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2011-00-22 15:04 >> 209 465 1195 IP 13/14 <br /> rl <br /> v 1 U—I V 1187 VANocmi T Cin. #2 <br /> CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> OFFICE: 209.239.5587 <br /> "Your Cslifornia Antifreeze Service Company" FAx: 209-239-$316 <br /> Transporter EPA#CAR000047167 <br /> SERVICE ORDER: <br /> _MANIFEST N _ <br /> 7l <br /> SUICkturt,I_:A 952,-1 <br /> 2, �•,4-7 *qj,*d}`i <br /> FPA .1D CAL i C!:, 106 53;Ct st.twiipr 120v Contact: -7liar!-sAak,11-TPrrm.S;.144A 30R1-P.. � <br /> DESCRIPTIONGODE <br /> 1V _,_77hmR}l77,_PTo L. <br /> 1,50 1,Srssi-�Antiirr ere PI•.U!, <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE I - <br /> WASTE DISPOSAL INFORMATION <br /> 01 NON-RCRA HAZARDOUS WASTE,UOUID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> 41 NON-RCRA HAZARDOUS WASTE,LIOUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE 134 <br /> OTHER:- <br /> 0' DESIGNATEDTSDF: <br /> o EVERGREEN OIL,INC.: 8880 t Ith Avenue•Newark,CA •CADDSM8741e•(510)7E5-4400 <br /> O THERMO FLUIDS: 655 Southnford Way•Sparks,NV 89431 623 <br /> •NVD910711•(776)2104398 <br /> U D/K DIXON: T300 Chevron Way•Dixon,CA 056M-CATOe00128=•(707)u93.6008. <br /> 93.6008 <br /> Cx'RAMOS ENVIRONMENTAL: 151 G.River Road•W.Sacramento,CA 065A1•CAD044003556•(018)371-5747 <br /> /b NU-SET INDUSTRIES: 9T7 So 700 West-Sett Lake City,UT 84104•UTD9t�469•(801)977-0220 <br /> p LT RNATE TSDF: <br /> U CFR: 93210 western Avenue-Unionfty,CA 94587•(510)487-DM <br /> (All Qenerator5/Customaro MUST read the following text.) <br /> M 1 am a large quantity generator,I certify that I have a program In pisce to reduce the volume end toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have eatacted the practicable method of treatment,storage,or dlapoeat currently available to me which mh*Wze the Present <br /> and future threat to human Ilfe and the emrimeet; C,if I em a email quantity generator,I have made a good faith to minimize my waste ponersUon and saleot the <br /> best Waste management method that Is av table to me that I Can afford. <br /> 'I HEREBY CERTIFY THAT I HAVE NOT MIXED 19 WASTE WTrH 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.9'8. <br /> 'I FURTHER AGREE TO ACCEPT THE ONAL CHARGES FOR LEGAL DISPOSAL IF THIS WAM IS OVER)WO RRM,TfJTAL" DES, CON INSANYP.C.D'-3. <br /> Custow1w. Lure Date Drfva re Oet• <br /> print Name Print Drtvoes Name <br /> All returned cnacks are subject to a$15.00 Service Charye, <br /> All amounts not paid within 30 days of Invoice aro aubl•ct to 1 112%interest per month,16%annually on unpaid balance, <br /> if account Is forwarded to collections and or an attorney oustomer will be retiponalMo for ail collection and or attorney fees. <br />