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BRANCH 7142 CSG 24 pflores, 03/02/10 15:40 PAGE 1
<br />Safety-Kleen Systems, Inc.
<br />5360 Legacy Drive.
<br />Building 2, Suite 100
<br />Plano, Texas 75024
<br />800-669-5740
<br />CUSTOMER# 29592b8 MUFFLER PLUS REFERENCE NBR.
<br />3408 E Main St # C5028428S
<br />-6634
<br />Stockton CA 95205 SRVC WEEK: 2010-30
<br />SRV( DATE: 03/02/10 1S:40,
<br />V NIMPURCHASE ORDER# PHONE 209 351-3981
<br />O TAX EXEMPTION N
<br />tLU
<br />� SERVICE/ PRODUCT/SERVICES
<br />C=.,!= PRODUCT TOTAL 1
<br />r7 r,Lu QVY UNIT PRICE TAX CHARGE
<br />12286/ i
<br />875480 LANUF NON USUOT HAZMAT, N 1.000 225.9000 0.00 225.90
<br />SERVICE TERM 8
<br />PROMO NOR: 0UJI I
<br />►`' (—fJ't 100001 FtE, FUEL SURCHARGE 1.000 12.1500 0.00 12.15 1
<br />0 h C- TOTAL SERVICE/PRODUCTS ---------
<br />238.0500 0.00 238.05 t
<br />U..t
<br />TOTAL CHARGE 238.05 .i
<br />CREDITS 0,00 1
<br />---------------
<br />TOTAL DUE 238,05 d
<br />------ U,
<br />UNPAID BALANCE THIS RECEIPTR
<br />238.05 N
<br />3
<br />3
<br />Pet, SK BOG 0250-001 Customer has comPleted the Customer Pack inu 3
<br />Certification Form. k
<br />GENERATOR STATUS as
<br />0 - 220 lbs/month So'
<br />Customer certifies that (i) the above-named materials Are pruperly
<br />classified, Packaged, marked and labeled, and are in proper condition
<br />for transportation according to the applicable regulations of the
<br />Department of Transportation and (ii) no material change has occurred
<br />either in the characteristics of the waste/material or in the process
<br />generating the waste/material. Customer agrees to pay the above
<br />charges and to be bound by the terms and conditions (1) set forth in
<br />(a) the General Terms and Conditions provided separately to Customer E
<br />or (b) any SK agreement signed by Customer and SK, and (2) O
<br />incorporated herein by reference. Unless otherwise indicated in the 4A
<br />payment received section, SK is authorized to charge Customer's
<br />account for this transaction. Custmner certifies that the individual a1
<br />signinu this Service Acknowledgement is duly authorized to sign and OJ
<br />bind Customer. Tire following provision is applicable to Safety-Kleen's
<br />Parts cleaner and paint gun cleaner. services: Customer agrees that it
<br />will not introduce any substance into the solvent Or aqueous cleaning
<br />solution, includiny without limitation any hazardous waste orhazdr-ditus la
<br />incidents waste constituent, except to the extant sudr introduction is d
<br />incidental to the normal use of the machine. Customer further agrees
<br />that it Will not clean parts,pairt guns that h.xve be..; carta::inatad A
<br />with or otherwise introduce Polychlorinated biphenyls (PCB's), re
<br />herbicides, Pesticides, dioxins or listed hazardous waste into the
<br />solvent or aqueous cleaning solution. Safety-Kleen has the capacity 3
<br />and is Permitted to accept, store, and/or reclaim the spent parts 3
<br />washer solvent; paint thinners, solvents and paints generated by
<br />customer; or dry cleaning filter cartridges, powder, and still
<br />residues containing perchloroethylene, petroleum naphtha, or
<br />triflurotrichloroethane dry cleaning solvents. Safety-Kleen and
<br />customer' agree that this agreement is intended to satisfy the ea
<br />m
<br />requirements of 40 CFR 262.20(e). IN THE EVENT OF AN EMERGENCY CALL s
<br />1-800-468-1760 (24 hours)
<br />ii
<br />eaLl
<br />NON RCRA HAZARDOUS WASTE LIQUIDS
<br />(OILY PIT SLUDGE AND WATER)
<br />FEDERAL WASTE CODES NONE
<br />STATE WASTE CODES 222
<br />TOTAL CONT 1 TYPE DM WT/VOL P SKDOT 400082
<br />CNT*: 100302642314 QTY: 75 PROFILE: 012286 CA CAI CODE:a
<br />DESIGNATED FACILITY NAME/ADDRESS:
<br />US ECOLOGY NEVADA
<br />11 MILES S OF BEATTY HWY 95
<br />BEATTY NV 89003
<br />FACILITY USEPA ID NO NVT330010000
<br />FACILITY STATE ID NO
<br />Per SK mngr
<br />BOG 0250-001 Customer has coleted the Customer Packing
<br />Certification Form.
