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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> -Your California Antifreeze Service Com an OFFICE: 209-239-5587 <br /> P Y FAX: 209-239-6316 <br /> t <br /> Transporter EPA#CAR000047167 <br /> ILSERVICE ORDER: 6 0 8 9 7 <br /> 1 O <br /> Customer <br /> The (SRYKHE9912 5400003) MANIFEST# <br /> r <br /> remont Ave./Marsh Lane CA 95207-9000 <br /> AL 000198 530 C omer* 1280 Contact;Charles Baker Terms: Net 30 $� " <br /> CODE DESCRIPTIONCITY UNIT PRICE AMOUN7 <br /> Ifin Proctana-Prime 5"n AAF 33 �1---� /�s`�-=- <br /> 50 Waste Antibreez Pick Up Ll 0 /U C A� <br /> Tank Serial Numbers: Non Taxable Sub Total 'Csq2 <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE C 8 <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 /> ❑ THER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880S ith Avenue•Newark,CA •CAD980887418•(510)795-4400 <br /> L] 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: 1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> �U-SET INDUSTRIES: 977 Sout 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ❑ ALTERNATETSDF; <br /> ❑ CFR: 33210 Western Avenue•Union City,CA 94587•(510)487-9277 <br /> Jel"(e <br /> All Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator, 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 thelected the practicable method of treatment,storage,or disposal currently available to me which minimize the present <br /> and future threat to human life anronment; 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 methodilable to met t I can afford. <br /> '1 HEREBY CERTIFY THAT 1 HAVE NTHIS WAST y H ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S.'1 FURTHER AGREE TO ACCEPT TNAL CHARG S FOR LEGAL DISPOSAL IF THIS WA I�OV 0HALIDES,OR CONTAINS ANY P.C.B'S. <br /> �- ,-7 U <br /> Customer Signature Date Driver Signature Date <br /> 5rUName / 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 />