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<br /> ORAkN 1 1 C5% 24 dbus[on, •1/11 14:22 PAGE 1 �
<br /> T1licable) Document No. T2.
<br /> 2 Page 1
<br /> Safety-Kleen Systems, Inc. 0
<br /> 5360 Legacy Drive. Y'
<br /> A
<br /> Blo0 2, suite 100
<br /> Pan . N
<br /> Plano, Tesas 751126
<br /> 800-669-5760 3
<br /> 209-565-1011
<br /> REFERENCE NOR.
<br /> 'IUSIUMEHa IODUI186 WILSON WAY LIRE 53892563
<br /> 221 N Wilson Way SRVC WEEN: 2011-17 \ IS EPA ID Number A.Transportet's Phone
<br /> Stockton CA 95205-4505 SHVC DATE: 04/21/11 14:21
<br /> PHONE 209-465-0281 - -
<br /> PURCHASE ORDERR PRODUCT/SERVICESTAN EXEMPTION NOR IS EPA ID Number B.Transporters Phone
<br /> SERVICE/ TOTAL
<br /> PRWUCT .ry UNIT PRICE TAX CMAMIE War IS EPA ID Number C.Facilitys Phone
<br /> /841 NP PALLEI 4DR W/ODHN 1.000 224.0000 10.16 244.16 bA
<br /> SERVICE TERM 12 WEEN W1�
<br /> PROMO NOR: 0
<br /> 12295/
<br /> 875480 LANDf NON USDOI HALMA3, N 2.000 145.5800 0.00 291.16
<br /> SERVICE TERM 12 WEEK
<br /> PROMO MR: 0 p 12.Containers Total Unit
<br /> a CONIS: L ISM-; MANIFtS Ie: 00166351/SKS FOHM to: US SK SXIVR IU1844114 V
<br /> (NIR: 110420103184 .IV: 4UO WI/VUL P PROFILE: 011295 SMUO1 6999568 O No. Type Quantity WtAtol
<br /> CN Te: 1104ZO104155 O1Y: 400 WI/VOL P Pk11f1LE: 011195 SKUUI 699958tl 61
<br /> 4040675S/ y
<br /> $15462 LANOF NDN USUOI HALMAI, N 0.0011 0.0000 0.00 0.00 r
<br /> SERVICE TEAM 12 WEEK Y
<br /> PROMO NOR: 0
<br /> 334S EMPTY DRUM 33 2.001) 52.0000 9.36 113.36 p
<br /> SERVICE TERM 12 WEEK L
<br /> PROMO NBR: 0 41.
<br /> 8003369 UMUM,55 U.N. MT-USED 1.000 60.0000 5.40 65.40 16
<br /> SERVICE TERM 12 WEEN tl
<br /> PROMO NOR: 0 3
<br /> 83635 WASTE SGL HRKE SRAVN4 1.001) 0.0000 0.00 0.00
<br /> SERVICE TERM 8 WEEN
<br /> PROMO NOR: 0
<br /> (ONIS: I I]DF: /401 MANIFESIC 4418/ "HM CD: BL SK SHIPR 203850098
<br /> CNIS: 110410103116 OIY: 40 WL/VOL V PROFILE: O15U1/b ]KDOI 14078
<br /> 3635 BkAKt ]HAVIN4] >GL ' 1.001) 88.luou O.W 85.60 e
<br /> SERVICE TEAM 8 WEEK m
<br /> PROMO NBR: 0 m
<br /> 3306 EMPIY PAIL BLACK 54 1.000 20.0000 1.80 21 80 are
<br /> 100001 FEt, FUfI SUH(HAHGt 1.001) 16.4500 1.48 17 93
<br /> 7899 FREIGHT 0.000 0.0000 0.00 0 00 p
<br /> .- _... . . .- �1 ..
<br /> IOIAL SEItVltE/VM000C I] 606.8300 38.20 842.61
<br /> TOTAL CHARGE 842.61
<br /> CREDITS 0.00
<br /> TOTAL WE 842.61 G
<br /> UNPAIU BALANIE IRIS HECLIP1 842.61 C
<br /> Y
<br /> 0
<br /> Y
<br /> 3
<br /> Y
<br /> GENERATOR STATUS w
<br /> 220 - 2200 lbs/month N VUI IM1e above-nametl melenela are Droperly dazVke4 tlesenben, of pacyageE.maryeE and Dpek04n0 are In proper
<br /> a a onalar.r.roo to Neripph.kre ulalrons of lM1a De arlm¢nl Vain ane4pn.
