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QAFETY-KLEEN SYSTEMS, INC. 0 <br />CALIFORNIA CONSOLIDATED MANIFESTING <br />ADDITIONAL GENERATOR RECEIPT INFORMATION <br />SERVICE DOCUMENT #: / 11077 D7 /f/ 9/ CUSTOMER <br />CONSOLIDATED MANIFEST DOCUMENT #: <br />GENERATOR COMPANY NAME: J M�Sr` ( /L <br />GENERATOR CONTACT NAME: 4J OI �/7 64 <br />CALIFORNIA STATE WASTE CODES /. <br />LINE ITEM (A): 1 � L <br />LINE ITEM (B): <br />LINE ITEM (C): <br />LINE ITEM (D): <br />TRANSPORTER #1 NAME/ADDRESS: <br />o) 66A& ('ori <br />TRANSPORTER #1 SIGNATURE: DATE: <br />GENERATOR CERTIFICATION AND SIGNATURE <br />I HAVE ESTABLISHED A PROGRAM_ TO REDUCE THE VOLUME OR QUANTITY AND TOXICITY OF <br />THE HAZARDOUS WASTE TO THE vR TO BE ECONOMICALLY PRACTICABLE./ <br />GENERATOR SIGNATURE: !^-t } ? / DATE: -61 Ao <br />COPY I - GENERATOR RETAINS COPY 2 - TRANSPORTER RETAINS COPY 3 - OPTIONAL <br />K577GF-R6564 PRT DATE: 11/11/OB <br />