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CSG SH-SSL-Box-23 Raymond Come.: 07/27/16 12:00 PAGE 2 <br /> SHIPPING DOCUMENT <br /> REFERENCE NBR. <br /> CUSTOMER#/GENERATOR: LK00044 Lkq 70597796 <br /> 2041 Navy Dr <br /> Attn Jerry SRVC DATE: 07/27/16 <br /> Stockton CA 95206-1142 <br /> PRONE 209-464-1111 CONTACT NAME: Lkq <br /> GENERATOR USEPA ID. CAL000268991 GENERATOR STATE 9060019999 <br /> MANIFEST#: 005522597sks FORM CD: 1D SHIP# 219475622 <br /> TRANSPORTER 1 TXROODOB1205 SAFETY-KLEEN SYSTEMS, INC. <br /> 5050 SALIDA BLVD <br /> SALIDA,CA. 45358 <br /> TNSP PHONE: 209-545-1011 <br /> TRANSPORTER 2 <br /> US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND 10) <br /> NON-RCRA HAZARDOUS WASTE, LIQUID <br /> (AQUEOUS PARTS STASHSR SOLUTION) <br /> FEDERAL WASTE CODES NONE <br /> STATE WASTE CODES 134 <br /> TOTAL CONT 1 TYPE DM WT/VOL G SKDOT 14941 <br /> CNTN: 160718968623 SZ: 30 GAL/114 L CONTAINERS QTY: 20 PROF$ 156023 CA CAT CODE:G <br /> DESIGNATED FACILITY NAME/ADDRESS: <br /> SA?ETY-KLEEN SYSTEMS, INC. <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95e28 <br /> TSA PHONE: 915-386-4913 <br /> FACILITY USSPA In NO CA00400a4511 <br /> FACILITY STATE In NO <br /> GENERATOR STATUS <br /> 0-220 lbs/month <br /> Customer certifies that (i1 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 iiii) the above referenced <br /> Generator Status is correct. Customer agrees to pay the above charges <br /> and to be bound by the terms and conditions (1) set forth in (a) 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. llnlcss 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 (198 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 number 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 /> IPCB's}, herbicides, pesticides, dioxins or listed hazardous waste <br /> into the solvent or aqueous cleaning solution_ Safety-Klaen 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 />