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BRANCH SSL CSG UMO-60 Joseph Lima Jr 08/20/15 15:22 PAGE 2 <br /> SHIPPING DOCUMENT <br /> REFERENCE NBR. <br /> CUSTOMER#/GENERATOR: CH40400 Chase Chevrolet 67923029 <br /> 6441 Holman Rd <br /> Stockton CA 95212-2703 SRVC DATE: 08/20/15 <br /> PHONE 209-475-6630 CONTACT NAME: Chase Chevrolet <br /> GENERATOR USEPA ID. CAL000117545 GENERATOR STATE <br /> MANIFEST#: 005028454SKS FORM CD: 1D SHIP# 216952813 <br /> TRANSPORTER 1 TXR000081205 SAFETY-KLEEN SYSTEMS, INC. <br /> 5050 SALIDA BLVD <br /> SALIDA,CA. 95368 <br /> TNSP PHONE: 209-545-1011 <br /> TRANSPORTER 2 <br /> US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID) <br /> NON RCRA HAZARDOUS WASTE,LIQUID <br /> ETHYLENE GLYCOL SOLUTION (LESS THAN 50%) <br /> FEDERAL WASTE CODES NONE <br /> STATE WASTE CODES 133 <br /> TOTAL CONT 1 TYPE TT WT/VOL G SKDOT 651 <br /> CNT#: 150820650955 SZ: BULK VOLUME CONTAINER QTY: 75 PROF# 156030 CA CAT CODE:E <br /> DESIGNATED FACILITY NAME/ADDRESS: <br /> SAFETY-KLEEN OF CALIFORNIA, INC. <br /> 6880 SMITH AVE. <br /> NEWARK CA 94560 <br /> TSD PHONE: 510-795-4400 <br /> FACILITY USEPA ID NO CAD980887418 <br /> FACILITY STATE ID NO <br /> If high risk source, SK rep. certifies that load specific PCB & <br /> Silicon testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> CESQG: Vehicle <br /> Customer certifies that (i) the above-named 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 Transportation and (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SK, and (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Customer's <br /> account for this transaction. If Customer fails to make payment when <br /> due, an amount equal to the lesser of (i) 1.3% per month (18% per <br /> annum) or (ii) the maximum amount allowed by law, will be added to all <br /> unpaid amounts outstanding. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorized to sign and <br /> bind Customer. The following provision is applicable to Safety-Kleen's <br /> parts cleaner and paint gun cleaner services: Customer agrees that it <br /> will not introduce any substance into the solvent or aqueous cleaning <br /> solution, including without limitation any hazardous waste or <br /> hazardous waste constituent, except to the extent such introduction is <br /> incidental to the normal use of the machine. Customer further agrees <br /> that it will not clean parts/paint guns that have been contaminated <br /> with or otherwise introduce polychlorinated biphenyls (PCB's), <br /> herbicides, pesticides, dioxins or listed hazardous waste into the <br /> solvent or aqueous cleaning solution. Safety-Kleen has the capacity <br /> and is permitted to accept, store, and/or reclaim the spent parts <br /> washer solvent; paint thinners, solvents and paints generated by <br /> customer; or dry cleaning filter cartridges, powder, and still <br /> residues containing perchloroethylene, petroleum naphtha, or <br />