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BRANCH 718501 CSG 22 BUXTON,DAVID 01/27/10 11:58 PAGE 1O <br />u <br />Safety -M een <br />5400 Legacy Dr. 8/ <br />Cluster II, Building 3 <br />Plano, Texas 7SO24 <br />209-545-1011 t <br />REFERENCE NB <br />CUSTOMER# 2957875 RUAN TRANSPORT CORP 0040720718 w <br />SERVICE TAX: 0.08750 837 E ROTH RD SRVC WEEK: 10 - <br />OS <br />COMS TAX: 0.00000 SRVC DATE: 01/27/10 11:50y <br />PRODUCT TAX: 0.08750 FRENCH CAMP CA 95231 <br />PHONE 209-983-9545 <br />PURCHASE ORDER# t0471794444 TAX EXEMPTION NOR: Ar <br />3 <br />PRODUCT/SERVICES <br />SERVICE/ TOTAL <br />PRODUCT QTY UNIT PRICE TAX CHARGE e° <br />94830 MODEL 94 W/2370/6317 1 120.0000 10.50 130.50 Cm <br />SM 94019321 TAG 1-000OOOOXX90209853 CLEAN 4 SPENT 0 it <br />SERVICE TERM 12 <br />100009 FUEL FEE SURCHARGE 1 8.1500 0.71 8.861 <br />------------------------------------'---- ca. <br />TOTAL SERVICE/PRODUCTS 128.1500 11.21 139.364 <br />USEPA TRANSPORTER 1 TXR000050930 GENERATOR USEPA CAL000290113 <br />USEPA TRANSPORTER 2 GENERATOR STATE <br />MANIFEST DOC # 002370597SKS FORM CODE 1D <br />US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID) G <br />NON-RCRA HAZARDOUS WASTE, LIQUID U <br />(AQUEOUS PARTS WASHER SOLUTION) C• <br />TOTAL CONT 1 TYPE DM TTL QTY 15 UNIT WT/VOL G SKDOT 14941 <br />CNT# 100116049669 QTY 15 WASTE CODE CA 134 d <br />DESIGNATED FACILITY NAME/ADDRESS: <br />SAFETY-KLEEN SYSTEMS, INC. <br />6000 88TH STREET <br />SACRAMENTO CA 95828 <br />USEPA ID NO CA0000084517 TOTAL CHARGE <br />STATE ID NO WASTE MIN <br />TOTAL DUE <br />UNPAID BALANCE THIS RECEIPT 139.36 <br />Machine clean and good condition? Yes <br />Decals in place and legible? Yes <br />Fusible link installed? Yes <br />Emergency closing of lid unobstructed? Yes <br />Machine properly grounded? Yes <br />Spent solvent meets acceptance criteria? Yes <br />Prop 6S warning (Calif. only)? Yes <br />GENERA70R STATUS <br />0 - 220 lbs/month <br />The generator has established a progr•wm to reduce the volume or, quantity <br />and toxicity of the hazardous waste to the degree, as determined by the <br />generator, to be economically practicable. <br />Customer certifies that (i) the above-nmmed materials are properly <br />classified, packaged, marked and labeled, and are in proper condition <br />for transportation according to the applicable regulations of the <br />-----Department of-Transportatiati and (ii) -no material- change-has—occurred— <br />either in the characteristics of the waste/inaterial or, in the process <br />generating the waste/material. Customer agrees to pay the above charges <br />and to be bound by the terms and conditions (1) set forth in (a) the <br />General Terms and conditions provided separately to Customer or (b) any <br />SK agreement signed by Customer and SK, and (2) incorporated herein by <br />reference. Unless otherwise indicated in the payment received section, <br />SK is authorized to charge Customer's account for this transaction. <br />Customer certifies that the individual signing this Service <br />Acknowledgement is duly authorized to sign and bind customer. The <br />following provi.ian is applicable **safety- MI *n's r+wrts cleaner and <br />paint gun cleaner services: Customer agrees that it will not introduce <br />any substance into the solvent or aqueous cleaning solution, including <br />without limitation any hazardous waste or hazardous waste constituent, <br />except to the extent such introduction is incidental to the normal use <br />of tire machine. Customer further agrees that it will not clean <br />parts/paint guns that have been conta,ninated with or otherwise introduce <br />polychlorinated biphenyls CPCB's), herbicides, pesticides, dioxins or <br />listed hazardous waste into the solvent or aqueous cleaning solution. IN <br />THE EVENT OF AN EMERGENCY CALL 1-800-468-1760 (24 hours) <br />SIGNATURE NAME: MOHAMOND <br />.iC <br />1 <br />A <br />J� <br />w <br />139.36 <br />0.00 M <br />--- <br />139.36 <br />m <br />