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VD/Lit 6Vle TVM 10: 4,7 1''!1A laVL3/VG7 <br /> CSG SK-SSL-BOX-23 Raymond Gomez 11/21/11 11:29 PAGE 2 <br /> SHIPPING DOCUMENT <br /> RFFRRFNCE NRR, <br /> CUSTOMER#/GENERATOR: 021038 Bob?; Lubr. 6 Smnq 75195014-7705577,737 <br /> 1403 Country Club Blvd <br /> Stockton CA 95204-4910 <br /> PHONE 209-943-3633 <br /> GENERATOR U6EPA 10. D902357117 GENERATOR STATE 00006 <br /> MANIFEST#: 006193919s a FORM CO; 1D SHIP# 223634574 <br /> TRANSPORTER 1 TXR0000 1205 SAFETY-KLEEN SYSTEMS, INC. <br /> 5050 SALIDA BLVD <br /> SALIDA,CA. 95368 <br /> TNSP PH(ANE: 209-545-1011 <br /> TRANSPORTER 2 <br /> US DOT DESCRIPTION (I CLUDING PROPER SUIPPING NAME, 14AZARD CLASS, AND ID) <br /> NON-RCRA HAZARDOUS WA TE, LIQUID <br /> (AQUEOUS PARTS WASHER SOLUTION) <br /> FEDERAL WASTE CODES N NE <br /> NATE WASTE CODES 134 <br /> TOTAL CONT I YYPE OM WT/VOL G SKDOT 14941 <br /> CHT#: 171031542334 Z: 30 GAL/114 L CONTAINERS QTY: 20 PROF# 156023 CA CAT COOE:G <br /> DESIGNATED FACILITY N E/ADDRESSt <br /> SAFETY-KLECN SYSTEMS, INC. <br /> 6000 BOTH STREET <br /> SACRAMENTO CA 95828 <br /> TSD PHONE; 916-386-4.13 <br /> FACILITY U5EPA 1D NO C 0000084517 <br /> FACILITY STATE ID NO <br /> GFNFJRATOR STATUS <br /> 0-220 lbs/month <br /> Customer certifies tha (i) the above-named materials are properly <br /> classified, packaged, ftarked and labeled, and are in proper condition <br /> for transportation acc rding to the applicable regulations of the <br /> Department of Transpor ation (ii) no material change has occurred <br /> either in the characte istice of the waste/material or in the process <br /> generdtir:y the waat:e/m total, and (lli) the above rrferenretl <br /> Gencrnta r Ri•.anuy In 00 refit, Customer agrCea to pay rho above Ghargcn <br /> and to bo bound by the terms and conditions (1) set forth in (a) the <br /> General Terms and Cond tions provided separately to Customer or (b) <br /> any SK agreement signei by Customer and sK, and t2) incorporated <br /> herein by reference. Iniess otherwise indicated in the payment <br /> received secton, SK i authorized to charge Customer's account for <br /> this transaction. If C stomer fails to make payment when due, an <br /> amount equal to the le ser of (1) 1.5Y per month (164 per annum) or <br /> (ll) the maximgm amours allowed by law, will be added to all unpaid <br /> amounts outstanding. C :tomer certifies that the individual signing <br /> this Service A.knawied ement is duly authorized to sign and bind <br /> Customer. Customer ack owledges that it is responsible for maintaining <br /> its Generator Status a d obtaining an ErA ID number if required by <br /> applicable law. The following provision is applicable to <br /> Safety-Kleen's parts cleaner and paint gun cleaner services: Customer <br /> agrees that it will not intt•nduce any substance Into the solvent or <br /> agwonun clennihy :colui: nn, including wlthnut llmil:ntlnn nny hdzardnud <br /> waste or hazardous wo, o r..onotituent, oxropt to the nxtont nur:h <br /> introduction Is incide tal to the normal use of the machine. Customer <br /> further agrees that it will not clean parts/paint guns that have been <br /> contaminated with or o herwide Introduce polychlorinated biphenyls <br /> (PCB's), herbicides, p aLicidda, dioxins or listed hazardous waste <br /> i.ntn the dnlvnnl: nr agtrnun gl.raning nnitiLiort. Safety-Kleeti hda the <br /> rapacity and is permit ed to accept, stern, and/or reclaim the spent <br /> parts washer solvents int thi.nnere, golvonta and pointe generated by <br /> customorl or dry Cl,eanl g filter Cartridge:, powder, and otLll <br /> residues containing per hloroethylens, petroleum naphtha, or <br />