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TECHN/CHEM Service Receipt/ Invoice No. 129721
<br /> Heritage Env. Svcs. - ICt US Ecology ystech Env.Corp.
<br /> Transporter: Authorized 1007 Vukan Rd. bwxy 95-12 mi S.oP 1420 S.Cement Rd.
<br /> 2349 Lincoln Avenue Facility: Benton,AR 72015 Beath,NV 59003 Fredonia,KS 66736
<br /> EPA ID: CAR000161836 98
<br /> Hayward, ARD1057870 NVT330010000 KSD06
<br /> 9833259
<br /> 016
<br /> 800.652.5455,510.785.5455 24-Hr Emergency No: InfoTrac#102393: 800.535.5053
<br /> Uniform Hazardous 010249 9�FLE Transporter 101356 Ref. 12/21/2020
<br /> Waste Manifest No. Manifest No. Date:
<br /> Express Cleaners CAL 000 318 558
<br /> Customer/ Abdullah VVakeel_y Generator EPA ID#:
<br /> Generator: 95377-02
<br /> 2271 West Grant line Road Customer Account#:
<br /> Tracy,CA 95377 —
<br /> (209)833-1742 Generator Status: SQG ESQ (40CFR 61 5)
<br /> CESQG Certification Initial:
<br /> DOT Containers Delivered 30-gal 55-gal Drums Picked-Up:
<br /> Open Plastic/Metal �,,. :..t
<br /> Closed Plastic
<br /> DOT Description of Hazardous Waste Quantity Waste Common Code Description Unit Unit Price Amount Due
<br /> .55- 5515C'.0'„
<br /> RQ, UNI 897,Waste Tetrachloroethylene,6.1, III Still Residue `
<br /> (F002) CA751 Solid Residue 30-0 $390.00
<br /> RQ, LIN 1897,Waste Tetrachloroethylene,6.1, III Standard 55-gal
<br /> (F002) CA751 Split 30-gal $390.00
<br /> RQ, NA 3082, Hazardous Waste, Liquid, n.o.s.,9, III CA134 Wastewater _30-gam a- $390.00
<br /> (Petroleum Distillates,Tetrachloroethylene)(D039)
<br /> Non-RCRA Hazardous Waste LiquidfTfl�sttfCxe- �--
<br /> (Petroleum Distillates, n-Siloxane,Glycol Ether(s), y;� CA213 So�. Mue
<br /> 30-0 $390.00 � 6 Cs2
<br /> Green EarthTM, R nexTm
<br /> Non-RCRA Hazardous Waste Liquid Standard ;5-ga -
<br /> (Petroleum Distillates, n-Siloxane, Glycol Ether(s), CA213 Split _30-gal $300.00
<br /> Green EarthTM, R nexT"^
<br /> Supplies,
<br /> DOT drum Recon Metal/Poly jGy-, � a�, o ",
<br /> Outstanding Account Balance: SUBTOTAL C<J
<br /> Payments rp Check / Other/Drums: Supplies axes
<br /> Check#: V� t Amount: EPA electronic manifest' Energy Surcharge
<br /> Please Pay C.O.D.* TOTAL AMOUNT DUES
<br /> (includes outstanding a/c bol.if any) (27r0
<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. unle=ss credit has been extended by Technichem, in which case,payment is due within 15 da, 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 wastes are not subject to the land disposal restriction provision of 40CFR
<br /> 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
<br /> hazardous waste to the degree I have determined to be economically practicable. ._--,
<br /> Print C Customer �r,,,,... Q• /F �
<br /> customer Name: + 444��� signature: r Date: ((
<br /> Pursuant to HSC Sec 25160.2 (c)(2)(C), Technichem here b confirms that all hazardous viste 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^d accepted the mater* Is for transport on the date undersigned
<br /> below.
<br /> Transporter ���
<br /> (�a // ✓],
<br /> Signature: M`� Date:
<br />
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