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U t14/2UlU 12:2b 5107855406 PAGE 01 <br /> TECHNICHEM Service Receipt / Invoice No. 111897 <br /> •Kar Chert l <br /> Transporter: Authorized Facility: R Indusrin <br /> 2349 Uncoln Avenue,Heyward,CA 94545 831 !9431 loot Wkxn ed, <br /> EPA ID: CAR000161836 C1eval�bw Ase7e1'rrra 9avicp efffebroa,II.0 EP.cr Doc eeean,,ur 72015ma MfAar Or.Helaso,OR43027 ARD991 o57aro <br /> For inquiry or customer service. OHDMSM$4 <br /> cal)(800)652-5455, (510)785-5455 24-hr Emergency No: Chem-Tel 1-800-255-3924 <br /> Uniform HazardousFT�E Transporter 100081 Ref 3/15/2010 <br /> Waste Manifest No. Manifest No. Date: <br /> Elite Clemers CAD981627409 <br /> Customer/ Generator EPA IDs' <br /> GenentOr Dimple Patel <br /> 32DI W.Benjamm Hch Drive Customer Account l: 95219-02 <br /> Stockton,CA 95219 Generator Status: SOG /CESOG(40CFR 261.5) <br /> (209)957-9361 <br /> CESOG Certlficatlon In9W: <br /> Drums DNNerad: y f Drums PlrJcediq' <br /> 2p.gal"Ierk7a <br /> ._a 4•S�'T 9 o'L— <br /> a <br /> 30-9al warer�a a a <br /> 55.ga1 waler.__a a s <br /> DOT Description of Hazardous Waste Ouanf Waste Common Unit Amount <br /> W Code Description Unit Price Due <br /> RO,Waste Tetrachloroethylene,6.1.UN 1897,111 .Q CA751 sidua 5S $460. nf--s, <br /> FO02 Solitl gidue {i,r+'SJ <br /> RO,Waste Tetrachloroethylene.6.1,UN1897,III CA751 Standard 5 <br /> F002 Slit 30' 5170. <br /> RO, Hazardous Waste,Liquid,n.o.s.,9.NA 3082,III 155- $390.2 55. <br /> (Petroleum Distillates.Tebachloroethybne)(D039) CA134 Wastewater00. <br /> Non-RCRA Hazardous Waste Liquid <br /> (Petroleum Distillates,Green Earth.Rynex) CA213 SON Residue W. <br /> Solid Residue50. <br /> Non-RCRA HazMdous waste Solid Q CA213 Standard(Petroleum Distillates.Green Earth,Rynex) 5 a70. <br /> Energy Surcharge <br /> $15.00 <br /> 0 Mile <br /> •Oonterakia ` it <br /> Ac orml Boars, $0•nnS957 <br /> SU`B�TOTAL Ga c-00 <br /> parrient ; <br /> Chem C.O.D. /Vo <br /> — Ano'" r -D $0.0 <br /> 0:hedk Discount <br /> VSo3741 D e- Please Pay C.O.D.* TOTAL AMOUNT DUE �Z <br /> (Inehrdri owrandlrp ah tial.'it arty) <br /> By my signature below, 1 ownity that the hazardous wastes named above are properly classified, described and packaged,end in proper condition for <br /> transportation per applicable 00T regulation,that these wastes are stored in undamaged containers that contain only rhe wastes as described. I further <br /> acknowledge that I have the authority to enter into the service agreement printed on the reverse, that 1 understand 'the total amount due will be paid <br /> C.O.D.unless credit hm been extended by Tnchnichem,in which caro,paymern is due within 30 days of the date of service. <br /> I may also Cantly, if indicated as such and by my initial above,that the wastes above are generated by a conditionally exempt small quantity generator <br /> (CESOG)as defined in 40 CFR part 281.5, and as such,per 40CFR part 268.1,these wastes are not subject to any land disposal restriction provision. <br /> of 40CFR part 268. Pursuant to HSC Sec 25160.2 (e)(4)(H). 1 also certify that I have established a program to reduce the volume Or quantity and <br /> toxicity of the hazardous waste to the degree as I have deNrmined to be economically practicable. <br /> Print cuema <br /> crebnar Nana: 'Q /�� � 9gnatum: <br /> tll� <br /> D.Is: <br /> Pursuant to HSC Sec 25160.2 (c)(2)(C). Technichem hereby confirms that as hazardous waste above wig only be transported to an authorized <br /> hazardous waste tmafinem facility,that the hazardous waste may first be transported to a storage a tra s(ar facility in accordance with the applicable <br /> provisions of the law. Technichem does not take tide to customer generated waste a other a aa. While exereisirg proper pre and safety <br /> precautions.I have removed the wastes above from the customers promlaea and accepted the me ls r Transport on the date undersigned below. <br /> otww»arer.nr.ro: <br /> PCWCOD -3 <br /> Trenaa9rter Slgrrbrn: <br /> i 0ala• <br />