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.TECHNICHEM Service Receipt / Inv*ce No.
<br /> Transporter:. Authorized Facility: ReSolvent,Inc.
<br /> ,4245 Halleck Street, Emeryville,CA 94608 831 Deming Way,SPREM ��D
<br /> EPA ID: CAD981375983 EPA ID: NVR0000 L1
<br /> For inquiry or customer service,call (800)652-5455 -8QQj2Z-3924
<br /> in Southern California,call (888)998-2436 24-hr Emergency No: ChemAqVl
<br /> Uniform Hazardous Transporter
<br /> HEALTH
<br /> Waste Manifest No. Manifest No.
<br /> Customer/ Generator EPA ID#:
<br /> Generator: Tl,Jd Customer Account#:
<br /> ''7'1b0
<br /> Generator Status: SOG CESQG(40CFR 261.5)
<br /> 3 CESQG Certification Initial:
<br /> Drums Delivered: Drums Picked-up:
<br /> " I# #
<br /> 20-gal water:-#-. ( (/�')
<br /> 30-gal water --#
<br /> #
<br /> 55-gal water # Waste Common Unit Amount
<br /> DOT Description of Hazardous Waste Quantity Code D-e-scription Unit Price Due
<br /> RQ,Waste Tetrachloroethylene,6.1,UN1897, III CA751 Still Residue
<br /> FO02) Solid Residue
<br /> (
<br /> RQ,Waste Tetrachloroethylene,6.1,UN 1897, 111 CA751 Standard
<br /> (F002) Spiit
<br /> RQ, Hazardous Waste, Liquid,n-o.s.,9,NA 3082,111 CAI 34 Wastewater
<br /> (Petroleum Distillates,Tetrachloroethylene)(D039)
<br /> Non-RCRA Hazardous Waste Liquid CA213 Still Residue
<br /> (Petroleum DistillatesSolid Residue)
<br /> Non-RCRA Hazardous Waste SolidCA213 Standard
<br /> Petroleum Distillates
<br /> Split
<br /> rne",ti
<br /> Outstanding
<br /> SUBTOTAL
<br /> Account Balance $ t
<br /> Payment Check C.O.D. /Volume /Other J
<br /> Discount W
<br /> ,heck Amount
<br /> Please Pay C.O.D.* TOTAL AMOUNT DUE
<br /> I includes outstanding a/c bal.*if any)
<br /> By my signature below, I certify that the hazardous wastes named above are properly classified,described and packaged, and in proper condition for
<br /> transportation per applicable DOT regulation,that these wastes are stored in undamaged containers that contain only the wastes as described. I further
<br /> acknowledge that I have the authority to enter into the service agreement printed on the reverse,that I understand*the total amount due will be paid
<br /> C.O.D. unless credit has been extended by Technichem,in which case,payment is due within 30 days of the date of service.
<br /> I may also certify, if indicated as such and by my initial above,that the wastes above are generated by a conditionally exempt small quantity generator
<br /> (CESQG)as defined in 40 CFR part 261.5, 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 (b)(4)(H), I 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 determined to be economically practicable.
<br /> Print Customer
<br /> Cuetonw-Name: Signature: -Date:
<br /> 6 wnlf wjlk
<br /> t above w9l,.--ol*y'1twjtmnapoft1*-,t* an-,a4thoriged
<br /> t4as.4 uAtment t�tr, fadillty.-th6t%thhsl
<br /> e� zardous,waster,may,fimt 6e��Jo
<br /> ,t
<br /> or trio law -hern doe§�ncit take.tltle to custonwv
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<br /> ;.,dr1bthermatwiat. Pr d�Saf ty
<br /> cce the hate undersigned b6low.
<br /> k - customer's premises and"a for tian��oit on
<br /> -H above from the
<br /> ransnorter slanature.', ate:
<br />
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