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I <br /> 1187 VANDERBILT CIR. #2 <br /> CALIFORNIA 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: <br /> 51448 <br /> Customer <br /> non Tire(SRYKNE991266 00003) �} MANIFEST# <br /> r <br /> Claremont Ave./Marzh ne f � n I t, � -7 L <br /> don, CA 95207 nnbl`�477-9000 `� <br /> PA*CAL 000 190 530 Cust er* 1260 Cofrtiet_Charles Baker Terms_ Net 30 Roo: Louie Machado <br /> CODE DESCRIPTIONCITY UNIT PRICE AMOUNT <br /> 50 Prestone-Prime I W50 AT f <br /> 50 IWaste Antikeeze 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,LIQt ID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> �4' NON-RCRA HAZARDOUS WASTE,LIQ1 ID(ETHYLENE GLYCOL SOLUTIONS)*NC,PLACARDS REQUIRED' STATE CODE 134 <br /> J OTHER: <br /> • DESIGNATEDTSDF: <br /> • BANGO OIL,LLC: 22211 Bango R ad•Fallen,NV 89406-NVR000080655•(775)852-2295 <br /> 7 D/K DIXON: 7300 Chevron Way• 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 /> U ALTERNATETSDF: <br /> CFR: 33210 Western Avenue•Union CiCA 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 environmer ; 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 /> I FURTH 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 Date Driver Siparfure. Date <br /> i <br /> , <br /> r 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 />