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2011-08-22 13:03 >> 209 465 1195 P 10/14 <br /> CALIFORNIA COOLANT SERVICE <br /> MaN I:cA, CA 19533LT CI 72 <br /> "Your California Antifreeze Service Company" •OWCE: 209-239-5587 <br /> Transporter EPA#CAR000047167 FAx: 209-239-6316 <br /> SERVICE ORDER: <br /> _ MANIFEST N <br /> ��7f?ISlt:lt'1 .'ICE'(S)�.1t�` T'�'�')1 r rSQ•�i�r�) <br /> 1.gcr5 G13rem��h 7>?. /1qJ-, S1,L e �10 ' \ <br /> Pik ID tt _ �rX?1 CP6?30 Cwf.fmles <br /> CODE DESCRIPTION OTY UNIT PRICE AMOUNT <br /> 50:50.A T+ <br /> 7wr5s:c._?-.Lti :eE'44 P ck '5n 1 C, <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total <br /> Tax <br /> TOTAL DUE <br /> WASTE DISPOSAL INFORMATION 7 <br /> O NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL)-NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,U ID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS HEOUIREcO- STATE CODE 134 <br /> THER: ----- <br /> U DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INCT1318, <br /> venue-Newark,CA -CA13980887410-(610)795-4400 <br /> D THERNO FLUIDS; =Southd Way-SpaMs,NV 88431 -NVD9112510711-(775)219-7396 <br /> LJ DIK DIXON: 7300 Cheon,CA 86820-CAT09WI2002-CM 893-8009 <br /> ❑ RAMOS ENVIRONMEiver Road-W�Sacramento,CA 4oWl -CAD0440036W-(916)371-5747 <br /> & NU-SET INDUSTRIES: Wast-Satt Lake City,UT 84101•UTD9825094W•(901)077-OM <br /> u L ATETSDF: <br /> Q CFR: 33210 Western Avenue-Union lty,CA D4587-(310)4874777 <br /> (All 4eneratora/Customers MUST read the following text.) <br /> U 1 am a large quantity generator,I certify that I have a program In piece to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically PreaUCable and that I have eelectod tha practicable method of trmhnent,stwege,or disposal cunwft available to me which minimitA the present <br /> and future throat to human his and the errvirvnment; Or,N I am a small quantity generator,I have made a good faith to minimkze my waste generation and 961W the <br /> m <br /> beet waste manegememethod that Is avallabie to me that 1 can afford. <br /> NOTCON CERTIFY THAT I HAVE NOT MIXED THIS WASTG WITH ANY ODM ,THAT THE TOTAL HALIDES ARE LM THAN 1000 RPM,;AND THAT rilE WASTE DOES <br /> NOT CONTAIN ANY P.C.6'S. �� ` \ <br /> I FURTHER ALAE£TO ACCEPT,>f —p;"AL CHARG41� �DISPOSAL IF THIS WASTE 15,OV A 100 OT ID ,OR CONTAINS ANY P.C.91. <br /> Customer Ignatb�ts' _ Data Date <br /> n <br /> 6Lia <br /> Print Name Print Drrv&r'e Nart►s <br /> All returned Checks era subject to a 916.00 Service Chsrgs. <br /> AII amounts not paid within 90 Gaye of Invoice ere subject to 1 112%Int—so t Per month,Is%annusity,on unpel0 oaten- <br /> If account to lomarded to coilectiorn and or an attorney customer will be responsible for as coltactlon end or attorney feee. <br />