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2011-00-22 13:03 >> 209 465 1195 P 9/14 <br /> 1187 VANDERBILT CIR. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> OFFICE: 209-239-5587 <br /> "Your California Antifreeze Service Company" FAX: 209-239.6316 <br /> Transporter EPA#CARD00047167 <br /> SERVICE ORDER: y. <br /> Srarawn Tire i liTffT_CS991266540Ci00 ) MANIFEST>� <br /> 4905 C!arffncT. a 11,rru 'M8rsh 1-41e <br /> Storetm-� C.y 95207 <br /> ZG9-PI-9000 w <br /> PR4,Its 4: (-"AL C Q 196 5 ;)CuTim ler4' 1260 'intact: Cli leaB3icirTetnw Diet 3G <br /> tiJ �,gnr.iil ezaFi -U9 <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUI; <br /> WASTE DISPOSAL INFORMATION STATE CODE 221 <br /> O NON•RCRA HAZARDOUS WASTE,U ID(USED OIL/MIXED OIL)-No PLACARDS REouIRED' STATE CODE 134 <br /> p NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' <br /> U OTHER:-.--.-- <br /> D <br /> THER: -•❑ DESIONATEDTSOF: <br /> ❑ EVERGREEN OIL,INC.: 9880 8 Ith Avenue•Newark,CA -CATAIS•(310)TSG 4400 <br /> ❑ THERMO FLUIDS: SW South 6 mord Way-Sparka.NV 580.11•NVDQM10711•(778)218-7390 <br /> ❑ D/K DIXON; 7300 Chevron Way•Dixon.CA OW20•CATOSWI2802•(70710836009 <br /> U RAMOS ENVIRONMENTAL: 15 5 S•Rtver Road-W.Sacramento.CA 95WI-CA00"OOM 8•(018)371-5747 <br /> ❑ NU-SET INDUSTRIES: 977 30 700 Went'Salt Lake Cky,UT 84104-UT04BY390A3a•(8011 9 77-0220 <br /> ❑ ALTERNATETSDF: <br /> ❑ CFR: 33210 Western Avenue-Urge Cky,CA 04387•1510)4 '> n <br /> (All(ieneratora/Customers MUST read the following tent.) <br /> I c that I have s 0mgram in Piaua to►educe the volume and toxicity of wpets gerwvted to the degree 1 have determined to be <br /> if I am a lame 4ua�gen•r�' car" hal the Practicable rent,etora9e,or dteooeai wmentlY evaWbie to me vrA9ch minM++i=•the present <br /> ecortomically practicable and that I have •d Or• mor I twee made a 9o0d faith l0 minimize my waste gatleratkxt end eebct tfia <br /> and future threat to human fife and the an ironnwt; or,H I am a small vua,"y D <br /> beet weate management method that Is ayailabie to me Chet I can Rfford. <br /> 11 HERESY CERTIFY THAT i NAYS NOT Mr1:4p TE THIS W� WITH ANY OTHER WA`iTE,TNAT T11E TOTAL NALIDGS ARG LE53 THAN 1000 P.P.M AND THAT THE WASTE DOS <br /> NOT CONTAIN ANY P.C.0'8. �ppp <br /> POSAL IF TTt13 WASiIZ iS,OVd P. M.T TAl tSI�LID�r OR CONTAINS,ANY RC.B'9. <br /> •1 FURTHER AGREE TO ACCEPT T11TIONAL CHARGES FOR LEGAL DIS � // <br /> Date <br /> Cuatormir Sig Geta Driver Signature <br /> 5' Print DrlvGe4'Erna <br /> Print Name <br /> All r9tuned checks aresubject <br /> ct 101t1/2%Interest per moot,F%annually On unpeld belea.ce. <br /> AllamouMs not Paid within 30 days of Invoice ere subJect fa 1 <br />