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<br /> iy SHIPPING DOCUMENT
<br /> REFERENCE NBR.
<br /> �Y CUSTOMER./LENEXATOR: SA32602Samba ren Chevrolet I35{D126
<br /> 1210 S Cherokee Ln
<br /> Lodi (A 95210-599{ SRVC DATE: 04/27/17
<br /> 9
<br /> PHONE SS9-472612 CONTACT NAME: Sanborn Chevrolet
<br /> GLNERATOR USEPA 1D. CAD054598289 GtNtHAIOR STATE
<br /> MANIFESTS; 005947920SKS FORM LD: 10 SHIPP 2222/8977
<br /> T HANSPOHTtM I TKR000081205 SAFEIY-KLLEN SYSTEMS, INC.
<br /> 'USO SALIDA BLVD
<br /> 1ALIOA,CA. 95368
<br /> 1NSP PHONE: 209-515-1011
<br /> TRANSPORTER 2 -
<br /> US 001 Dti(RIPIlON (1NCLUUING4HOPLH SH1PPlNG NAME, HAZARD CLASS, AND 10)
<br /> NON-RCRA HAZARDOUS WASTE. LIQUID
<br /> (UOIL)
<br /> FEDERAL WASTE CODES NONE ..
<br /> STATE WASTE CODES 221
<br /> TOTAL CONT 1 TYPE TT WT/VOL G SKOOT 11219
<br /> (NTP: 170127723121 SZ: BULk VOLUME CONIAINEfl QTY: 1/S PKOFP 116017 CA
<br /> DESIGNATEDFACILITY NAME/ADDRESS: '
<br /> SAFETY-KL
<br /> IEN OF CALIFORNIA
<br /> 6880 SMITH AVE.
<br /> NEWARK CA
<br /> 9{560
<br /> TSD PHONE: 510-795-1100
<br /> FACILITY USEPA ID NO CAD98D887418
<br /> FACILITY STATE IO NO
<br /> If high risk s rep. certifies that load specific PCB i Silicon
<br /> testing have beencc wnyleted prior tv yl.nPinq this load.
<br /> GENERATOR STATUS
<br /> SQG/LQG: Vehicle
<br /> Customer certifies that (i) the above-naoed arterials •t Properly
<br /> classified, packaged, narked and labeled, and•e in proper condition
<br /> /or transportation acco rd my to te APyl icable rcqulations f the
<br /> Department of Transportation (ii)'.. rterial ch.9,ha. oCcu rI �•
<br /> either to the characteristics o! the waste/m.teriAl o n t y cess
<br /> generating the waste,/material, anA (iii) the•hove reform ceA
<br /> Gen rater Status is cv root. Custom r q s tv pay the.hov haryes
<br /> .adeto be bound by therte rma And
<br /> <end iliums (I) set forth the(a) the
<br /> General loans and Conditions provided separately to Customer or (b)
<br /> any SK agreenrnt signed by Customer and SK, and (2) incorporated
<br /> I
<br /> erein b, :,'.
<br /> y re ferenca. Unla sa oche rw iso indicated in the payment
<br /> received section, SK is au Uiori:ed to chary.Custairr'a• ant for
<br /> this transaction. I/Customer fails to make pgment when due, a
<br /> u..equal to the leaser of (i) 1.5%per ,oath.('
<br /> onth (180 ger annund or
<br /> (ii) the,n. unt all awed by law, will be added to all unpaid
<br /> ants outstanding. Custv,ner certifies that the in d iv iJual siuniny
<br /> this Service A'knawledgenent is duly au char ized to sign and bind
<br /> Custaner. Custa,uer acknowledge. that i( is responsible for n. in lain my
<br /> its Generator Statue end obt Pill my an EPA ID number if required by
<br /> •VPlicable len. The Pollewiny provision is•yylicebl. to
<br /> Safety-Kleen's parts clever end ya int gun clever a Custon�.r
<br /> aq r<es that it will not introduce any substance into thecsol vent o
<br /> ague Clea I solution, ncl tiding uitbeut 1Lnitat ion any hazardous
<br /> •steuvr hazardous waste c nstlluent, a ceps tv the utant such
<br /> iu troduct ion is inti dent•lvta then rnul use.! the arch ine. Cu.tauer
<br /> further agrees that it ui 11 not clean parts/paint 4uns that have Leen
<br /> anlaninated with o other.iso introduce yvlych1. mated biphenyls
<br /> herb is idesr Pesticides, diosins or listed hazardous waste
<br /> into the solvent o aqueous cleaning solution. Safety-Kleen has the
<br /> upac ily And is permitted to Pccapt, .tare, Pend/er reclaim the spent
<br /> parts washer solvent; paint thinners, solvents and paints g..er.t.d by
<br /> custonur; or dry clouting filter cartridges, powder, and still
<br /> es idues containing perchloroethylent, patrolman naphtha, or
<br /> triflurotrichlaroethane dry cleaning solvents. Customer Ayres that it
<br /> is esponsible for properly classifying its waste st rerna as Used Oil
<br /> r NenhaP ardour Waste in accord ente with the provision of/0 CFR
<br /> 262.11 end applicable state
<br /> aws. Customer agreesthat it will not
<br /> introduce anynon-conforming substance into the SK Property,
<br /> nclud ing, without limitation, any hazardous waste or hazarJoua waste
<br /> constitw ani.(i.e., yolychlvrinated biphenyls C'PCB s'"), herbicides,
<br /> yes tic ides, dioa ins, or listed hazardous wastes) a ceyt to the.stent
<br /> uch introduction tv incidental to the"l
<br /> u ,f the SK Pr.per lye
<br /> In the .ant of the introduction of such n - nf.rminy haurdous
<br /> ate, Custaner Agrees that it will be respells ible fur all costs and
<br /> aMdlatin ecyenses relate) too arcs illy frmn the proper m na9anenl
<br /> and disposal of e non-cenf—dri.waste, including the costof
<br /> eyu iy,at l Jecont anthi inatiun and subsequent disposal. Final ing
<br /> will be based on the actual s rvicas provided, which nay include
<br /> add it Tonal charges for off specification waste and s rcharpes. Final
<br /> voice mmunt my be su a than the an ant listed onulhe printed
<br /> receipt. If any legal action i ted because•f an
<br /> loped
<br /> disputa, brach, default o m i.representation, the Cu,taner also
<br /> .groes that the prove it ingrparty will be entitled to
<br /> r r
<br /> reasonable attorney's fees and coats associated with thea.
<br /> enforminy cvntrninativn•ent. Safely-Kleen's failure to s e
<br /> Custerner's material or tate a retain srryle, inn waY c nst itutesa
<br /> of Custaner's obs iyalion to yrop.rly classify ltsomate rials.
<br /> Sa/ety-Kleen relies en Custairr's representations end Customer is
<br /> espansibl.for inforu,iny Safety-Kleen of any process chanycs That inay
<br /> alter the characteristics o/the materials Provided. 2N THF EVENT OF
<br /> AN EMERGENCY CALL••2{-MR"ER" 1-WO-K8-1760 (Safety-Klee n)
<br /> I have established a pr.gran to reduce the .lune or quantity and
<br /> to.icit)of the hazardous was
<br /> t. to the d.yree to be ace nwa scally
<br /> pre.ticable.
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<br /> LJ
<br /> si(ftntCre
<br /> CUSTOMER/GENERATOR: Sanborn Chevrolet ;im MAY 19 2017
<br /> ENVIRONMENTAL HEALTH
<br /> <� DEPARTMENT
<br /> TRANSPORTER: 3o.eph R Lime 3r
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