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'I i; UF : SJ ItP.NIFEST ', : _'. 190 .`, FORM CD : BL SHIPO : 236631905
<br /> CNT4 : 220 .315 > 05718 CITY : 30 NT /VOL P PPOFR : 1951021 SKDOTk : 8764814
<br /> 1110030 RECOVERY FEE 1 . 0 108 . 66 0 . 00 106 . 66
<br /> . ki .. bt ; L - i'Ianlf= Br Fe" I . 0 20 . 00 0 . 00 20 . 00
<br /> 3230 TAX HANDLING N / C DRUM DROP 30 2 . 0 0 . 00 0 . 00 0 . 00
<br /> TOTAL SERVICE / PRODUCTS - - - - - - - - - - - - - - -
<br /> 829 . 66 0 . 00 © 2 '3 . 66
<br /> TOTAL CHARGE 629 . 66
<br /> CREDITS 0 . 00
<br /> - - - _ - - - - - - - - - - - - _ _ _ _ _ _ ..
<br /> TOTAL DUE 829 . 66
<br /> UNPAID BALANCE THIS RECEIPT 829 . 66
<br /> GENERATOR STATUS
<br /> C - 220 lbs / msnti
<br /> _u . . . - ,er certifies that lil the I have established a program to reduce the volume above -named materials are properly or
<br /> quantity and tnx.icit. y of the hazardous waste classified , packaged , marked and to the degree- to he economically
<br /> h , " . . ._ . - , rabel _ d , and are in proper condition for t ansportarion according to the applicable regulations of the
<br /> ne rrmemr of Tra sportation ( 1i ) no material change has occurred either in the characteristics of the waste / material or
<br /> - , I gr ecatino rheacreiinaterial , and ( III ) the above referenced Generator St = cus _ correct . Customer agrees
<br /> to pay the above charges and to oe bound by the terns and conditions ( 1 ) set -orth in ( a ) the Genera Terms and
<br /> Conditions provided separately to Customer or ( b ) any SPC agreement signed by Customer and Sr. , and ( 2 ) incorporated herein
<br /> ty :preference . Unless orherwise indicated in the payment received section , SK is authorized to charge Customers account
<br /> , , l tIII _ r I 31' sa Ition . If Customer fails to Dake payment when oaqso
<br /> an amount actual to the lesser (of ( i ) 1 . 5 , th
<br /> per mon
<br /> ( ld � Der annum ) or ( ii ) the maximum amount allowed by law , bill be added to all unpaid amounts outstanding . Customer
<br /> certifies char rhe individual signing chis Service Ackncwledgement is duly authorized to sign and bind Customer . Customer
<br /> :; , i: ncw _ edges that it is responsiolc for maintaining its Generator Status and obtaining an EPA ID number if required by
<br /> applicable law . The following provision is applicable to Safety-Klee s parts cleaner and paint ami cleaner services :
<br /> simmer agrees that it will not introduce any substance into the solvent or aqueous cleaning soiu : ion , including without
<br /> liniitarrno any hazardous waste or hazardous waste constituent , except to the extent such introduction is incidental to
<br /> c . � � . , _ of the machine . Customer further agrees that it will nut clean parts / paint guns that have been
<br /> contaminated with or otherwise introduce polychlorinated biphenyls ( PCBs ) , herbicides , pesticides dioxins or listed
<br /> hazardous waste into the solvent or aqueous cleaning solution . Safety - Kleen has the capacity and is permitted to accept ,
<br /> r ., • I re_ , im _ sr .: n . t ;asher culvert paint tellers , oLvents and paints generated by customer ; or dry
<br /> ming t _. _ r _ r ca jridgea , oowder , and still residues containing perchloroethyleno , petroleum naphtha , or
<br /> trif lurotrichlo roe thane dry cleaning solvents . Customer agrees that it is responsible for properly classifying its waste
<br /> streams as Used Oil or Nonhazardous Waste in accordance with the provision of 40 CBR 262 . 11 and applicable state laws .
<br /> :lust -: mer agrees that it will not introduce any non - confirming substance into the SK Property , including , without
<br /> limitation , any hazardous waste or hazardous waste constituent , ( i . e . , polychlorinated biphenyls ( " PCBs " ) , herbicides ,
<br /> pesticides , dioxins , or listed hazardous wastes ) except to the extent such introduction is i c '_denra - to the normal use
<br /> of the SK Property . In the event of the introduction of such non -conforming hazardous wastes Customer agrees that it will
<br /> be responsible for all costs and re :nediat _ on expenses related to or arising from the proper management and disposal of
<br /> the non - conforming waste , inalcding the cost of equipment decontamination and subsequent disposa ' . Final invoicing will
<br /> be, based on the actual services provided , which may include additional charyes for off specification waste and
<br /> surcharges . Final invoice amount :nay be more than the, amount listed nn the printed receipt . If any Legal action is
<br /> nr = nr � trf . ,. . a Yrf an alleged dispute , breach , default , r u , re (. resenta tion , the . us orre .r also agrees that the
<br /> provsxiing party will be entitled to recover reasonable attorneys fees and costs associated .with the non - conforming
<br /> r. untan: inutioi , event . Safety-Kleer. s failure to screen Customers material or take a retail: sample , in no way c _ mstitutes e
<br /> _ . , be n = sift' atert at . efery IT1eer ekes . ; towers repres er t-, riot = and
<br /> _ n . _ . < � p� , r ; _ rr t .m r :n '7 ., a feet' Kleen cf a ry pro e_ s changes that may arrer the charaoteristics of the
<br /> • I I . . r 10 rF Ctr Hscb -rr and / o , atcry - h .. - _ , spp l icab l c , as the
<br /> m e , . . , r rp , r .- . . _ s:) e . sly all agency authority by rhe qer orator to act as the genera _pr ' s agent and accordinyly ,
<br /> . _ � . Fl . rl - ., n � 1 Jafety < 1 - en , ate. applicable , ma / change the transporter ( s ) designated on the manifest , or add a new
<br /> - nsporrer , during transportar ion wil. the generator ' s prior , explicit approval . IN THE EVENT OF AN EMERGENCY CALL
<br /> • ' :' 1 - HP . - Rrrr1 - 4r1 ; 0 f5afery - F: leen ) A vat stile reclveiv tee that fluc . . ates with the DOE national average
<br /> m _ . nay he applied zt your rn xo : ce . For more irfornnation regarding aur recovery fee calculation please go to
<br /> 4tcp : / ; saf � ry - la een . eorn / custorne r - service / environmental - fees / recovery- fees . Please note e-manifest fees applicable to
<br /> rr: i ,, ord= r met' not be included it the total above and will be included in the final invoice or credi - card statement .
<br /> RECEIPT ONLY - THIS IS NOT AN INVOICE
<br /> J j ` '
<br /> CUSTOMER. / GENERATOR : Sorge Richards
<br /> RECEIVED
<br /> APR 0 7 20 ^ 2
<br /> ENVIRONMENTAL. HEALTH
<br /> DEPARTMENT
<br />
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