERNATETSDF:- <br /> NU-SET INDUSTRIES: 977 Sout 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ❑ A <br /> ❑ CFR: 33210 Western Avenue•Unionty,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 have 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 pra 11 <br /> cable 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 q entity 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 /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXEC THIS 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 FURTHER AGREE TO ACCE DDITI L CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 100�,P A.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signature Date DriverSign Date <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid ithin 30 days of invoice are subject to 1 1/2%interest per month,18°%an on unpaid balance. <br />