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1187 VANDERBILT CIR. #2 <br /> CALIHRNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "r "Your California Antifreeze Service Y <br /> Com an OFFICE: 209-239-5587 <br /> Company" <br /> Transporter EPA#CAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: 57253 <br /> Customer <br /> MANIFEST# <br /> cannon Tire (SRWHE9912 5400003) 1 <br /> !05 Claremont Ave./Marsh Lane n <br /> oddon, CA 95207 <br /> 9-477-9000 <br /> At CAL 000 198 530 Cu Omer t 1280 Contact_Charles Baker Terms: Net 30 Rep; Louie Machado <br /> CODE DESCRIPTIONCITY UNIT PRICE AMOU"N. <br /> 50 Waste Antilresz Pick U d N C Uv <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total w` <br /> Tax <br /> TOTAL DUE �3 6J <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,Ll )UID(UD OIL/MIXED OIL)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> _ \ TYLENE <br /> NON-RCRA HAZARDOUS WASTE,LI UID(EGLYCOL 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 S anford 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 /> (_q 111U-SET INDUSTRIES: 977 Sout 1 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ❑ ALTER\\NATETSDF: <br /> ❑ 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 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 elected 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 en ronment; Or,if 1 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 a ailable to me that I can afford. <br /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXE 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 RC.B'S. <br /> '1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE I O R 1000 .P. . OT ALI S,OR CONTAINS ANY RC.B'S. <br /> /V 7, �Iew <br /> CLM o/rftr Signa / Date Driver gnature Date <br /> &iDoName 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 />