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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" OFFICE: 209-239-5587Fax: 209-239-6316 <br /> Transporter EPA#CAR000047167 <br /> Y <br /> SERVICE ORDER: 55883 <br /> Customer <br /> MANIFEST# <br /> non Tire (SRYKHE991 5400003) 0d ,S -7 7> Co <br /> rdei)�5 <br /> Claremont Ave.!Marsh one O <br /> don, CA95207 <br /> 77-9000 <br /> PA*CAL 000 198 530 Cu or*. 1260 Contact_Charles Balser Terms_ Net 30 Rea, Louie Machado <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> 0 Waste Antifreeze Pick Up /AJ C IeV C <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> ❑ 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 /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880S ith Avenue-Newark,CA -CAD980887418-(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South St nford Way-Sparks,NV 89431 -NVD982510711-(775)219-7396 <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 64104-UTD982589459-(801)977-0220 <br /> C] ALgER NATETSDF: <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 t at 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 s lected 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 envi onment; 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 av ilable to me that I can afford. <br /> '1 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 RC.B'S. <br /> 'I FURTHER AGREE TO- PT THE ADDITI NAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OV 1 0 P. .TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> 111qk) <br /> Customer Signature Date Dri r/SSiignature Date <br /> ame Prin 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 />