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TECHN/CHEM Service Receipt/ Invoice No. 128579
<br /> Systech Environmental Corporation
<br /> Transporter: Authorized 1420 South Cement Road,Fredonia,KS 66736
<br /> 2349 Lincoln Avenue Facility: KSD980633259
<br /> Hayward,CA 94545
<br /> EPA ID: CAR000161836
<br /> 800.652,5455, 510.785.5455 24-Hr Emergency No: InfoTrac#102393: 800.535.5053
<br /> Uniform Hazardous 009964?�KFLE Transporter 101206 Ref. 2/19/2019
<br /> Waste Manifest No. Manifest No Date
<br /> Customer/ Express Cleaners CAL 000 318 568
<br /> Generator EPA ID#:
<br /> Generator: Abdullah Wakeely
<br /> 2271 West(:want Line Road Customer Account#: 95377-02
<br /> Tracy,CA 95377 ,
<br /> (2Q9)833-1742 Generator Status: SQG/CESQG 40 F 261.5)
<br /> CESQG Certification Initial:
<br /> DOT Containers elivered 30-gal 55-gal Drums Picked-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, LIM897,Waste Tetrachloroethylene, 6.1, III Still Residue 55-gal $550.00
<br /> (F002) CA751 Solid Residue 30-gal $390.00
<br /> RQ, UN1897,Waste Tetrachloroethylene,6.1, III Standard 55-gal $550.00
<br /> (F002) CA751 Split 30-gal $390.00
<br /> RQ, NA 3082, Hazardous Waste, Liquid, n.o.s.,9, III 55-gal $550.00
<br /> (Petroleum Distillates,Tetrachloroethylene)(D039) CA134 Wastewater 30-gal $390.00
<br /> Non-RCRA Hazardous Waste LiquidSt' sidu 55- al 00
<br /> (Petroleum Distillates, n-Siloxane,Glycol Ether(s), � CA213 esidue 30-g $390. 0
<br /> Green EarthTM, R nexT
<br /> Non-RCRA Hazardous Waste Liquid Standard 55-gal $550.00
<br /> (Petroleum Distillates, n-Siloxane,Glycol Ether(s), CA213 Split 30-gal $390.00
<br /> Green EarthTM, R nexT"" -
<br /> Drtrm Surcharge:
<br /> DOT Reco e ,Poly$40 co .
<br /> Outstanding Account Balance: - SUBTOTAL
<br /> Payment vl„5a— Check Other/Drums:
<br /> Check Amount: e e o C S Energy Surcharge
<br /> Please Pay C.O.D.* TOTAL AMOUNT DUE
<br /> (includes outstanding a/c bal.if any) kf
<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 gener d by a condi ionally exempt small q ntity generator(CESQG)
<br /> as defined in 40 CFR part 261.5, and as such, per 40CFR part 268.1, these wastes ei not subject o the land spgsal re iction provision of 40CFR
<br /> part 268. Pursuant to HSC Sec 25160.2(b)(4)(H), I also certify that I have establish d program reduce th vol,me o quantity and toxicity of the
<br /> hazardous waste the degre I have et rm' to be economically practicable.
<br /> Customer Name:rPrint ��d'J��Q e Customer _._.
<br /> I
<br /> //
<br /> f
<br /> Signature: Date:
<br /> 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
<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 and ac pted the materials forepnsport on the date undersigned
<br /> below.
<br /> Transporter F
<br /> Signature: Date:
<br />
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