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TECHN/CHEM Service Receipt / Invoice ,tA�No . II Transporter : Authorized - � YYe /' 1liA �'i �' . ►ir . � �rCS . l l E: Cl1 � � 4ytitech N: nv . ( `urp . 2349 Lincoln Avenue Facility : 10Q7 � 'ii�CA1[ Rd � ." R •'; ' ` ; ' � '7 ` " � � > x `� ;' ` i .i26, S . t;ei�ueiri [dd . Hayward , CA 94545 Bel�t611, AR �20ji 4 • �eri� atf :_a . �ti � 4fr7 :i (► EPA ID : CAR000161836 ARD98jO5T871i 800 . 652 . 5455 , 510 . 785 . 5455 24 - Hr Emergency No : InfoTrac # 102393 : 800 . 535 . 5053 Uniform Hazardous 01024 _ Transporter Ref . Waste Manifest No . 9 � � Manifest No . Date : Customer/ Patica' ood� 1- 1t:31ttt"5 Generator EPA ID # : Generator : Je11 lotto 15?Ol Country Club Blvd Customer Account # : StOclCion, ( : _� .ii _) Q . 1 Generator Status : SQG / CESQG ( 40CFR 261 . 5 ) CESQG Certification Initial : DOT Containers Delivered 30 - gal 55 - gal Drums Picked - Up : Open Plastic/ Metal - Closed Plastic DOT Description of Hazardous Waste Quantity Waste Common Unit Unit Price Amount Due Code Description RQ , UN1897 , Waste Tetrachloroethylene , 6 . 1 , III CA751 Still Residue ( F002 ) Solid Residue RO , UN1897 , Waste Tetrachloroethylene , 6 . 1 , III CA751 Standard ( F002 ) Split RQ , NA 3082 , Hazardous Waste , Liquid , n . o . s . , 9 , III CA134 Wastewater ( Petroleum Distillates , Tetrachloroethylene ) ( D039 ) Non - RCRA Hazardous Waste Liquid ( Petroleum Distillates , n - Siloxane , Glycol Ether ( s ) , � CA213 Solid Resi � �"^- ` � - �� Non - RCRA Hazardous Waste Liquid Standard ( Petroleum Distillates , n - Siloxane , Glycol Ether ( s ) , CA213 Split Green EarthT"^ , RynexT "" ) ' � _ ' Outstanding Account Balance : SUBTOTAL _ ,, Payment Check OtherlDrums : Check # : Amount : Energy Surcharge * TOTAL AMOUNT DUE Please Pay C . O . D . includes outstandin a / c bal if an I certify that the hazardous wastes / materials named above are properly classified , described , and packaged . These items are stored in undamaged containers , contain only the items as described , and are in acceptable condition for transportation per applicable DOT regulations . I further acknowledge 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 C . O . D . unless credit has been extended by Technichem, in which case , payment is due within 15 days of the date of service . 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 ) 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 restriction provision of 40CFR part 268 . Pursuant to HSC Sec 25160 . 2 ( b ) (4 ) ( H ) , I also certify that I have established a program to reduce the volume or quantity and toxicity of the hazardous waste to the degree I have determined to be economically practicable . Print Customer - � � � Customer Name : Signature : - Date' Pursuant to HSC Sec 25160 . 2 ( c ) ( 2 ) ( C ) , Technichem hereby confirms that all hazardous waste or materials listed above will be transported to an authorized hazardous waste treatment facility and that the hazardous waste may first be transported to a storage or transfer facility in accordance with the applicable provisions of the law . Technichem does not take title to customer generated waste or other material . While exercising proper care and safety precautions , I have removed the wastes above from the customer ' s premises and accepted the materials for transport on the date undersigned below . Transporter / ) Signature : Date : I