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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOT iT SERVICE MANTECA, CA 95337 <br /> "Your California AntifreE Service Company" OFFICE: 209.239-5587 <br /> Transporter EPA# )00047)67 FAX: 209-239-6316 <br /> SERVICE ORDER: 4 9 7 2L' <br /> Customer <br /> rannon Tire (SRYKHE99128 5400003) MANIFEST# <br /> 905 Claremont Awe./Marsh one J "' - <br /> oddon, CA 95207 <br /> 09.477-9000 <br /> PA*CAL 000 196 530 Cus mer#: 1260 Contact: Charles Baker Tens: Net 30 Rep: Louie Machado <br /> CODE DESCRIPTION QTY UNIT PRICE AMOUNT <br /> 50 Prestone-Prime 0/50 A,r. �( <br /> 50 Waste Antifreeze Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total <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 /> J NON-RCRA HAZARDOUS WASTE,LI UID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED` STATE CODE 134 <br /> J OTHER: <br /> J DESIGNATEDTSDF: <br /> J BANGO OIL,LLC: 22211 Bango oad•Fallen,NV 89406 NVR000080655•(775)852-2295 <br /> J 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 /> J NU-SET INDUSTRIES: 977 Sout 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> J ALTERNATETSDF: - -- <br /> J CFR: 33210 Western Avenue•Union C ,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 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 practi able 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 antity 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 /> 'I HEREBY CERTIFY THAT I HAVE NOT MIXED HIS 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 ACC I L CHA ES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. g <br /> Customer Signature Date Driver Signal Date <br /> I Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid w thin 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />