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THERMO FLUIDS' Truck#: <br /> Truck Gross Wt: <br /> The Responsible Solution Tare Wt: <br /> Next Service Date <br /> Truck Net Wt: <br /> CUST LOC# <br /> Customer/Generator Transporter Onek Receiving Facility <br /> Name Thermo Fluids Inc Thermo Fluids Inc <br /> 4301 W.Jefferson St 4301 W Jefferson Phoenix,AZ 85043 AZR000003681 <br /> Address,City,State Zip = Phoenix,AZ 85043 Thermo Fluids Inc <br /> 1 4000 Arcata Las Vegas, NV 89030 NVR000001925 <br /> C•, S �� `� UY0I.CIL f; 602-272-2400 Filter Recycling <br /> AZR000003681 180 W. Monte Avenue Rialto,CA 92376 CAD982444481 <br /> ��� k Tc'`� rc�• Services <br /> US DOT#:641752 11660 rSan Pedro St.Carlson,CA 90746 CAD981696420 <br /> EPA ID# FEDERAL TAX ID:59-3210374 Crosby and Overton <br /> 1610 W. 17th St. Long Beach,CA 90813 CAD028409019 <br /> Generator Phone CA182640/HW Transporter 3871 Thermo Fluids Inc <br /> 910 4th Street Santa Ana,CA 92701 <br /> Manifest Thermo Fluids Inc <br /> Number(s) 665 S.Stafford Way,Sparks, NV 89431 NVD982510711 <br /> Remit to: <br /> Thermo Fluids Inc Payment CheckType <br /> Method of Pa t # Field Test Result Test T e <br /> MSC#285 <br /> PO Box 29048 CASH CREDIT CARD TERMS PO# ppm Q-4000 Hydrochlor <br /> Phoenix,AZ 85038 <br /> DEL PU HM Proper Shipping Description Tank Size Tank# #of Container TotalQTY Unit of price Total <br /> Containers Type Measure <br /> Non-RCRA Hazardous Waste Liquid,Used Oil-CA 221 <br /> Non-Regulated Material,Used Oil Filters for Recycling <br /> Non-RCRA Hazardous Waste Liquid,Spent Antifreeze-CA 133 <br /> Non-RCRA Hazardous Waste Liquid,Brake Fluid-CA 343 <br /> Non-Regulated Material,Brake Lathe Grindings for Recycling <br /> Non-Regulated Waste,Spent Aqueous Parts Cleaning Solvent-CA 134 <br /> t <br /> Non-RCRA Regulated Hazardous Waste Solid,Absorbents - CA 352 <br /> MINVIrIVIM11V L-1'4 I/ <br /> Non-RC RA Regulated Hazardous Waste Liquid,Oily Water - CA 223 Wl=&l_rr1CDA TA4E:K1T <br /> Drums,NOI(Empty) <br /> RQ,UN3082,Environmentally Hazardous Substance,Liquid n.o.s. <br /> x (Ethylene Glycol),9, PGIII ERG 171 (New Antifreeze) <br /> Circle One: HD Premix,HD LongLife,Concentrate <br /> Fuel Charge % <br /> *For Terms and Conditions please go to:http://www.thermofluids.com/bol_T&C Fuel Charge Tax Rate <br /> Sales Tax % <br /> Thermo Fluids Inc.hereby advises the GENERATOR that your shipment of used oil may be transported to a facility that is required to comply with federal regulations <br /> applicable to management of used oil,but that is not required to comply wih the more stringent requirements applicable to hazardous waste management facilities. <br /> California facilities that handle or process used oil are required to meet those more stringent requirements,and some out-of-state facilities that process used oil <br /> also meet those requirements.These include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial <br /> assurances for closure and accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not these more stringent requirements. TOTAL <br /> Generator Certifies a program is in place to reduce the volume,quantity and toxicity of the hazardous waste to a degree determined by Generator to be practical. <br /> This is to certify that the above-named materials are properly classified,described,packaged,marked and labeled,and are in proper condition for transportation <br /> according to the applicable regulations of the Department of Transportation. <br /> Generator Name Transporter Name Receiver Name <br /> Generator Signature Transporter Signature Receiver Signature <br /> Date Date Date <br /> In Case of Emergency contact CHEMTREC and identify Thermo Fluids as contract holder 800-424-9300 <br /> TFI Office Use Only <br /> BT BO YD AT DT O L or B YA EC ET <br /> S SO S SO S s0 S SO S SO <br />