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r FOR OFFICE USE ONLY HCC Generator#: C rySta I NCC Service Agreement#: Clean• HERITAGE-CRYSTAL CLEAN, LLC ("HCC") GENERATOR CERTIFICATION �kL P6(;;SS Customer's EPA ID#: C Lcytio89 £C$Cf (Qustomer) `)_N .�Q Customer's State ID#(if applicable): VTo'N (Address) C ca - 9S'`-I —cf3 (City) (State) (Zip Code) (Phone Number) THIS FORM IS DEEMED PART OFTHE ABOVE REFERENCED SERVICE AGREEMENT BETWEEN HERITAGE-CRYSTAL CLEAN,LLC ANDTHE IDENTIFIED CUSTOMER AND ALL TERMS AND CONDITIONS AND CERTIFICATIONS CONTAINED THEREIN ARE DEEMED A PART HEREOF. ALL SERVICES ,Conditionally Exempt Small Quantity Generator(CESQG) (orsfateequlvalentdesignation) The Customer hereby certifies that it qualifies as a Conditionally Exempt Small Quantity Generator by generating less than 100 kilograms(approximately 28 gallons)of characteristic(D codes),F,K,or U-Iisted hazardous waste during a calendar month,and less than one kilogram(approximately 2,2 pounds)of acute hazardous(P-listed)waste during a calendar month. The Customer also certifies that no more than 1,000 kilograms of characteristic F,K,or U-listed hazardous waste and no more than one kilogram of acute hazardous waste was accumulated on-site at any one time during a calendar month.The Customer will inform HCC if more than 1,000 kilograms;of characteristic F,K.or U-listed hazardous waste or more than one kilogram of acute hazardous waste is accumulated on-site at any one time during a calendar month. ❑Generator Does NOT Quality as Conditionally Exempt Small Quantity Generator The Customer hereby certifies that it qualifies as: ❑Small Quantity Generator(SOG) or ❑ Large Quantity Generator(LOG) >100 kg/220 lbs.Per month and >1000 kg 12200 lbs.Per month _ nn <7D00 kg 12200 Ibs.Per month J s GENERATOR'S QUANTITY CERTIFICATION raiNdaJ PARTS CLEANER SERVICES Customer represents,warrants and certifies as follows: The Parts Cleaner fluids are generated In Customer's iness operations without Customer addirg'eny additives or other materials to the fluids and the fluids do not include any waste generated by any other person or any other lou ass operation. Customer understands that any Pests Cleaner fluids lends HCC for pickup have�ot been mixed with any materials regulated as hazartlous waste antler RCRA,or any polychbtlnatetl bl-phenyls(PCBs)or other materials regulated der TSCA and•alf constituents present In such fluids are contaminants resulting from,and incidental to, normal use of the fluids as a degreaser or Deaner and any failure o se Crrafions to be hue antl accurate may result in its fluids being classified as hazardous waste subject to federal and state laws and regulations. / ❑Non-Hazardous Parts Cleaner Program Certt a n Customer hereby certifies that it qualifies for HCC's Non-Ha;mlous Parts at Program and understands that the HCC degmasing/cleaning fluids picked up by HCC may be managed as a non-hazardous waste. ❑Reuse Program Certification Customer hereby certifies that it qualifies for HCC's Reuse Program and understands at the HCC degreasinglcleaning fluids picked up by HCC may be utilized as an effective subeflule for a commercial chemical product. In the event of any breach of this Certification or,t malytical results determine that the fuids do 1 quality,said determination in HCC's sole discretion,HCC retains the light to disqualify the fluids from either the Non-Hazardous Parts Cleaner or Reuse Program in which ,Customer will be obligated to pay for testing,management and disposal of the fluids as hazardous waste.The person signing this Certification has reviewed the Customers facilites,administrative practices and operational procedures(or has directed the completion of such review by others)and based upon such review,Is wining to make this true,accurate and complete Cerfication. SOLVENT USE CERTIFICATION iniva6r USED • Customer acknowledges that HCC may,but is not req 'retl to,retain samples of materials,which ma be used to confirm contaminants In said materials. Customer represents,warrants and certifies Net the west atenals described in this Agreement ese services meets the definition of used oil In 40 CFR 279("Used Oil means any oil that has been refined from crude oil,or shy sy tic oil,that has been used a a result for such use Is contaminated by physical or chemical impuntles') and has not been mixed with other regulated materials,including not limited to ponjhird noted bi-phenyls(PCB's),other materials regulated under TSCA,or hazardous waste,and recognizes that HCC Is retying on this Certification to props mage waste matenals,and in the event that this Certification is untrue,Customer accepts complete responsibility for all costs related to the proper management and I of e waste materials and any commingled materials. Customer acknowledges that the Used Oil will be co-mingled by HCC wit rf oil It partes and that in the event the Used Oil is found to be nonconforming,either before or after said co-mingling,HCC may refuse to accept or revoke or acceptance o Used Oil and Customers indemnification in the Service Agreement shall apply to said nonconforming Used Oil and other used oil received from o r partes which is affect q@reby. USED OIL CERTIFICATION infils) Customer hereby agrees to immediately notify HCC of any facts that would result in a change as to the truth,accuracy or completeness of the above Certification or any prior Certifications of the Customer,These initialed Certifications hereinabove supersede all prior Certifications as to the Certifcaflon subject mater,but no other Certifications.The signature below applies to all of the Certifications inhaled hereinabove by the Cus mer. all (Printed Name of Responsible and Authorized Party) V (Signature) (Datel 12005 Rev.08/05 Printed in USA CUSTOMER FORM 20344