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12/02/2012 3: 15PM FAX 140002/0002
<br /> TECHNICHEM setvic ace "/ Ic5�Invoie
<br /> 7 `1p 0. 1301$
<br /> Transporter: Authorized ' � 1)RintcoC.'hettucalludustr;to
<br /> 2349 Uneoln Avenue Facility: r!T� Z
<br /> p i 1 D07 Vulcan Rd,Benton.AR 72015
<br /> rdCAA 94545 ( �LY 7 f ARD98I05781D
<br /> Heyward, 7 V
<br /> EPA lo; Roop161$3� IlifoTrac#102393, 1.800.535.5053
<br /> 800.652.5455,510,785.5455
<br /> '' IVoe
<br /> 24-Hr EmergencyN :.Ch
<br /> Unlbnn rl fto 0 '402683 ,5, r Traneprt"r
<br /> wants Me�if
<br /> —i No, TLE � l 104533R"r `2112/ 013
<br /> tvtentrert No,. 7
<br /> Date!
<br /> Customer/: � Calutoll Dry'ClcailCrs , . � �A17981 638 3G4
<br /> Generator Timothy Yoon Generator EPA ID#:
<br /> 48 West Harding Way Customer Account# 95204-05
<br /> Stockton,CA 95204
<br /> (209)466-3558
<br /> Generator Statu 61.
<br /> Etft�
<br /> ,
<br /> Drums Delivered 30-gal 55-gat Drums Picked-Un: C9pG rt
<br /> Open Plaalic/Metal
<br /> Closed Plastic � _ DEC 0 2 2013..'-.:
<br /> bAl WIN
<br /> TY
<br /> DOT Deecrlptlon of Hazardous Waste Quantltyl Waste Common Unit UnhI �H EP
<br /> Code Description /f1if�A}EtOpug
<br /> RQ,Waste T.eltachloroethylene,,6.1,UN1897,,111 CA751' Still Residue 55 gal $495.00
<br /> (F002) .
<br /> Solid Residue 30-gal $295.00
<br /> RQ,Waste Tetrachloroethylene,6.1,UN1897, III / Sia 55-gal . 5.00
<br /> (F002) 7. . CA751
<br /> -- -. Split '220.00
<br /> RQ,Hazardous Waste,Liquid,n.o.s.,0,NA 3082;III 55-gal $395.00
<br /> (Petroleum Distillates,Tetrachloroethylene)(D039) CA134 .Wastewater 30 al
<br /> g $245.06
<br /> Non-RCRA Hazardous Waste Llquld Still Residue 55-gal $495.00
<br /> (Petroleum Distillates,Green Earth, Rynex) CA213 Solid Residue 30-gal $285.00
<br /> Non-RCRA Hazardous Waste Solid Standard 55-gal $425.00
<br /> (Petroleum Distillates, Green Earth,Rynex) CA213
<br /> ` Split 30-gal $226.00
<br /> 77
<br /> �•: .• ,,:. $4,44 _.
<br /> SUBTOTAL
<br /> Outstanding Account Balance ']"fir
<br /> Payment
<br /> heck,ck, Other:•
<br /> Check -
<br /> __�_�_ Energy Surcharge
<br /> Please Pay ' . • TOTAL AMOUNT DUE
<br /> (includes outstanding a/c bal.If any)
<br /> lam✓.
<br /> I certify that the hazardous wastes named above are properly clas9lfied, described, and packaged. These wastes are stored In undamaged oontalners
<br /> that contain only the wastes as described, and are In proper condition for transportation per applicable DOT regulations. I further acknowledge that I
<br /> have the authority to enter Into the service agreement printed on the reverse, that understand 'the total amount due will bo paid C.Q.A. unless credit
<br /> hes been extended by Tochnlchgrn;in which case,poyrnorrt is due within 15 days of the date of service.
<br /> I also certify, If Indicated as such by my Initial above,that the wastes above are generated by a Conditionally exempt small quantity generator(CESQG)
<br /> as defined in 40 CFR part 251,5, and as such,per 400FR part 26 .1,these wastes are not subject to any land disposal restrictlon provision of 40CFR
<br /> part 268. Pursuant to HSC Sac 25160,2 (b)(4)(H), I also certify that I have aslabllshad a program to reduce the volume or qusntltyand toxicity of the
<br /> hazardous waste to the degree ata I have determined to be economically practicable.
<br /> Print Customer
<br /> Cwtorner Nemo, afpnolura:
<br /> Otto:
<br /> Pursuant to HSC Sec 251$0,2 (c)(2)( Technlchern hereby confirms that all,hazardous ste above wil only be ansportod to an authorized
<br /> hazardous waste treatment facility and that the hazardous waste ri)ay first be transported,to a storage or only f clllly in accordance with the
<br /> applicable provlslons of the law.Technichom does not take title to r�ustomer generated waste or other material. While exercising proper care 'and safety
<br /> procautlons,I have removed the wastes abov4 from the customer's;promises and accepted the materialt;for frena on below.
<br /> erhrer ince�jr
<br /> erc�l•`�� Transport6r
<br /> Slpnsture:
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