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12/02/2013 3: 15PM FAX
<br /> KJL fj0001/0002
<br /> 14fi4,4
<br /> TECHNlCHEM - I t
<br /> 61ce No.12 3 3 4 4
<br /> Transporter: Authorized r 1)Ritieco Chemical Ltthtctrles
<br /> 2349 Lincoln Avenue Facility: 1007 Vulcan Rd,Belden,AR 72015
<br /> Hayward,CA 94545 AItU98t057870
<br /> EPA ID;cARoog161836 •„ SAN JOAQUIN COUNTY I0bTrac#102393: 1.800.
<br /> 800.852,5455,510.785.5455 535.5053
<br /> ENVIRONMENTAL 24-Hr Emergency No.Cti �' g
<br /> UnNormHazertloun rQ�2f5g3f3�/�/♦,FLLr. r apo ar,
<br /> 4� is Rat
<br /> waste L.A sst No. ,•. ,_ ;naenlrnst No. 10'0576 pate: 6/4/2013
<br /> Cvinpn DlY Cleallers
<br /> Customer/
<br /> Generator;, Generator EPA ID#: CAD981•.638 364
<br /> ''Tunottly'Poon •
<br /> 48 West Harding Wad Customer AccounC#: " '95204-05
<br /> Stockton,CA 95204,
<br /> ''Generator Status: SQGCESQC OCFR 261:5)
<br /> (209)466-3558 `'
<br /> ion Initlah
<br /> Drums Delivered 30-gal CESQG Certificat
<br /> 55.001 Drums Pl ked-Up:
<br /> Open Plastic/Metal I '
<br /> Closed Plastic
<br /> DOT Description of Hazardous Waste Waste COgtMon
<br /> P Quantity Coda Descrl tion Unit Unit Price , Amount Due
<br /> F002 Waste,Tatrachloroethylene„6.1,.UN1897.,,111 r� .55-gal.. . OU,
<br /> V. Solid Residue $29 p
<br /> - __ ...
<br /> RQ,Waste T9trachloroethyleno'8 1,UN1897,III' CA757 'Standard $425;00'
<br /> (F002)
<br /> - Split
<br /> Rd,Hazardousl/Vaste,Liquid,n.o.s.,9,NA 3062,Ill CA134 Wastewater,.
<br /> 55'gill $395 UU”
<br /> (Petroleum Distillates,Tetrachloroethylene)(0039) 30-gal $24S Ob'
<br /> Non-RCRA Hazardous.Waste Liquid q ,CA213 Still Residue �. 55-grtl _ '��i5�5,00
<br /> (Petroleum Distillates,Green Earth,Rynox) -i . , Solid Residue 30�
<br /> g $285A0"
<br /> Non-RCRA Hazardous Waste Wild CA213 Standard 55-gel $�l25'00
<br /> (Petroleum Distillates,Groan Farth,Ryne><) I'' Spilt
<br /> 30 gal 1220,00
<br /> !' lJ SCit R f av
<br /> Outstanding'Account valance, $Q'00 SUBTOTAL
<br /> Payment Check ) Other'. --
<br /> Check M a,.,. ,,,.Amount:
<br /> _ Energy Surcharge $15.00
<br /> TOTAL AMOUNT�DUE
<br /> Phase Pad C.Q.D:*
<br /> (Includes outstanding ate bal.it any) -
<br /> I certify that the hazardous wastes named above arta properly classified,doscrlbed, and packaged. These wastes are stored In undamaged containers
<br /> that contain only.the wastes as described, and are in proper Gond lion for transportation per applicable DOT regulations, I further acknowledge that I
<br /> have the authority to enter Into the service agreement pknted on the reverseiAhat I understand "the total amount due will be'pald C,O.D, unless credit
<br /> hes been extended by'Technlchom,In which cast',pgyrn6ntis due r{fthln 15 days of the date of asrvlce.
<br /> I also certify,If Indicated as such by my initial,above,that-tt a-wastes above are generated by a conditionally exempt-small quantity generator(CESQG)
<br /> as defined in 40 CFR part 281.5 and as such,per 40CFR'pad,26il,these waste6 are not subject to any land disposal restdcllon provie(on of 40CFR
<br /> part 2$8. Pursuant to HSC Sac 25160.2(b)(4)(H), I also certify h t I have estabilsh -a program to reduce the volume or quantity and toxicity of the
<br /> hazardous waste to the degree as I have determined to,l#e econ mi ally practicable.
<br /> Print Customer
<br /> customer Namin SIgnoturs: DOW
<br /> Pursuant to HSC Seo 25180.2 (c)(2)(C), Technichem hereby co firms that all haz@rdous wast ova will on y be tra rted to an'.authorized
<br /> hazardous waste treatment facility and that the hazardous wast may first be transported to a s rage ur transf _ cilily in accordance with the
<br /> applicable provisions of the law.Technichem does not take title to customer 6ewrstbd waste or other matoriel.While exetdi9ing p ope ' re and safety
<br /> precautions,I have removed the wastes above from tho ustom®r'g remises and accepted th m�atellal!for tranepo n th�dala darslgnod Ue w.
<br /> DrfuerlOrf}en irtemo:
<br /> Perc/COD Tmnspo
<br /> Signet.► Date;
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