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Jul 01 OS 04: 31p <br /> 'f633 Att � b�QliIS <br /> TECHNICHEM Service Receipt / Invoice No. n�nry_/, <br /> Trensgo0ar: Authorized Facility: ReSolvent,Inc. "T,�n",'7� �oo.� <br /> 42,45,Halleck Street,Emeryville,CA 94608 831 Deming Way,Sparks,NV.89431 ' <br /> EPA ID; CAD981375983 EPA ID: NVROOD076158 <br /> For inquiry or customer service,call(800)652-5455 F� <br /> in Southem California,call(868)998-2436 24-hr Emeraencv No: Chem-Tel 1-800-255-3924 <br /> Uniform Hazardous - Transporter . - Ref. <br /> Waste Manifest No. - - Manifest No - Dste� <br /> Customer/ Generator EPA ID#: <br /> Generator. ^ I - <br /> I Customer Account# <br /> Generator Status: SQG /CESOGI(40CFR 261.5) <br /> CESQG Certification Initial: <br /> Omms Delivered: _ Dmms' 'ckcd-up: <br /> 20-gal water_# # # <br /> 30-gal v21er # # # <br /> 55 gal water_# # # <br /> DOT Description of Hazardous Waste Quantity Waste Common UnitUnit Amount <br /> Code Deb ion Price Due <br /> RO,Waste Tetrachloroethylene,6.1,UN1897,III CA751 Still Residue <br /> F002 Solid Residue <br /> RO,Waste Tetrachloroethylene,6.11 U141897,III CA751 Standard <br /> F002 Split - <br /> RQ,Hazardous Waste.Liquid, n.o.s.,9,NA 3082,111 CA134 Wastewater `- <br /> (Petroleum Distillates,Tetrachloroethylene)(DO39) - <br /> Non-RCRA Hazardous Waste Liquid - oit.:' CA213 Still ReeSiid� <br /> Petroleum Distillates Solid R.,du - <br /> .. _... . <br /> Non-RCRA Hazardous Waste Solid CA213 Standard <br /> Petroleum Distillates Split - <br /> "Outstanding C <br /> Account Balance $ 7 Z SUBTOTAL <br /> Payment Check C.O.D. /volume /Other <br /> Check#: Amount $ : .�-++^' -iI s7 Discount%: <br /> TOTAL AMOUNT DUE <br /> -_- — - -.- (includes outstanding are MI.'If any) <br /> By my signature below, I certify that the hazardous wastes named above ale property classed. described and packaged,and in proper condition for <br /> transportation per applicable DOT regulation,that these wastes are stored in undamaged containers that contain only the wastes as described. I fuNper <br /> acknowledge that I have the oulhony,to enter into the service agreement printed on the reverse that 1 understand <br /> I may also ceni fy, d indicated as such and by my initial above,that the wastes above are generated by a contll I y exempt sm 11 quantity generator <br /> (CESOG)as defined in 40 CFR part 261.5,and as such,per 40CFR part 268.1,these wastes are not subject t 61sPOSal restrict' rovi n <br /> of 40CFR part 268. Pursuant to HSC Sec 25160.2(b)(4)(H), I also certify that I have established a program to - <br /> toxicity of the hazardous waste tilthe degree as I how determined to be economically practicable. <br /> Print .. .. Custom" <br /> Customer Name: signature: Data: <br /> Pursuant to HSC Sec 25160.2 (c)(2)(C), Technichem hereby conflnns that all hazardous waste above will only be transported to an authorized <br /> hazardous waste treatment faciNty,that the hazardous waste may first be transported to a storage or transfer facility in accordance with the applicable <br /> provisions of the law. Technichem does not take fdle to customer generated waste or other material. While exercising proper care and safety <br /> precautions,I have removed the wastes above from the customer's premises and accepted the materials for transport on the date undersigned below. <br /> a rhace memo: <br /> Transporter Signature: Date: <br />