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i 42 TECHNICHEM Service Receipt / InA ce No. Transporter: Authorized Facility: ReSolvent, Inc. 4245 Halleck Street, Emeryville,CA 94608 831 Deming Way, Sparks, NV 89431 EPA ID: CAD981375983 EPA ID: NVR000076158 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 Transporter Ref. Waste Manifest No. Manifest No. Date: tltsr.tivtU lwtiuttiiittt; Customer/ Generator EPA ID#: Generator: C)wlles Patel 5',56 Pacific Ave.,Sew Customer Account#: Stoi.klolit,(.:A 9520 Generator Status: SQG /CESQG(40CFR 261.5) k209)47 7..4 _ CESQG Certification Initial: Drums Delivered: Drums Picked-up: 20-gal water: # # # 30-gal water: # ' # # 55-gal water: # # # DOT Description of Hazardous Waste Quantity Waste Common Unit Unit Amount Code Description Price Due RQ,Waste Tetrachloroethylene,6.1, UN1897, III CA751 Still Residue F002 Solid Residue RQ,Waste Tetrachloroethylene,6.1, UN1897, III CA751 Standard F002 Split RQ, Hazardous Waste, Liquid,n.o.s.,9,NA 3082, III CA134 Wastewater (Petroleum Distillates,Tetrachloroethylene)(D039) Non-RCRA Hazardous Waste Liquid CA213 Still Residue Petroleum Distillates Solid Residue Non-RCRA Hazardous Waste Solid CA213 Standard Petroleum Distillates Split "Outstanding SUBTOTAL Account Balance Payment Check C.O.D. /Volume /Other Check#: Amount Discount%: TOTAL AMOUNT DUE Please Pay C.O.D.* (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 the service agreement printed on the reverse, that I understand'the total amount due will be paid C.O.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. �Y 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 0rovisions 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. driver/office memo: I Transporter Signature: Date: