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+1 O <br /> t► <br /> G <br /> y <br /> 41 <br /> r <br /> BRANCH 718501._,V3C25 ESCAM.ILLA,DAVID 12/30/08 14:40 PAGE 1.X <br /> Y <br /> i� <br /> Safety-M een <br /> 5400 Legacy Dr. <br /> Cluster II, Building 3 Ui <br /> Plano. Texas 75024 3 <br /> 209-545-1011 it <br /> REFERENCE NBRE <br /> CUSTUMEH# 3264660 ]RACY CHRYSLER JEEP DODGE 0038046856 <br /> SERVICE TAX: 0.07750 3460 NAGLEE RD SRVC WEEK: 09-01 <br /> cams TAX: 0.00000 SRVC DATE: 12/30/08 14:35 <br /> PRODUCT TAX: 0.07750 TRACY CA 95304 <br /> PHONE 209-820-1800 <br /> PURCHASE ORDER# 70745 TAX EXEMPTION NBR: S <br /> PRODUCT/SERVICES ' <br /> SERVICE/ TOTAL <br /> PRODUCT <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 26730 MODEL 26 W/STAND 6317 1 168.7806 13.08 181.86 <br /> S/N 67491 "TttG T00000003000249992 CLEAN I SPENT 0 <br /> SE CE TERM 12 <br /> 100009 FU�FtE SURCHARGE 1 11.8200 0.92 12.74 E <br /> ----------------------------------------- <br /> TOTAL <br /> --------------------------------------TOTAL SERVICE/PRODUCTS 180.6000 14,00 194.60 <br /> UStPA ]RANSPOREtH 1 MOGOG50930 GENERATOR USEPA CAL000332356 L' <br /> USEPA TRANSPORTER 2 GENERATOR STATE <br /> MANIFEST DOC # 001586670SKS FORM CODE 1D r <br /> US DUE UtSCRIPTION (INCLUOIN(. PROPER SHIPPING NAMt, HALARD CLASS, AND ID) <br /> HAZARDOUS WASTE, LIQUID, N.O.S. <br /> M <br /> 9 NA3082 PG III (8039) t1F <br /> (ERG/171) <br /> TOTAL CONT I TYPE OF TTL QTY 5 UNIT WT/VOL G SKDOT 839 0 <br /> CNT# 81206455839 QTY 5 WASTE CODE CA 839 <br /> E <br /> DESIGNATED FACILITY NAME/ADDRESS: E <br /> SAFETY-KLEEN SYSTEMS, INC. <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 <br /> USEPA ID NO CA0000084517 TOTAL CHARGE 194.60 <br /> STATE ID NO WASTE MIN 0.00 m <br /> ------------- <br /> TOTAL DUE 194.60 ' <br /> UNPAID BALANCE THIS RECEIPT 194.60 y <br /> Machine clean and good condition' Yes �T <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes E <br /> Machine properly grounded? Yes 0 <br /> Spent solvent njeets acceptance criteria? Yes W <br /> Prop 65 warning (Calif. only)? Yes C <br /> a <br /> GENERATOR STATUS d <br /> 0 - 220 lbs/month <br /> The generator has established a program to reduce the volume or quantity t <br /> and toxicity of the hazardous waste to the degree, as deterwined by the 4 <br /> generator, to be economically practicable. 01 <br /> Customer certifies that (i) the abuve-nalaed materials are properly <br /> classified, packager!, marked and labeled, and are in proper condition <br /> for transportation according to tine applicable regulations of the 3 <br /> Department of Transportation and (ii) no material change has occurred E <br /> either in the characteristics of the waste/material or in the process E <br /> generating the waste/material. Customer agrees to pay the above charges <br /> and to be bound by the terms and conditions (1) set forth in (a) the <br /> 6cneral Teru,s and Cmiditioos PruV Md d separately to Customer or (b) any <br /> 58 agreement s'i—ghed by Custonrer and SK, and (2) incorporated herein by c <br /> reference. Unless otherwise indicated in the payment received section, m <br /> SK ss authorized to charge Customer's account for this transaction. <br /> Customer certifies that the individual signing this Service <br /> Acknowledgement is duly authorized to sign and bind Customer. The <br /> following provision is applicable tuSafety-Kleen's parts cleaner, and aq <br /> paint gun cleaner services: Customer agrees that it will not introduce v <br /> any substance into the solvent or aqueous cleaning solution, including {T <br /> without liunitation any hazardous waste or hazardous waste constituent, <br /> except to the extent such i0 roduction is incidental to the normal use <br /> of the machine. Customer fu.iher agrees that it will not clean <br /> parts/paint guns that have L.-.•n cautaninated with or utherwise introduce E <br /> polychlorinated biphenyls (PC6'0, herbicides, pesticides, dioxins or Q <br /> listed hazardous waste into the solvent or aqueouscleaning solution. IN N <br /> THE EVENT OF AN EMERGENCY CALL 1-800-468-1760 (24 hours) <br /> d <br /> Z <br /> d <br /> W <br /> A <br /> SIGNATURE NAME: ADAM 3 <br /> E <br />