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ECEI E® ?
<br /> nF-C 22 2014
<br /> rECHNICHEN Se ice Receipt invoice No. :'.212 7 C
<br /> F-i�4
<br /> Transporter: V I h U E NTUAQLTH e-
<br /> 2349 Lincoln Avenue DEPARTULK
<br /> Hayward,CA 94545
<br /> EPA ID;CAR000161836
<br /> g@pcv w
<br /> 800.652.5455,510.786.5455
<br /> 24-Hr Einer No:C"Wj
<br /> Wasin Manifest No, rfiifllpOftafR.f.
<br /> manifoot NO, 100691
<br /> Customer/
<br /> Generator: Generator EPA ID#:
<br /> Customer Account ft:
<br /> Generator Status: SQG I�ESQ(3(40CFR 261.5)
<br /> CESOG Certification initial
<br /> Drums Delivered 30-gal 55-gal- Orurno Picked-Up;
<br /> O,enfl
<br /> Closed Plastic
<br /> DOT Description of Hazardous Waste quantity Common
<br />
<br /> Unit Unit Price
<br /> Code _Description Amount Due
<br /> RQ,Waste Tetrachloroethylene,6,1.UN 1897.111 Still Residue
<br /> (F002) CA751
<br /> Solid Residue 3O!,!,of
<br /> RQ,Waste Tatrachloroothylene,6.1,UN 1897,111 ---717 ......7,
<br /> (17002) CA751 Standard
<br /> Spilt
<br /> RQ,Hazardous Liquid,n.o,s.,9.NA 3082,111
<br /> (Petroleum Distillates,Tatrachloroathylene)(DO39) CA134 Wastewater V
<br /> ..)
<br /> tilt f3eatdsre Non-RCRA Hazardous Waste Liquid ir :,,Oi
<br /> (Petroleum Distillates,Green Earth,Rynex) CA213,,-
<br /> %I "f,1SSolid Residue
<br /> Non
<br /> -RCRA Hazardous Waste Solid
<br /> (Petroleum Distilletes, A2f3 Standard
<br /> Green Earth,Rynex) split
<br /> 1,lynex)
<br /> t
<br /> Outstanding Account Balance: SUBTOTAL
<br /> Payment Check Other:
<br /> Check#: '../ ( e". -
<br /> Amount: J"
<br /> Energy Surcharge
<br /> Please PayTOTAL AMOUNT DUE
<br /> C.0:.jD,, (includes outstanding a/c bal.)tany) 'C�;
<br /> I certify that the hazardous wastes named above are Properly classified,desirAbed,and packaged. These wastes are stored in undamaged Containers
<br /> that contain only the wastes as described, and are In Proper condition for transportation per applicable E)OT regufationti. I further acknowledge that I
<br /> hAvO the authority to enter Into the service agreement Printed on the reverse, that I understand the total
<br /> has been#Rxlkqn(fedt)y 7erhniohom,jt)wly(,-h PI'Yry'Ont is doe within IS days of rhe date of serjjo, 8MOunt due will be paid C.0,0, unless credit
<br /> I also canifY, If indicated as such by my initial above,that the wastes above are generated by a conciltiomally exempt small quantity generator(CE$QG)
<br /> as defined in 40 CFR Part 261.5,and as such,per 40CFR part 268,1,these wastes are not subject
<br /> art 268. Pursuant to HSC Sec 25160,2(b)(40), I also certify that I have established a program u
<br /> P bject to any land disposal restriction Provision of 40CFR
<br /> hazardous waste to the degree as I have determined to Ogre to reduce the volume or quantity and toxicity of the
<br /> be economically practicable,
<br /> Print
<br /> Customer Name! c000tomerA:,
<br /> --Data:
<br /> Pursuant to HSC Sec 25160.2 (c)(2)(C), Technichem hereby confirms at 811 hazardous waste above will only be transported to an authorized
<br /> hazardous waste treatment facility and that the hazardous waste may f1pt be transported to 8 stOrag(4 Or transfer facility in accordance with the
<br /> applicable Provisions of the law.Technichem does not take title to customer generated waste or other material. While exercising proper care and safety
<br /> precautions,I have removed the wastes above from the Customer's Premises and accepted thelmaterials for transport on the date undersigned below.
<br /> M�arjo
<br /> Trangoftr
<br /> Sion Date;
<br />
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