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1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> ILI "Your California Antifreeze Service Company" OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAX: 209-239-6316 <br /> SERVICE ORDER: <br /> Customer <br /> Brennen Tire f;SRYKHH991 3) MANIFEST# <br /> 4905 Clwvmc Lt Ave. /Marsh <br /> Stodwri,CA 95207 <br /> 209-477-9000 <br /> FPA ID#- CAL 000196 530 Omer# 1260 Contact Charles Baker Terms Net 3 <br /> DESCRIPTIONCODE • <br /> 150 CCS Prime 50/50S✓ C9 <br /> 050 Waste Artifreme P ido Up <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE (jam <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 /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880S nith Avenue•Newark,CA •CAD980887418•(510)795-4400 <br /> J 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: 15 5 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 Sou h 700 West•Salt Lake City,UT 84104•UTD982589459•(801)977-0220 <br /> ALTERNATE TSDF: <br /> l+ 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 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 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 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 P.C.B'S. <br /> '1 FURTHER AGREE TO ACCEPT DITI NAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OV 1 ORP. TOTAL HALIDES,OR CONTAINS ANY RC.B'S. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Driver's Name <br /> All returned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid ithin 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance, <br />