<br /> C.atomer ctrl irio t1.et (i) tilt •Love-n.,eI ..Ler iels e it VruPm'lY ; Month Day Year
<br /> .1...ifiml, y.ck.teJ, narked ind labeled, and ..it in p..... ....
<br /> fur tren>yerteti.li eL.erdiny. to tilt applicable reyuleti.ns of lire -'
<br /> Department of Tr•upur tet iun end (ii) fill 111,11ti ial cllenye Las uuurre3l
<br /> e LI... , [he cLaracler isliu of lilt ...Le/in itt,-tel u- in the pr..... Iva on this form are not subject to federal regulations for Transportation or Disposal.
<br /> eneretin elle ...to ter Wa [m l.nmr. Month Da Year e
<br /> V U /nw ayreo to pay lila .Leve Y
<br /> (A)te> a„J to be bouml by We tion. anJ undiliens Cl) sal furto i
<br /> (a) b) n, SK
<br /> Tern. mil Centtomo tr.v,A., separately to Cua[mntr
<br /> or (b) any 'l ayreeuby siyneJ Ly CuslUollrll the SN, enJ (2)
<br /> inl.rp.r...J Leve in LY rcfSk i. . h.rirs .flitrwt>e iCr icat.. in tilt m
<br /> til-LUL t re.. iveJ smtiun, SK i> aullmtl Le to chary.. t siren inji tura Month Day Year
<br /> .,u fl. 117 a trameat ion. t tnt 6 urs tries that the inJividuel
<br /> blind Cy this Service Ackmmul eP,.vint is s Applicable
<br /> licable to to stYn and O°
<br /> Lint CoLmnirl HJ fellow iRY 1t.1ml ten is tI; tcable [e Safety-Kleen't ��
<br /> pada of illtr and Oetnl Vino clearmr s ices: Criof .. A,r te.r, that i[
<br /> will nal i;n"rudu any substance Ines t.t selvenl or "..etas cleantnU lute Monts Day Year
<br /> h.l.. t i.y w mal i i Ito aey hettrit .a vaso or
<br /> lin,idtnu. .,ie . ,al Ment, e..tni t. the e,lent arrth 1th.d.tl i,.n I E .
<br /> .t it el t. of 11.nnal u>e .f 111.. or,, iuc. Gut bet fw4Ler syreo > C
<br /> tl,el it will net clew, y.rta/peint amu Wet Leve been PCB'..inateJ Y
<br /> ut[h ,i othc rwtse introd.ce inlych/a rtnated ..Phenyls .tCB's),
<br /> hel4i,nt or Polio iJo, .Iivcina .r listed t,-Klt.. mea to into Lha C
<br /> solvent or upltj i clean int svlul iun. Safe ty-K1 ten hes the capatity Y
<br /> and is pe rniilleJ tll .""I. store, end/.r ..11 .lo lila >Penl Par[>
<br /> ash.r ,; V•intcth inners, w.rt,id and poi Jar Venerate) by Y
<br /> c uatenK r; or dry clean int filter carer i Jyes, ...
<br /> .. .a th. still 1
<br /> ,i idue> .i,hl..tt ..it J,urocthylene, pe[rul elannapb[ha, u except as noted in Item 19.
<br /> Iriflurotr,tt roetLene dol tle..ntrly intended
<br /> Safety-oleenrenA 01
<br /> colunWr ..tree I0 this z.20(e). is intended lu sat MER the ll.
<br /> regareGENCY of 40 CFR 861710(e). et 'IHE EVENT OF AN EMERGENCY [ALL 14 A lure Month Day Year
<br /> HR EMERGENCY R 1-800 468-1760 (Safety-Klee. Cont roc[ R 99138) N
<br /> 3
<br /> 44em' 3'$ COPY FORM NO.01-90291(11/09)
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