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TECHN/CHEM Service Receipt/ Invoice No. 128926
<br /> Transporter: Authorized O Heritage Env.Svcs. US Ecology Iksystech Env.Corp.
<br /> 2349 Lincoln Avenue Facility: 1007 Vulcan Rd. Highway 95-12 mi S.of I f420S.CementRd.
<br /> Hayward,CA 94545 Benton,AR 72015 Beatty,NV 89003 Fredonia,KS 66736
<br /> EPA ID:CAR000161836 ARD981057870 NVT330010000 KSD980633259
<br /> 800.652.5455, 510.785.5455 24-Hr Emergency No: InfoTrac#102393: 800.535.5053
<br /> Uniform Hazardous !t7!� Transporter Ref.
<br /> Waste Manifest No, Q1024 LE Manifest No. 101259 Date: 8r16/2019
<br /> Customer/ Express Cleaners Generator EPA ID#: 8-56r
<br /> Generator: Abdullah Wakeely
<br /> 2271 West Grant Line Road
<br /> Customer Account#: 95377-02
<br /> Tracy,CA 95377
<br /> Generator Status: SQ CESQG 40CF 1.5)
<br /> (209)833-1742
<br /> CESQG Certification Initial:
<br /> DOT Containers Delivered 30-gal 55-gal D u P eked-Up:
<br /> Open Plastic et
<br /> Closed Plastic
<br /> DOT Description of Hazardous Waste QuantityWaste Common
<br /> Code Description Unit Unit Price Amount Due
<br /> RQ, UN1897,Waste Tetrachloroethylene,6.1, III CA751 Still Residue 55-gal $550.00
<br /> (17002) Solid Residue 30-gal $390.00
<br /> RQ, LIN 1897,Waste Tetrachloroethylene,6.1, III CA751 Standard 55-gal $5.50.00
<br /> (F002) Split 30-gal $390.00
<br /> RQ, NA 3082, Hazardous Waste"Liquid, n.o.s.,9, III 55-gal $5.50.00
<br /> (Petroleum Distillates,Tetrachloroethylene)(D039) CA134 Wastewater g
<br /> 30-gal $390.00
<br /> Non-RCRA Hazardous Waste Liquid ti esidu 55-
<br /> (Petroleum Distillates, n-Siloxane,Glycol Ether(s), CA213 esidue �+
<br /> Green EarthTM, R nexT"^ 3p- tg0 0—c,.[,--
<br /> Non-RCRA Hazardous Waste Liquid Standard 55-gal $55Q.00
<br /> (Petroleum Distillates, n-Siloxane, Glycol Ether(s), CA213 Split
<br /> Green EarthTM, R nexT"") 30-gal $390.00
<br /> Supplies: -T
<br /> DOT drum Recon Metal/Poly -�
<br /> Outstanding Account Balance: OUBTOTAL
<br /> Payment � / Check Other/Drums: Supplies/Taxes
<br /> Check#: V` .V Amount: YYc(,od EPA electronic manifest/ Energy Surcharge $25.00
<br /> Please Pay C.O.D.* TOTAL AMOUNT DU
<br /> (incudes outstanding a/c bol.if an 0"a
<br /> 1_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 wast are not subject to the Ian disposal restriction provision of 40CFR
<br /> part 268. Pursuant.to HSC Sec 25160.2 (b)(4)(H), I also certify that I have es
<br /> o redu e volume or quantity andtoxicity of the
<br /> hazardous waste to the degree I have determined to be economically practicablPrint Customer
<br /> Customer Name: e-V'Vw .'V Q4- Z Signature: DPursuant to HSC Sec 25160.2 (c)(2)(C), Technichem hereby confirms that ar 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.i'n.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 premis and accepted them rials for transport on the date under igned
<br /> below.
<br /> Trans porte
<br /> Signature Date:
<br />
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