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1187 VANOERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> "Your California Antifreeze Service Company" <br /> OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: 61515 1 G 1 C <br /> Customer MANIFEST# • <br /> Tire (SRYKHE99128 5400003) OO <br /> rPA. <br /> remon#Are.!Msrsh Lane CA 95207 <br /> -0000AL 000198 530 C *mar t. 1280 Contact;Charles Baker Terms_ Net 30 ftpl ** <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUN7 <br /> I Sin Proatnnp Pn*mo 50160 AIF S71 <br /> 50 Waste Alntitreez Pick U `�J AJ C N C <br /> Tank Serial Numbers: Non Taxable Sub Total /$ y <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE L(O <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,L UID(USED OIL/MIXED OIL)`NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,L UID(ETHYLENE GLYCOL SOLUTIONS)`NO PLACARDS REQUIRED- STATE CODE 134 <br /> J OTHER: <br /> Cl DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880 S nith Avenue•Newark,CA •CAD980887418•(510)795-4400 <br /> THERMO FLUIDS: 655 South Sanford 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: 15 5 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> NU-SET INDUSTRIES: 977 Sou In 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> OALT TE TSDF: <br /> O 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 hat 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 ironment; 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 ail able 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 RPM.;AND THAT THE WASTE DOES <br /> NOT CON NY P.C.B'S. <br /> '1 FURTHE{{ A�� EE TO ACCEPT THE ADDI NAL CHARGES FOR LEGA SPOSAL IF THIS WASTE 1 O F}-1 RM. A AL S,OR CONTAINS ANY P.C.B'S. <br /> Customer Sign ture Date Driver Signatu`re/ Date <br /> r l � <br /> 6rOName Print river's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid i fithin 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />