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�j� 1187 VANDERBILT CIR. #2 <br /> CrAlRNIACOOLANT SERVICE �� MANTECA, CA 95337 <br /> v <br /> Your California Antifreeze Service Cam an ���; OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 P y ,v " FAX: 209-239-6316 <br /> SERVICE ORDER: 58 J L <br /> tomerCu <br /> cannon Tiro (SRYKHE99128 5400003) MANIFEST# <br /> 5 Claremont Ave./Marsh ane <br /> Stoddon, CA 95207 <br /> 209-4774M <br /> A#CAL 000 198 530 Cu I <br /> omer#: 1260 Contact;Charles Baker Terms: Net 30 <br /> CODE DESCRIPTIONQTY UNIT PRICE AMOU <br /> 150 Prestone-Prime 50/50 AIF <br /> 50 Waste Antiftez Pick Up <br /> Cd <br /> p r 'a3 Zo <br /> So l.eS,o* ff 50LA <br /> o c a s ; f Sd h e /JC-- <br /> a <br /> Tank Serial Numbers: Non Taxable Sub Total <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 /> �VNON-RCRA HAZARDOUS WASTE,LI UID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED` STATE CODE 134 <br /> U\—OTHER: <br /> J DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880 S ith Avenue•Newark,CA •CAD980887418•(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South St nford Way•Sparks,NV 89431 •NVD982510711 •(775)219-7396 <br /> J 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 /> !`�—W41-SET INDUSTRIES: 977 Sout 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ❑ ALTERNATETSDF: <br /> J 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 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 env ronment; 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 a ilable to me that I can afford. <br /> I 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 R0-la'S. <br /> 'I FURTHER AGREE TO ACCEPT THE AD I NAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS /100 P.M.. TOTA IDE OR CONTAINS ANY P.C.B'S. <br /> Lr Signature Date Drive)I-Kgnature Date <br /> (,-� srZ_e <br /> , Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid v ithin 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />