Laserfiche WebLink
7-1 e'3-01 <br /> - .Ngs6 pnnt or type.(Form designed for use on elite(12-pitchoriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Pae 1 of 3.Emergency Response Phone --. 4.1111 nifest T ac 'n16833 <br /> u ber - <br /> I WASTE MANIFEST CAR000102707 1 1-800-468-1760 60f 6 8 3 3SKS- <br /> 5.Generators Name and MallinAddress Generators Site Address(if different than mailing address) <br /> RUBBER <br /> INC.29 SSACRAMENTOT RECEIVE C <br /> LODI CA 95240 <br /> Generators Phone: 800-285-1600 1 MAY 2 2 200 <br /> ��'`�'��5?.�W§'rn,YSTE"l INC. D.S.EPA ID Number TXRC00050930 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address SArETY—KLEEN SYSTEMS, INC. 000760 U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAME14TO CA 55828 <br /> 916-386-4913 CA0000084517 <br /> Facility's Phone: <br /> go. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(it any)) No, Type Quantity wt./Vol. <br /> X 1SlASTE PAINT RELATED TMATERIAll UN1263, DM P F003 D001 0018 <br /> o PO II, / <br /> [� D035 0039 212 <br /> z 2. <br /> w <br /> 3. <br /> 4 <br /> 14..Special Handling Instruct ons and Additional Information SK TRCX#114528092 0038940373 00031$3217 0920 24 <br /> 1)ER>III <br /> SK AUTHORIZED TO RErA N LICENSED SUBSEOUENT CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment confemt to the terms of the attached EPA Acknowledgment of Consent <br /> I canny that the waste minimization statement identified in 40 CFR 262.27(a)(I I am a large quantity generator)a(b)(if I am a small quantity generator)is true. <br /> Generators/Offerors PdntedfT Name Signature / /j Month Da Year-, <br /> 611) <br /> —1 16International Shipments i <br /> 4- 1:1 Import to LLS::.- ❑Export from U.S. Port of enrrylexd: <br /> . <br /> Transporter signature for exports only): . - Date leaving U.S.: <br /> CE 17.TrgmpOnerAcknowledgmentorR ipt of Materials <br /> T enspormr 1 Printedffyped N e Signalu - Month Day Year <br /> Q Transporter 2 Printed7Fyped'Name Signature Month Day Year <br /> cc <br /> 18.Discrepancy <br /> i 18a.Discrepancy Indication Space ElQuantity L1 Type Partial Type j t <br /> ❑ Reaction ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA IO Number <br /> J <br /> U <br /> ran Facility's Phone: <br /> w 18c.Signature ofAtemate Facility(or Generator) Menti Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 H141 2. 3. 4. <br /> 20.Designated Facility 0 Operator.Certification of re?aAlbaumnlous materials covered by the manifest except as nded in Item 18a <br /> 1 PnntedfFyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.MI) Previous dilions are obsolete. DE NATED FACILITY TO GENERATOR <br /> 1)0012607 2) 3) 4) <br />