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CSG SK -SSL -BOX -21 Brandon J Gaither 01/15/16 09:33 PAGE 3 <br />SHIPPING DOCUMENT <br />REFERENCE NBR. <br />CUSTOMER#/GENERATOR: KI18372 Hie Country 69002951 <br />1515 N Main St <br />Manteca CA 95336-3243 SRVC DATE: 01/15/16 <br />PHONE 999-999-9999 CONTACT NAME: Kia Country <br />GENERATOR USEPA ID. CAL000043665 GENERATOR STATE <br />MANIFEST#: FORM CD; DP SHIP# 218211896 <br />TRANSPORTER 1 TXR000081205 SAFETY-KLEEN SYSTEMS, INC. <br />5050 SALIDA BLVD <br />SAIIDA,CA. 95368 <br />TNSP PHONE: 209-545-1011 <br />TRANSPORTER 2 <br />US DOT DESCRIPTION )INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID) <br />DRAINED USED OIL FILTERS <br />FEDERAL WASTE CODES NONE <br />STATE WASTE CODES <br />TOTAL CONT 2 TYPE DN WT/VOL P SKDOT 14476 <br />CNT#: 160111309029 SZ: 55 GAL/205 L CONTAINERS QTY: 300 PROF# 156033 CA CAT CODE:C <br />CNT#: 160111309028 SZ: 55 GAL/205 L CONTAINERS QTY: 300 PROF# 156033 CA CAT CODE:C <br />DESIGNATED FACILITY NAME/ADDRESS: <br />SAFETY-KLEEN SYSTEMS, INC. <br />5050 SALIDA BLVD <br />SALIDA CA 95368 <br />TSD PHONE: 209-545-1011 <br />FACILITY USEPA ID NO CAT000613968 <br />FACILITY STATE ID NO <br />GENERATOR STATUS <br />0-220 lbs/month <br />Customer certifies that (i) the above-named materials are properly <br />classified, packaged, marked and labeled, and are in proper condition <br />for transportation according to the applicable regulations of the <br />Department of Transportation and (ii) no material change has occurred <br />either in the characteristics of the waste/material or in the process <br />generating the waste/material. Customer agrees to pay the above <br />charges and to be bound by the terms and conditions (1) set forth in <br />(a) the General Terms and Conditions provided separately to Customer <br />or (b) any SK agreement signed by Customer and SK, and (2) <br />Incorporated herein by reference. Unless otherwise indicated in the <br />payment received section, SK is authorized to charge Customer's <br />account for this transaction. If Customer fails to make payment when <br />due, an amount equal to the lesser of (1) 1.5% per month -(188 per <br />annum) or (ii) the maximum amount allowed by law, will be added to all <br />unpaid amounts outstanding. Customer certifies that the individual <br />signing this Service Acknowledgement is duly authorized to sign.and <br />bind Customer. The following provision is applicable to Safety-Kleen's <br />parts cleaner and paint gun cleaner services: Customer agrees that it <br />will not introduce any substance into the solvent or aqueous cleaning <br />solution, including without limitation any hazardous waste or <br />hazardous waste constituent, except to the extent such introduction is <br />incidental to the normal use of the machine. Customer further agrees <br />that it will not clean parts/paint guns that have been contaminated <br />with or otherwise introduce polychlorinated biphenyls (PCB's), <br />herbicides, pesticides, dioxins or listed hazardous waste into the <br />solvent or aqueous cleaning solution. Safety-Kleen has the capacity <br />and is permitted to accept, store, and/or reclaim the spent parts <br />washer solvent; paint thinners, solvents and paints generated by <br />customer; or dry cleaning filter cartridges, powder, and still <br />residues containing perchloroethylene, petroleum naphtha, or <br />triflurotrichlorcethane dry cleaning solvents. Customer agrees that it <br />is responsible for properly classifying its waste streams as Used Oil <br />