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- THERMO (?) FLUIDS ? ?INVOICE/BiIIRof Lading C
<br />The Responsible Solution _PO #
<br />(800),350-7565
<br />Next Delivery
<br />FED ID 59-3210374 , US:DOT# 641/7{.52/ ?
<br />COST LOC it op "i'..- ." ? : L
<br />1888746
<br />?` I Exhibit B
<br />s
<br />4 I
<br />Truck Gross Wt
<br />Tare Wt
<br />Truck Net Wt
<br />Truck # l C.?? 7 is
<br />CustlGen Name, Transporter Name Receiving Facility,
<br />Address ` Address f y / Address
<br />City, St Zip . -:. City, St Ziq,' -- ., City, St Zip
<br />Phone - Phone Phone
<br />EPA# (if Required) EPA # (if Required), ?'-_ 2 EPA # (if Required)
<br />Billing Address (if Different)
<br />Field Screen Test (Circle One): HydroChlor, -40091 Result:. G} -
<br />Quantity Inventory/
<br />P/U DEL U of M RQ Shipping Description N. .. Rate Tank Size Total
<br /> UN1993, Flammable Liquid, N.O.S., Class 3, PG III,
<br />ERG 128 (Unused Fuel) Circle One: Jet Fuel, Gasoline
<br /> UN1993, Combustible Liquid, N.O.S.,'Class 3, PG III,
<br />ERG 128 (Unused Fuel) Circle One: 'Diesel, Jet Fuel
<br /> UN1268, Petroleum Products, N.O.S., Class 3, PG III,
<br />ERG 128 (New Solvent)
<br /> UN1268, Petroleum. Products, N.O.S., Class 3, PG III,
<br />ERG 128 (Used Solvent)
<br /> UN3082, Environmentally Hazardous Substance, Liquid, N.O.S.
<br />(Ethylene Glycol), Class 9, PG III, ERG 171 (Used Antifreeze)
<br /> UN3082, Environmentally Hazardous Substance, Liquid, N.O.S.
<br />(Ethylene Glycol), Class 9, PG III, ERG 171 (New Antifreeze)
<br />Circle One: Premix, Cone, Ext Life
<br /> Non-Regulated Liquid, Used Oil
<br /> Non-Regulated Liquid, Used Oil Filters
<br /> Non-Regulated Solid, Specialty Filters
<br /> Non-Regulated Solid: Circle One: Dirt, Sludge, Absorbent
<br />Profile: ;
<br /> Non-Regulated Liquid, Circle One: Grit Trap Separator, Storm Drain,
<br />Mop Water, Other Profile:
<br /> Service Fee
<br /> Other:
<br /> Other:
<br /> Total
<br />GENERATOR SIGN BELOW, Subject to terms and conditions as specified on reverse side of form.
<br />Generator
<br />Signature Transporter
<br />Signature ? > Receiver
<br />Signature
<br />Name Name Name
<br />
<br />Date f Date Date
<br />
<br />r f j
<br />In Case of Emergency, Call: Chemtrec 140'0-424;-9300
<br />REMIT TO THER_MO FLUIDS INC. 1 METHOD OF PAYMENT:
<br />39354 TREASURY CENTER CASH / CREDIT CARD /TERMS
<br />CHICAGO, IL 60694-9300- A m aM CHECK #
<br />4W -A 1
<br />9
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