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8 TECHN/CHEM Service Receipt/ Invoice No. 129345
<br /> Transporter: Authorized Heritage Env.Svcs. US Ecology [ Systech Elm.Corp.
<br /> 2349 Lincoln Avenue Facility: 1007-Vak=Rd, Highway 95-12 mi S.of 1420 S.Cement Rd.
<br /> Hayward,CA 94545 Benton,AR 72015 Beatty,NV 89003 Fredowda,KS 66736
<br /> EPA ID:CAR000161836 ARM1057870 NVT330010000 KSD9806332_i9
<br /> 800.652.5455,510.785.5455 24-Hr Emergency No: InfoTrac#102393:800.535..55053
<br /> Uniform Hazardous 1 �1 Transporter 1l11]M Ret. 2/52020
<br /> waste Manifest No. 010249 Manifest No. 101309 Date:
<br /> Customer/ ASAP Cleaners Generator EPA ID#: CAL 000 449 736
<br /> Generator: Jorge Ptielo
<br /> 212 West Kelldeman Lane Customer Account#: 95240-11
<br /> Lodi,CA 95240 Generator Status: SQG CESQ (40CF 61.5)
<br /> (209)367-3600 a
<br /> CESQG Certification Initial:
<br /> DOT Containers Delivered 30-gal 55-gal Drums Picked-Up:
<br /> Open Plastic/Metal
<br /> Closed Plastic
<br /> DOT Description of Hazardous Waste Quantity Waste Common Unit Unit Price Amount Due
<br /> Code Description
<br /> RQ, UN1897,Waste Tetrachloroethylene,6.1,III Still Residue
<br /> (F002) •' CA751 Solid Residue 55-�a1 $550.00
<br /> 30 $390.00
<br /> RQ, UN1897,Waste Tetrachloroethylene,6.1,III CA751 Standard SS.� $550.00
<br /> (F002) Split 30 $390
<br /> .00
<br /> RQ,NA 3082,Hazardous Waste,Liquid,n.o.s.,9,III CA134 Wastewater 55-gal $550.00
<br /> (Petroleum Distillates,Tetrachloroethylene)(D039) $190.00
<br /> Non-RCRA Hazardous Waste Liquid till esid
<br /> (Petroleum Distillates,n-Siloxane,Glycol Ether(s), CA213 I esidue 55- $550.00 6'
<br /> Green EarthTm,R nexTM) Q.
<br /> Non-RCRA Hazardous Waste Liquid Standard
<br /> (Petroleum Distillates,n-Siloxane,Glycol Ether(s), CA213 Split , 5510 $350.00
<br /> Green Earthrm,R nexrm 3 ;
<br /> 01)
<br /> Supplies: 35 a-
<br /> DOT dnun Recmt Metal/Poly
<br /> Outstanding Account Balance: SUBTOTAL
<br /> O� Cori
<br /> Payment Check •` .+' I Other/Drums: Supplies/TaXes
<br /> Check#: Amount: �Q•,� EPA Clectror6c,mm-ifest 1 Energy Surcharge
<br /> $25.00
<br /> Please Pay C.O.D.* TOTAL AMOUNT DUE ,
<br /> (includes outstanding a/c bal.if any) C/50. (J�/
<br /> I certify that the.hazardous wastes/materials named above are properly classified, described, and packaged. These items are stored in undamaged
<br /> .containers,contain only the items as described,and are in acceptable condition for transportation per applicable DOT regulations.I further acknowledge
<br /> that I have the authority to enter into this service agreement and the conditions printed on the reverse side. Further, 'the total amount due will be paid
<br /> C.O.D.unless credit has been extended by Technichem,in which case,payment is due within 15 days of the date of service.
<br /> I certify,if indicated as such by my initial above,that the wastes listed above are generated by a conditionally exempt small quantity generator(CESQG)
<br /> as defined in 40 CFR part 261.5, and as such, per 40CFR part 268.1,these wastes are not subject to the land disposal rest'ction provision of 400FR
<br /> ,part 268. Pursuant to HSC Sec 25160.2(b)(4 ), I also certify that I have established a pro ram to reduce the volurT r uantity and toxicity of the
<br /> hazardous waste to th degree I have deter m d to be eco n mically practicable.
<br /> Print i-, Customer
<br /> Customer Name: Signature: r
<br /> Pursuant to HSC Sec 25160.2 (c)(2)(C), Technichem hereby confirms that hazardous waste or materials listed above will be transported to an
<br /> authorized hazardous waste treatment facility and that the hazardous waste may first be transported to a storage or transfer facility in accordance with
<br /> the applicable provisions of the law. Technichem does not take title to customer generated waste or other material.While exercising proper care and
<br /> safety precautions, I have removed the wastes above from the customer's premises an cepted the materials r transport on the date undersigned
<br /> below.
<br /> Transporter ^
<br /> Signature: Date:
<br /> —4V
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