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1187 VANDERBILT CIR. #2 <br /> ALI NIA COOLANT SERVICE MANTECA, CA 95337 <br /> -Your L nia Antifreeze Service Camp an OFFICE: 209-239-5587 <br /> •r <br /> Irarlsporter EPA# CAR000047167 Y FAX: 209-239-6316 <br /> SERVICE ORDER: b'' <br /> 5 _ r <br /> Customer <br /> 'tire (SRYKHE99128 5400003) MANIFEST# <br /> Cmo <br /> larent Ave./Marsh one <br /> o Mon,CA 95207 <br /> 09-477-9000 <br /> PA*CAL 000 198 530 Cu omen: 1280 Contact:Charts: Baker Terms: Net 30 Rep: Louie Machado <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUN7 <br /> Z -- <br /> AL50 AN <br /> 50 Waste Antifreeze Pick U �C <br /> zt <br /> Tank Serial Numbers: Non Taxable Sub Total 7Q_ <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE Z35ZLL.. <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED- STATE CODE 221 <br /> J -NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED- STATE CODE 134 <br /> ❑ OTHER:_ <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880S ith Avenue•Newark,CA •CAD980887418•(510)795.4400 <br /> I ❑ BANGO OIL,LLC: 22211 Bango Road•Fallen,NV 69406•NVR000080655•(775)852-2295 <br /> ❑ D/K DIXON: 7300 Chevron Way Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ( ❑ RAMOS ENVIRONMENTAL: 151 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> �&,NU-SET INDUSTRIES: 977 Sout 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ❑ ALTERNATETSDF: _ <br /> ❑ CFR: 33210 Western Avenue•Union ity,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 <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present <br /> and future threat to human life and the environment; Or,if I am a small quantity generator,I have made a good faith to minimize my waste generation and select the <br /> best waste management method that is available to me that I can afford. J <br /> '1 HEREBY CERTIFY THAT 1 HAVE NOT MIXE THIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. __ __ —- -- --- ----- — --- --- <br /> I FURTHER AGREE TO ACCEPT THE ADDITI NAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE I OVER 1 P.M TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> t-I'I-- 0 j <br /> Customer Signature Date Driver Signature Date <br /> AAiKI. L, <br /> 9MName Print Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid Within 30 days of invoice are subject to 1 1/2o%interest per month.18%annually on unpaid balance. <br />