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CSG UMO-01 Joseph R lima Jr OS/11/17 14:17 PAC <br /> {�� C <br /> 1—be SHIPPING DOCUMENT <br /> REFERENCE NRR. <br /> CUSTOMER//GENERATOR: SA12961 Sanborn Car Wash L Quirk Lube 73677897 <br /> 1210S Cherokee Ln <br /> Lodi CA 95241-591! <br /> PHONE 661-948-6044 CONTACT NAME: Sanborn Car Wash d <br /> GENERAIOR USEPA 10. CA0054598289 GENERATOR STATE <br /> MANIFEST#: 005947176SKS FORM CO: ID SHIP#222374237 <br /> TRANSPORTER 1 TXROOOOB1205 SAFETY-KLEEN SYSTEMS, INC. <br /> 5050 SALIVA BLVD <br /> SALIVA,CA. 95368 <br /> TNSP PHONE: 209-S4S-1011 <br /> TRANSPORTER 2 <br /> US D01 OtS(RIPIION (1NCLUOING PROPER SHIPPING NN4f, HAZARD LLASS, AND 10) <br /> NONRCRA HAZARDOUS WASTE,LIQUID <br /> ETHYLENE GLYCOL SOLUTION (LESS THAN 501) <br /> FEDERAL WASTE CODES NONE <br /> STATE WASTE CODES ... <br /> TOTAL CONT 1 TYPE TT WT/VOL 6 SKDOT 651 <br /> CNTB: 170511018106 SZ: HULK.VOLUME CONTAINER QIY: 20 PROF# 156030 CA <br /> DESIGNATED FACILITY NAME/ADDRESS: <br /> SAFETY-KLEEN OF CALIFORNIA <br /> 6880 SMITH AVE. <br /> NEWARK CA 94560 <br /> TSD PHONE: 510-795-4400 <br /> FACILITY USEPA ID NO CA0980187418 <br /> FACILITY STATE ID NO <br /> If high risk source, rep. certifies that load specific PCB L Silicon <br /> testi <br /> no have been completed prier to pumping this load. <br /> GENERATOR STATUS <br /> CESQG: Vehicle <br /> Custo*mr certifies that (i) the ab.........d materials a e pruperly <br /> c lassif ie J, package,, marled anJ laL<led, •nJ• n groper cont iIio. <br /> for tramp*r M1t1:n• .rdiny to the applicable regulations of the <br /> Department of Transpor tatien (ii) n rrterial change has orred <br /> either in the characteristics of the waste/material or in theyroces. <br /> generating the waste/material, and (iii) the above referenced <br /> Generator Status i co rec t. Customrr agrees to gay the above aharyes <br /> andeto be bound bysthe rlenm and comdit Tons (1) set forth in 6J the <br /> General Terms and Conditions provided separately to Custoner or (b) <br /> Amo <br /> any SK ayreament siyn.J by Cust peer and SK, and (2) i orp*rated <br /> herein by reference. Unless*the raise indicated in the payment <br /> received section, SK a au thori:ed to charge Customer's ant for <br /> Ihis transaction. If Customer fail: to make papnent whe due, <br /> ant equal to the lesser of (i) 1.58 par month (18%ger mn.r0 or <br /> (ii) the moa imam r ant allowed by law, will be added io all un,jil <br /> ants outstand iny. Custpner certifies that the inJividu•1 signing <br /> this Service Acknowledganent is duly authorized to sign and bind <br /> fust Omar. Customer acknowledges that it y esP., ble for n in to.i., <br /> its Generator Status and obtaininy an EPAsID ..ober if requi1red by <br /> applicable law. The following provision is applicable to <br /> Safety-Kleen's parts cleaner and paint gun cleaner s 'vices: Oust onar <br /> agrees that it will not introduce any whstance into the solvent o <br /> aqueous clean my solution, including without limitation enY hazardous <br /> este or hazardous waste c nstituent, a ceyt to the eetent such <br /> int roductien is inc identaloto the n nial u of the much ine. Cust*nier <br /> further agrees that it will not clean parts/paint juns that have been <br /> contrninated with o otherwise introduce yol ychlo n nate,biphenyls <br /> OPCB's), herbicides'pesticides, dioxins or listed hazardous waste <br /> into the solvent o aqueous cl can my solution. Safety-Klee.has the <br /> capacity and is pa nnitted to accept, store, and/*r reclaim the spent <br /> Perls washer solve.l; Paint thinners, *lvents and paints generated by <br /> ustomer; or dry clean my filler cartridges, Powder, and still <br /> residues containing parchloroethylene, petrol mn navhCha, a <br /> tri fl urotrichloroethane dry clean ino solvents. Customer agrees that it <br /> e.Pons ible for properly class if Yiny its was to st'e'm as used 0i1 <br /> r Nonhazardous Waste in a mrd:...with the provision of 40 CFR <br /> 262.11 and applicable stateclaws. fustumer agrees that it will net <br /> introduce any n - o forming substance into the SK P—party. <br /> including, wit horrt climitalion, any hazardousante or hazer,*.•waste <br /> ns tit...t,(i.e., yol ychl or inated biphenyls ("PCBs"), herbicides, <br /> Pesticides, di*.ins, r 11saJ hazardous wastes) a cePt to the Gent <br /> uch introduction is inc ident•1 to then.nal u of the SK Property. <br /> In the event of the introduction of suchen - onf*nming hazardous <br /> waste, Customer agrees that it will be responsible for all costs and <br /> reneJ Tat ion expenses related to or arising frp the proper manayruenl <br /> CSG SK-SSL-UMO-01 Joseph R Lima Jr 05/11117 14:17 PAGE 1 <br /> Sig—tve <br /> CUSTOMER/GENERATOR: Sanborn Car Wash 8 Quick Lube pedre raja MAY i 9 2017 <br /> ` ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Slarature <br /> TRANSPORTER: Joseph R Lima Jr <br /> LAST PAGE <br />