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May 113 05 03: 30p Je K i tto 477a►165 p. 2 <br /> ICHEM <br /> Service Recep# / Invai � 1 . 1 Q <br /> :rfan 028Q <br /> 42 <br /> 83 <br /> §r r ibik V41a <br /> For rngWi or customer Bei, Il/8D0 EPA 1D: Y �s3r <br /> In SOr1tl1@F7t "(.�� a /Voc "rY'I 1 <br /> 24h <br /> tJnifon>* r Een . o hefri 'T <br /> mer N <br /> � <br /> f e1:`Y 255-3t4 <br /> 1Naete:Msnitaa_tNo. Transporter <br /> .Customer/ �tV1bManNbst 4 <br /> Generator y C14t Qea t!. <br /> Generator EPA ID t <br /> Customer Account e: <br /> rlDr"ktt?N. <br /> 4-. 4 ;��I CF� Generator Status. SQG I sod `5) <br /> onana t>� : <br /> 20-pal wafer 0 Drum I PfGceckp: CESO°CerNBcadon n <br /> 34ga1 water-# <br /> T,C <br /> S5-0 water- <br /> A <br /> DOT DesaiptIon of Haza us Waste <br /> Quantity WGoadatee Common Unit <br /> RQ,Waste Tet►achfOroeth UnR Amount <br /> F002 ylene,6.1,UN1897,III / CA751 StitPries dug t Residye- - / <br /> RQ,Waste Tetrachloroethylene,6.1,UNf897,11! S°lidd P-64ue , , , <br /> T � <br /> CA751 Standard t� Y <br /> Ro,Hazanyous Waste.Liquid,n.o.s.,9,,NA 3082,til it <br /> (Petroleum D)WItaees,Tetrach ) 13039 CA134 <br /> Non-RCRA Hazardous Waste Wastewater <br /> ,,�•''t)isiiNat@a UgUld <br /> "Non-RCRA Hazardous Waft SOW Solid RestOue. <br /> IreftiNleum Distillates) CA213 Standard <br /> Account Balance <br /> Prnient Ghoa SUBTOTAL <br /> Check r Amara $ C.O.D. /volume r 00>er <br /> >. t7taaotrnt%: <br /> Pleas Pa C.O .. TOTAL AMOUNT DUE <br /> E <br /> BY my signature below, I cert' (tnrJudas mftb�na are bat 'irany) t if <br /> dy that the haz`ardoug wastes named above <br /> importation per applicable DOT regulation stored aro properly classified,despite and f <br /> acknowledge that I have the authoritythat wastes are stoned in undama packaged,and In proper condaio <br /> G.O.D.anises credit has been to <br /> enter into the service agreement rt undamaged containers that contain only the wastes as <br /> endd by Tachnichem.in which printed on the reverse,that I understand• I further <br /> I may also case,PaYment Is due wtthfn 30 days of the d� total due Moll be pard <br /> Y certify.If in <br /> as such and by my initial above,that the <br /> (CESt2G)as defined In 4o CFR part 251.5,and as such,per 4pGpR wastes above are generated by a conditional <br /> r'4`�FR Part 268. Pursuant to HSC Sec 35160.z (by, part 268.1'�e was are not subject ty exempt small quantity generator <br /> toaddty of the hazardaua waste to the ) l also certi��that I have established a to any land disposal rostriction provision <br /> �9r?e f have d@4srrnined to be econom' preb� pro9ro►►r to reduce the volume or quantity and <br /> PNnt <br /> c <br /> Pursuant to HSC Sec 25160.2 (c)(2)(C), T nichern hersb 4aa: <br /> hazardous waste troatment Y confirms <br /> oto+dslons of the law. T Wl�'that the hazardous waste may first be tra ll hazardous waste above will,On <br /> echnichern does not'take title to customer generated ryv Leto a�r�or transfer Nci ry be transported it the <br /> authorized <br /> precautions,I have removed the wastes above from other mate' i. in accordance Mitt,the applicable <br /> xi�rtnr�,memo. aratOmer'g na While <br /> exerasing proW care and "fXy <br /> premises and accepted the materials for transport on the date undersigned below, <br /> W1 L8tne Transporatiignat •'` �( j <br />