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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLY MANTECA, CA 95337 <br /> "Your California Antifreeze S. <br /> OFFICE: 209.239-5587 <br /> Transporter EPA#CARD' c FAX: 209-239-6316 <br /> 0 <br /> SERVICE ORDER: 50253 <br /> Customer <br /> rd <br /> non Tire(SRYKHE99126 5400003) MANIFEST# <br /> Claremont Ave./Marsh anecton, CA 85207 <br /> 477-9000 <br /> PA*CAL 000 198 530 Cust mer* 1280 Contact: Charles Baker Terms__ Net 30 Rep: Louie Machado <br /> CODE DESCRIPTIONAMOUNT <br /> 50 Prestone-Prime 0/50 AIF ��Cv <br /> 50 Waste Antltreeze Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total /ewe <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> J NON-RCRA HAZARDOUS WASTE,LIQ AD(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED- STATE CODE 221 <br /> OWRCRA HAZARDOUS WASTE,LIQ ID(ETHYLENE GLYCOL SOLUTIONS)`NO PLACARDS REQUIRED- STATE CODE 134 <br /> J OTHER: <br /> J DESIGNATEDTSDF: <br /> J BANGO OIL,LLC: 22211 Bango R ad-Fallen,NV 89406-NVR000080655-(775)852-2295 <br /> J D/K DIXON: 7300 Chevron Way- Non,CA 95620-CAT080012602-(707)693-6008 <br /> J RAMOS ENVIRONMENTAL: 1515 .River Road-W.Sacramento,CA 95691 -CAD044003556-(916)371-5747 <br /> _-tl 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 /> (AII Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator,I certify that I 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 /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXED T IS ASTE W NY 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 TOA PT THE ITION L RGES FOR LEGAL DISPOSAL}F THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C. . <br /> uS50Tl61 Signature Date ure Date I <br /> r ame Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid witIin 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />