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i 2-1 44 TECHNICHEM Service Receipt J` Invoice No. 10L.L Tr, so&ter- Authorized Facility: ReSolvent,Inc. 4iFW1Hallec-k Street,Emeryville,CA 94608 831 Deming Way,Sparks,NV 89431 PA'19: CAD981375983 EPA ID: NVR000076158 PA For inquiry or customer service,call(800)652-5455 in Southern California,call(888)998-2436 24-hr Emergency No: Chem-Tel 1-800-255-3924 Uniform Hazardous ATransporter Ref. Waste M ,� 44 178 Manifest No. Manifest No. . Date: Customer/ v o;"sGenerator EPA ID#: Generator: Customer Account#: Generator Status: SOG CESQG(40CFR 261.5) CESQG Certification Initial: idsPicked-o- Drums Delivered: # 20-gal water- 30-gal water:------#-- # 55-gal water # DOT Description of Hazardous Waste Quantity Waste Common Unit Unit Amount Code Description Price Due 5 RQ,Waste Tetrachloroethylene,6.1,LIN 1897, 111 Still Residue 1�6.71 CA751 (FO02) Solid Residue RQ,Waste Tetrachloroethylene,6.1,UN1897,IIICA751 Standard S29 s)5 (17002) 1 Split -- $12. RQ,Hazardous Waste,Liquid, n.o.s.,9,NA 3082,111 CA134 Wastewater (Petroleum Distillates,Tetrachloroethylene)(13039) 1%-7-5 Non-RCRA Hazardous Waste Liquid CA213 Still Residue J (Petroleum DistillatesSolid Residue) Non-RCRA Hazardous Waste Solid CA213 Standard'" (Petroleum Distillates) Split 90 Outstanding Account Balance V /I q! SUBTOTAL /0 Payment Check C.O.D. /Volurne I Other, Check#: Amount Discount 9%: Please Pay C.O. D.* TOTAL AMOUNT DUE (includes outstanding a/c bal.*if any) By my signature below, I certify that the hazardous wastes named above are properly classified,described and packaged, and in proper condition for transportation per applicable DOT regulation,that these wastes are stored in undamaged containers that contain only the wastes as described. I further acknowledge that I have the authority to enter into th6'^service agreement printed on the reverse,that I understand*the total amount due will be paid C.0-D. unless credit has been extended by Technichem,in which case,payment is due within 30 days of the date of service. 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 (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 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 toxicity of the hazardous waste to the degree as I have determined to be economically practicable. Print Customer Customer Name: Signature: Date: Pursuant to HSC Sec 25160.2 (c)(2)(C), Technichem hereby confirms that all hazardous waste above will only be transported to an authorized hazardous waste treatment facility,that the hazardous waste may first be transported to a storage or transfer facility in accordance with the applicable provisions of the law. Technichem does not take title to customer generated waste or other material. While exercising proper care and safety precautions,I have removed the wastes above from the customer's premises and accepted the materials for transport on the date undersigned below. dnverloffice memo: ow new addrvk%- 213-01,Lint-AA*Avr,tfaywwd.C.A 94MS- Transporter Signature. Date' 55FTA,CAROw"O'c" A