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.L-ROX-23 RONmod Gomez 01/10/20 09:33 PAGE 2 <br /> SHIPPING DOCUMENT CSG SK-SSL-NOX-23 Raymond Dome¢ <br /> IN THE EVENT OF AN ENERGENCY CALL a*34•Hr•Nanber** 1-#00-4ia-170O(Sahty-S1&en) 01/10/20 00131 <br /> [IlSTOB1R#/GEN[RATPR; CL21517 CleanREFERENCE MIN, <br /> Planet iklb3ff3-tg000l21a1 <br /> 250 Port Rd Safety-Kleen Systems , Inc. <br /> Stockton CA 05203.0000 <br /> PHONE 200.71$-149E 2600 N Control Epy, suit, 200 <br /> Richardfeo, TX .7$000 <br /> GENERATOR USEPA 10. CAL000420550 OFC01 100 STATE CORFObtTE1 400.440.5710 <br /> MN4IFESTP: ITAN USKS00081 FORK CDt 10 $Rip! 230404204 24 HR EMERGO01 N0•Na-1700 (Safet S1ean) <br /> TINISMRTER 1 T)01pDON32pf Safety Man 2015451011 y <br /> Sp50 3ALIDA*LVD <br /> SALMA,CA. 01341 CUSTOMERS CL24SI7 CIO" PlanetREFERENC <br /> ,�ANSPORTERk 1w PHONE: Sof-S4S-1011 250 Port Rd R211�9RVEK <br /> StOCkt*d CA 15203.0000 SRVG OATEN 01. <br /> US DOT DESCRIPTION CWLWXM PROPER +EPPING HARE, WAND CLASS, AND 10) RILL TO CUSTOMS RILL lb ADNEPHOW55N.715.1f57 <br /> CL14111 CIN* ►twt <br /> NON.1gA HAZARDOUS USETl, SOUL 250 Pert Rd <br /> FEDERAEOWAST CODE USED OIL FILTERS) Stedtea CA 15203.0000 <br /> FEDERAL WASTE CEDES 11000E PHONE 200.711-Si57 <br /> STATE CASTE CODES 233SKINOT PLOOL459 ORDER# TAX EWTOTAL CONE 1 TYPE DM Irl'/L C P IMS 7872675 PRODUCT%SERVICES <br /> CNTdt 200106077524Cp3 <br /> BJ752t 52t SS GAL/t05 L TAINOK RTYI 250 PROFS 116033 C <br /> OESICd3ATEO FACILITY NNIS/ADDRESS: SOVICT/ } <br /> 1013 FlY3D5 INC CITY UNIT PRICE TAX CNARG2 <br /> 12183 SE CARPWTCR 011 13313 M4,SS CASTE O,F. 11000 #a.7500 0.00 4 <br /> ISO SHOWMAS OR 1703$-/N/ SERVICE TORI 12 LEES <br /> 150 PH01R; 593.7M-4f 39 ' <br /> TATE ID Nq <br /> FACILITY IO NO ORpMN02f197 <br /> 3313 111011.51 GAL FOR O.F. 1.000 12,5000 0.00 1 <br /> FACILITY STATE 1ERVICE TBRI 12 MEEK <br /> GENERATOR STATUS SUM CARTRIDGE OIL FILTERS SSG 1.000 0.0000 0.00 <br /> 0.220 lbs/eMath SERVICE TERN 12 KIN <br /> C4" COW -SERVICE NOT MM <br /> I00030 REOW WIDl <br /> [WMV FEE 1.000 1S,sw 0,00 1 <br /> Mot TAX NNOLING N/C ot DROP 30 1.000 0,0000 0,00 <br /> ..._..._- ...,,........... <br /> TOTAL fOMt!/pR001M:i5 00,7500 .......0.00 0 <br /> TOTAL C314w N <br /> alolTS o <br /> T01At DDE So <br /> .- UNPAID BALANCE THIS RECEIPT 00.75 <br /> CUSTOM /GENERATOR: teres&thaw AN <br /> M <br /> GO4OIAlOR 1TATUf <br /> 0.220 lbs/Netth <br /> I boa establisbed a PrNrw to raducq <br /> toxicity N the b"Ar4 a, watt to the *.ia) r ""tity mad <br /> sjgnohre Practic4ble, + t acewunically <br /> 713ANSPORTO3; Raymond Goma <br /> 1 <br /> i <br /> ...� SlpTnt,xe <br /> TRANSPORTER 2: 05TWO / GENERATOR: tarot thew <br /> LAST PAGE �,....�• <br /> SIVAhre <br /> TRMKPORTER: Rrymen4 Game, <br /> ....................................... <br /> CSG SR-Sf' . <br />