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CONTAINER MANAGEMENT SERVICES, LLC CONTAINER RECEIVING RECORD 21301 Cloud Way,Hayward,CA 94545 Emptier: L 0 sz-T2 F C_ 14 A)V Address: :: �-s Tqy < City/State/Zip: - zI A Date: - _ _ �� Purchase Order#: EMPTY CONTAINER CERTIFICATE. herehy certify that fliew cuntainen are empty as that term is defined in the California Contaminated Container Regulations,Title 22 Section 66261.7*,and that lhev have been prnprrlr prepared for tr.n%portulinn under the regulations of the U.S.Department of Trnnsporintian,49 CFR 171.29". *rille 22,Seclion 66261.7 state,(see rtgalatiun for exact lunguagc)A container which previously held hazardous material is empty iF (1 IPOURABLE LADING--no material can he poured or druined from the container when it is held in any orientation(e.g..tilted,inverted,tic.) (2) NONPOURABLE LADING—no material remains in or on the container that can feasibly be rentoscd by physical methods which are commonly employed to remoNe such materials.The interior of the container%hall not contain crusted or a mass of solidified material. Further,if 1 am notified that there is excess residue inside the container OR the container does not meet the M,terV47%1S,LLC accrptanre criteria,I hvrehr agree to Initlate timely and appropriate shipping and shipping papers to return the container to the generating site,or agree to accept charges for the return of the containers. "*DOT's 49 CFR 173.29 states that all openings on the empq container must be cloud,and that all markings and latwls must be in place its if the containerwere full of its original contents.A DOT shipping paper Is not required for transportation of any empl}container for reconditioning ria contract or private carrier.DOT placarding is not required for vehicles carrying empty contalners. A container That has held a material listed as an acute hazardous wane a%specified in 40 CFR 261.31,261-11.261.33(c)or extremely hazardous pursuant to Title 22 66261.1111,66261,11.1 and Appendis X of the CCR is emph if it has been triple rinsed using a solvent capable of removing the waste and all pourable residues have been removed. Inventory* ❑ Return Goods "frailer# ❑ Delivered to CMS, LLC Purchase/Charge: , , I-1 Pick up made with delivery *lt invvilyry items are commingled,like items of similarPick up made- No Delivery quality will be returned. , I -� Customer CMS, LLC Pay/Charge Pay/Charge Count Count Description Each Total _-.---- RD00135-TH UN 0.9 Min 55g . ............. - RD00136-'I'H Non-UN 0.8 55g ................ -- RD00137- OH UN 0.9 Min 55g .......... ...... ---.-------- --— RD00138- OH UN 0.9 SAB 55g .....*....0..*. RD00139-OH Non-UN 0.8 55g................ _. RD00385- Deheader 0.8 55g ....... . . . . . . .... . RD00386-Deheader 0.9 55g ........ . . . . .. . . . . RD0043.5-Junk Steel Drum .............. . . . . RECLMINIED- RPOU RP00140 -TI1 Natural L-1 Poly 55g........ . . . .141 -TH Black L-1 Poly 55g ............ . _._ RP00142 -TH Blue L-1 Poly 55g .............. RP00143-AC'1'11 Poly ........ ............... _..._ RP00433- OH UN Poly 55g .... ... ... ...... EWRONMENTAL HFA1' RP00434- Silicone/Composite 55g ............. DEPARTMENT —. 1/1100548- Plastic Recycling................... __-- R100147 -275 Cal. IBC ........... ..........* __ -- -- 111001 50-330 Cal. IBC V am Other . ........... ............ .. . .......... _--*Y 292014 Other ............. ... . TOTAL. .tee .. �..c.:.: :1........ ENVIRON -.., ..-, � - � IfIIE —----- -- -----._.. -= HEALTH OFP Freight Charge Customer may he charged For some or all of the above items. ARTMENT' 5 X Printed name of,Authorized Representotic for Empty Container Generator i X ; / (t X H O C Signature of Authorized Representative for Empty Container Generator CMS,LLC (J ;, DOC#CRR Rev.05/2009