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1187 VANOERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> tIL "Your California Antifreeze Service Comp an OFFICE: 209-239-5587 <br /> ! Transporter EPA#CAR000047167 y FAX: 209-239-6316 <br /> SERVICE ORDER: 56502 <br /> Customer <br /> rannon Tire (SR YKHEgg 126 5400003) MANIFEST# <br /> 905 Claremont Ave. /Marsh ane ( �, �; n - l lat' <br /> ockton, CA 95207 U <br /> 09.477-9000 <br /> PA*CAL 000 196 530 Cu omer*: 1260 Contact: Charles Baker Terms_ Net 30 Rep; Louie Machado <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUNT <br /> ec <br /> 150 Presion - Prime §0150r <br /> 50 v taste Antifreeze Pick Up <br /> Tank Serial Numbers: Non Taxable Sub Total / '] v <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE / '� I 2 b <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)-NO PLACARDS REQUIRED- STATE CODE 221 <br /> Q NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE 134 <br /> ❑ THER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880 Srr)ith Avenue•Newark,CA •CAD980887418•(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South StInford Way•Sparks,NV 89431 •NVD982510711 •(775)219-7396 <br /> 0\,D/K DIXON: 7300 Chevron Way I Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL: 1511 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 South 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. <br /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXED HIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PRIM.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'&-' / ---- — — — — --__ —.-- — <br /> 'I FURTHER AGREE TO ADDITIO AL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.T AL HA ES,O CONTAINS ANY P.C.B'S. <br /> z3 , <br /> Customer Signature Date Driver Signature Date <br /> 0r t"Name Print Driver's 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 1/2%interest per month,18%annually on unpaid balance. <br />