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03-22 13:01 >> 209 465 1195 P 1/14 <br /> MEN1187 VANDERBILT CIA. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> our Cafifvrnia Antifreeze Service Company" Omcc 209.239.5587 <br /> Transporter EPA#CAR000047107 FAX: 209-239.6316 <br /> SERVICE ORDER: <br /> ■ ^66.5M1 ,.. ti, / MANIFEST <br /> 41o1 �i CEtt1��1L �V�. ,'M3f`11Y_i111Q 1 I�� �� KI <br /> Stol kr.an,r fS P52,0'' V `-' <br /> :�9-4'77-0-h }(? <br /> FPA ID A Co!, 0 196 570 f"a1. 'rlmer It. 1260 C'ui"cL- C-risrin F9ka Tetms�-Kcx 30hem <br /> CODE DE.SCHIP I ION QTY UNII PRICE AMOUNT <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION <br /> O NON-RCRA HAZARDOUS WASTE,UO XD(USED OIL I MIXED OIL)*NO PLACARDS REOUIRED- STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIO. ID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED' STATE CODE 134 <br /> OTHER: . <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 0880 Smith Avenue-Newark,CA -CA0980887418-(510)796-4400 <br /> ❑ THERMO FLUIDS: 6M South fateord Way-Spark5,NV 88131-NVD0a2610711-(775)218-7398 <br /> ❑ D/K DIXON: 7900 Chevron Way-Dixon,CA 05M-CATMWI2W2-(TOT)82a-O C8 <br /> /UQ RAMOS ENVIRONMENTAL: 151 S.River Road-W.Sacramento,CA 9W1-CAD044003558-(910)371-5747 <br /> ALANU-SET INDUSTRIES: Gd <br /> 77 Snh 700 Wast-gait Lska City,UT 84104-UTDOB259B459-(801)977.0220 <br /> ❑ AL RNATETSDF; <br /> O CFR: 33210 Western Avenue-Union 61ty,CA WW7-(510)4874277 <br /> (All Gienorators/CUstomGre MUST road the following text.) <br /> !a Vrs 1 have determined to fH <br /> H I am a large auent►ty gwmMor,I certify t let,have a Program in piece to reduce the volume and toxloity of waste gonw*ed degree <br /> economically practicable end that I have ed the precKcable method of Uvatment,storage,or disposal currently aystlanle to me wMch minim"the peasant <br /> and future threat to human Isle and the env( meet Or,H I em a smell quanft generator,I have made a good raft to minlmtze my waste generation and select the <br /> best waste management method that is av7blo to me that I can afford. <br /> '1 N�AE9Y CaRh�rtU►T 1 HAVE NOT MIXED THIS WAt3TL!flfWi AMY OTHER WASTE,THAT THE TOTAL HALIDES ARE LM THAN 1000 RPM.;AND <br /> THAT THE WASTE DOES <br /> NOT CO�IFTAIyAN�PC,6'8 <br /> `I FyATMER AOREEy�O AC�tPT ZONAL CHAROFS FOR L GAL OMPOSAL IF THIS Waw 13 p. RP l S. R CONTAINS ANY P.C.a'9, <br /> Date <br /> 1 <br /> C`ttstomer Signature Date Driver Signature <br /> Print DMer's Nam <br /> Print Name <br /> All retumd shacks are eutXect toe 615.00 Service Charge. <br /> All amounts not paid irlthin 30 days of Invoke are subject to 11/2%interest Per morrth,48%annually on unpaid balance <br /> if amoum Is rorwardsd to colioctfars and or an attorney cuatOIW will be rstgdtside for all corlaotion and or attorney fees. <br />