<br />GENERATOR STATUS
<br />0 - 220 lbs/month
<br />Customer certifies that (i) the shove -nand materials are properly
<br />classified, packaged, marked and labeled, and are in proper condition
<br />for transportation according to the applicable regulations of the
<br />Department of Transportation and (i i) no material change has Occurred
<br />either in the characteristics of the waste/material or in the process
<br />generatinu the waste/material. Customer agrees to pay the above
<br />charges and to be bound by the terms and conditions (1) set forth in
<br />(a) the General Terms and Conditions provided separately to Customer
<br />or (b) any SK agreement signed by Customer and SK, and (2)
<br />incorporated herein by reference. Unless otherwise indicated in the
<br />payment received section, SK is authorized to charge Customer's
<br />account for this transaction. Customer certifies that the individual
<br />signing this Service Acknowledgement is duly authorized to sign and
<br />bind Customer. The following provision is applicable to Safety-Kleen's
<br />parts cleaner and paint gun cleaner services: Customer agrees that it
<br />will not introduce any substance into the solvent or aqueous cleaning
<br />solution, including without limitation any hazardous waste or
<br />hazardous waste constituent. except to the extent sudr introduction is
<br />incidental to the normal use of the machine. Customer further agrees
<br />that it will not clean parts/paint guns that have been contaminated
<br />with or otherwise introduce polychlorinated biphenyls G'CB's).
<br />her•birides, pesticides, dio+ins Or listed Jur>ardnuc waste into the
<br />solvent or aqueous cleaning solution. Safety-Kleen has the capacity
<br />and is permitted to accept, store, and/or reclaim the spent parts
<br />washer solvent; paint thinners, solvents and paints generated by
<br />customer; Or dry cleaning filter cartridges, powder, and still
<br />residues containing perchloruethylene, petroleum naphtha, or
<br />triflurotrichrloroethane dry cleaning solvents. Safety-Kleeu and
<br />customer agree that this agreement is intended to satisfy the
<br />requirements of 40 CFR 262.20(e). IN THE EVENT OF AN EMERGENCY CALL
<br />1-800-468-1760 (24 hours)
<br />CUSTOMER / GENERATOR :Juan Mendez
<br />3
<br />3
<br />BRANCH 7142 CSG 24
<br />pflores, 03/02/10 15:41 PAGE 2 a
<br />s
<br />REFERENCE NOR. i
<br />CUSTOMER#/GENtRATOR: 29S9268
<br />MUFFLER PLUS
<br />50284285 tr
<br />3408 E Main St # C
<br />s
<br />Stockton CA 95205-6634
<br />SRVC DATE: 03/02/10
<br />PHONE 209 351-3981
<br />GtNtHAIOR PROVINCIAL ID NO. CAL00o264034 6ENtRAIOR SSFATE
<br />MANIFEST DOC#: 002SO8068SKS
<br />FORM CODE: US SK SH1PMLN1
<br />NO: 200218432
<br />CARRIER 1 TXR000050930
<br />CARRIER 2
<br />US OUI UESCRIPIION (INCLUDING
<br />PROPER SHIPPING NAML, HAZARD CLASS, AND 10)
<br />NON RCRA HAZARDOUS WASTE LIQUIDS
<br />(OILY PIT SLUDGE AND WATER)
<br />FEDERAL WASTE CODES NONE
<br />STATE WASTE CODES 222
<br />TOTAL CONT 1 TYPE DM WT/VOL P SKDOT 400082
<br />CNT*: 100302642314 QTY: 75 PROFILE: 012286 CA CAI CODE:a
<br />DESIGNATED FACILITY NAME/ADDRESS:
<br />US ECOLOGY NEVADA
<br />11 MILES S OF BEATTY HWY 95
<br />BEATTY NV 89003
<br />FACILITY USEPA ID NO NVT330010000
<br />FACILITY STATE ID NO
<br />Per SK mngr
<br />BOG 0250-001 Customer has coleted the Customer Packing
<br />Certification Form.
<br />GENERATOR STATUS
<br />0 - 220 lbs/month
<br />Customer certifies that (i) the shove -nand materials are properly
<br />classified, packaged, marked and labeled, and are in proper condition
<br />for transportation according to the applicable regulations of the
<br />Department of Transportation and (i i) no material change has Occurred
<br />either in the characteristics of the waste/material or in the process
<br />generatinu the waste/material. Customer agrees to pay the above
<br />charges and to be bound by the terms and conditions (1) set forth in
<br />(a) the General Terms and Conditions provided separately to Customer
<br />or (b) any SK agreement signed by Customer and SK, and (2)
<br />incorporated herein by reference. Unless otherwise indicated in the
<br />payment received section, SK is authorized to charge Customer's
<br />account for this transaction. Customer certifies that the individual
<br />signing this Service Acknowledgement is duly authorized to sign and
<br />bind Customer. The following provision is applicable to Safety-Kleen's
<br />parts cleaner and paint gun cleaner services: Customer agrees that it
<br />will not introduce any substance into the solvent or aqueous cleaning
<br />solution, including without limitation any hazardous waste or
<br />hazardous waste constituent. except to the extent sudr introduction is
<br />incidental to the normal use of the machine. Customer further agrees
<br />that it will not clean parts/paint guns that have been contaminated
<br />with or otherwise introduce polychlorinated biphenyls G'CB's).
<br />her•birides, pesticides, dio+ins Or listed Jur>ardnuc waste into the
<br />solvent or aqueous cleaning solution. Safety-Kleen has the capacity
<br />and is permitted to accept, store, and/or reclaim the spent parts
<br />washer solvent; paint thinners, solvents and paints generated by
<br />customer; Or dry cleaning filter cartridges, powder, and still
<br />residues containing perchloruethylene, petroleum naphtha, or
<br />triflurotrichrloroethane dry cleaning solvents. Safety-Kleeu and
<br />customer agree that this agreement is intended to satisfy the
<br />requirements of 40 CFR 262.20(e). IN THE EVENT OF AN EMERGENCY CALL
<br />1-800-468-1760 (24 hours)
<br />CUSTOMER / GENERATOR :Juan Mendez
<br />
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