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i <br /> 40 1187 VANDERBILT CIR. #2 <br /> CA ORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> ""Your California Antifreeze Service Company" OFFICE: 209-239-5587FAX: 209-239-6316 <br /> Transporter EPA#CAR000047167 <br /> Customer <br /> - V li V <br /> SERVICE ORDER: G n 4 C <br /> fiM (�WbE�01 0004 ) MANIFEST# <br /> r <br /> remord Ave./Marsh Lane-GON 20T D S 7 � (DS9y3-7AL 0001N 630 Cu omerA 1260 Contact_Charles Baker Terms; Not 30 > '* <br /> .D <br /> 50 Preston-Prime 50/50 AT s'Co .2.21-`0 a <br /> 50 Waste Antikeoz Pick Up AJ <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE lj <br /> WASTE DISPOSAL INFORMATION <br /> D NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)-NO PLACARDS REQUIRED` STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED' STATE CODE 134 <br /> CIL OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880 S ith Avenue-Newark,CA -CAD980887418-(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South St Word 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 84104-UTD982589459-(801)977-0220 <br /> ❑ ALT 13NATETSDF: <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 1 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 HIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.R'S. <br /> '1 FURTHER AGREE L CHARGES FOR LEGAL DISPOSAL IF THIS WA T IS ER 1JP .TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> Customer Signatur Date Dr r Signature Date <br /> Arf <br /> 1' 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 />