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HomeMy WebLinkAboutRECIEPT 9/29/2010 IIIIIIIIVIIIIIIiIII 05 IE Sep 29 10 09: 47a Downtown Chevron 6616380224 p. 1 LOWE ' s LOAF'S HIM. im. 1601 COLII#U5 STREET BA10:RSFRO, CA 93305 (661) W-9000 — SALE — SALES is FS?LAIE3 13 09-29-10 30128 ROL LEAD BATTERY 611 4.5A 17.82 SUBTOTAL: 17.82 TAX: 1.47 TWICE OSA41 TOTAL: 19.29 CASH : 20.00 DMK: 0.71 STORE: 2424 TERKNAL: 05 09/29!10 016:09:52 # OF ITEMS PURCHASEO: 1 EXCLM M. SERVICES AM SPECIAL ORIIfR ITEMS THANK YOU F8R SWING LOW'S. SEE WERSE SHE FOR RETURN POLICY. STWE MANAGER: FRANCISCO UN ' "TOMCK?LET US 00 AT: SPIN 06 p P.O. Box 10764 w....., VYY,I1�, •..I.,.V.Vr1 t x/QIs sepy/t�iPis I Bakersfield,CA 93389-0764 , sePilice Hazardous haste TPenB w�� 661.322.8258 a Fax 661.322.8883 EPA NO,CA1.000268462-Waste Oil Hauler#4483 ' N WER/TMNSIPORTER 9ILL1NGINFORNATION fi IER NAME NAME O COD O NET 30-OAC SALES REP DRESS ADDRESS CONTACT NAME /, STATE ZIP CITY STATE ZIP P.O.N L/ NO. PHONE NO. CUSTOMER EPA ID NO. CUSTOMER N0, Q a OD QUANTITY AMOUNT (U CU O (D r, (D (D L t `� a L U C 0 O C 0 V/,) O Qr r to t.� T0R'9Cffl"ICATI0I* SALES t` mowledge that I have read and agree to the terms on the(averse rile or tMs form.)Generator We"that Generatorshall be responsible for arty and all damages.Including without 11 mltallon the coat of olsening TAX it and d4oeing c1commingled feedeladcs,caused by any contaminants In Ganerstor's waste(Including wit out 4mbtlon polItychlortnsled blphenyls and other listed hazardous wastes)which render such waste I forrscycting by CSI,whether or not0merator had knowtadpa of such contaminants,orathetwlae Incurred by CS I,as a resulto(Genenator's failure to accurately characterize Its waste. TOTAL O ntof any[apt aotl ArIsIng out of any breach orsD&W breach of IN&agneementor to antom any provision ofthle agreement,the prevalling party IMI be entitled to racom reasonable attorneys feet and r4law CHARGES O ,Indudbtg arbitration and court costs. arge quantity generator,I oaAtfy that I have a program In place to reduce the volume and toddty of waste generated to the degree I have determined to be economically practicable and that I have selected the O 9 method of treatment,storage,or disposal cunsrrt y available to me which mintmtms awpresent and future threat to human health and the an olronment OR If I am a smell quantity generator,I have made a good :to minlmlte mywaste gsneralbn and selactthe bsatweate management method that Is available to me mid that I can afford. °ctlon Station ❑Cash TSDF: DRIVER'S DATE N emment Source 0 Check SIGNATURE: ' Q ne Source ❑Credit Card DATE W :ultural Source GENERATOR'S SIGNATURE: striai Source