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CSG SK-SSL-BOX-23 Raymond Gomez 01/17/17 11:44 PAGE 2 <br /> SHIPPING DOCUMENT <br /> REFERENCENOR, <br /> CUSTOMER#/GENERATOR: MOOU44 Lkq 72634264 <br /> 2041 Navy Dr <br /> Attn Jerry SRVC DATE: 01/17/17 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 CONTACT NAME: Lkq <br /> GENERATOR USEPA ID. CAL060265997 GENERATOR STATE 9060019999 <br /> MANIFEST#: Q05729758sks FORM CD: ID SHIP# 22130421S <br /> TRANSPORTER 1 TXPOOOOO1205 SAFETY-KLEEN SYSTEMS, INC. <br /> 5050 SALIDA BLVD <br /> SALIDA,CA. 95358 <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 /> {AQUEOUS PARTS WAS$ER SOLUTION} <br /> FEDERAL WASTE CODES NONE <br /> STATE WASTE CODES 134 <br /> TOTAL CONT 1 TYPE DM WT/VOL G SKDOT 14941 <br /> CHT#: 161126667128 SZ: 30 GAL/114 L CONTAINERS QTY: 20 PROF# 156023 CA CAT CODE:G <br /> DESIGNATED FACILITY NAME/ADDRESS: <br /> SAFETY-KLEEN SYSTEMS, INC. <br /> 6000 BOTH STREET <br /> SACRAMENTO CA 95828 <br /> TS7 PHONE: 916-386-4913 <br /> FACILITY USEPA ID NO CA0000OA4517 <br /> FACILITY STATE ID NO <br /> GENERATOR STATUS <br /> 0-220 lbs/month <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 (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material, and {iii} the above referenced <br /> Generator Status is Correct. Customer agrees to pay the above charges <br /> and to he bound by the terms and conditions (1) set forth in (al the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> any SK agreement signed by Customer and SK, and (2) incorporated <br /> herein by reference. unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for <br /> this transaction. If Customer Fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.5% per month (18% per annum) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding. Customer certifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and bind <br /> Customer. Customer acknowledges that it is responsible for maintaining <br /> its Generator Status and obtaining an EPA ID r:umber if required by <br /> applicable law. The following provision is applicable to <br /> Safety-Kleen's parts cleaner and paint gun cleaner services: Customer <br /> agrees that it will not introduce any substance into the solvent or <br /> aqueous cleaning solution, including without limitation any hazardous <br /> waste or hazardous waste constituent, except to the extent such <br /> introduction is incidental to the normal use of the machine. Customer <br /> further agrees that it will not clean parts/paint guns that have been <br /> contaminated with or otherwise introduce polychlorinated biphenyls <br /> (PCB's), herbicides, pesticides, dioxins or listed hazardous waste <br /> into the solvent or aqueous cleaning solution_ Safety-Kleen has the <br /> capacity and is permitted to accept, store, and/or reclaim the spent <br /> parts washer solvent; paint thinners, solvents and paints generated by <br /> customer; or dry cleaning filter cartridges, powder, and still <br />