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00 1187 VANDERBILT CIR. #2 <br /> LI 'ORNIA COOLA ERVICE MANTECA, CA 95337 <br /> OFFICE: 209-239-5587 <br /> ""Your California Antifreeze. company"' Fax: 209-239-6316 <br /> Transporter EPA#CAR( <br /> IL <br /> SERVICE ORDER: �! �.4 3 <br /> Customer <br /> rannon Tfre(SRYKHE991MANIFEST# <br /> 2 5444443) 3 Co�,��S�-(� <br /> 905 Claremont Are.I Marsh one <br /> oMon, CA 95207 <br /> 9.477-9000 <br /> PAE CAL 000 198 534 C omertlk 1280 Contact;Cherie:Baker Tennsi Net 30 &C. Louis Machado <br /> CODE DESCRIPTIONOTY UNIT PRICE AMOUNT <br /> 151) Prattano-Primp 5W50 A/F <br /> J50 Waste Antlfreez Pill;U /V C_ /� Q__ <br /> Tank <br /> - <br /> Tank Serial Numbers: Non Taxable Sub Total Z <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 /> J DESIGNATEDTSDF: <br /> J EVERGREEN OIL,INC.: 6880 Smith Avenue•Newark,CA •CAD980887418•(510)795-4400 <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 /> ❑ RAMOS ENVIRONMENTAL: 1515 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 /> ❑ ALTERNATE TSDF: _ <br /> J CFR: 33210 Western Avenue•Union City,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. <br /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXED 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 TOO TTH LDITI NAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE W.000 P :M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signature _ Date Driver St ature Date <br /> i <br /> PrihO Name Print Driver's Name <br /> All returned checks are subject to a S15.00 Service Charge. <br /> Allamounts not paid within 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />