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<br /> UNIFORM HAZARbOUS 1. Go rabrs US PPA ID No. moniferh Docvmenl No. 2. Page T is orrmation in thesflbd�d'anas',t''?? '
<br /> WASTE MANIFEST t; G 91. 2 F37 579 0 of 1 required by rdwf tow. '
<br /> 3. Qanerotor'&Nome and Malling Addnst R O LAS RUBBER C O. INC. A. Slate lrlanif.'et DocpTMt Number,, �,,.I�^ ', '-�14
<br /> 9210 W LIryNE RD 2 2 3'
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<br /> TRACY�, �. 9537,"3
<br /> B, State Generator's 0
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<br /> ,n a. Generoior', Phone(20g) 836-0 ?6
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<br /> CV 5. Tranrporler I Company Nome 6. US EPA ID Number C. State Tronaporl-'s10[Raserwd.l
<br /> o ,LEEI'4 IMC f 'r'�GG�a �9^!k D. Transporter&Phone
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<br /> ~°L f. Transponse 2 Compdny Name B- US EPA ID Number E. State Tronsporter's ID(Reserved.) ;a
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<br /> F. Transporter,Phone
<br /> 9, De,ignoted Facility Nome and Site Address ! U.l. 10. US EPA ID Number G. Slate Facilily s ID
<br /> d SAFETY--KLEEN 5YS'rEis-, INC
<br /> 5050 SAL IDA BLVD rl, Facili,y's Phone {
<br /> 14X SAL I DA CA 9536e CAT0010 12969
<br /> O 209 545-1011 ";;"Al
<br /> ....�� 11, US DOT Dercriplion(incliNHd Cld ID Nmber)
<br /> (including Proper Shipping Nome, otorose,anui 2. Containers t3- Totoi I�. Univ
<br /> `t laj No. Type 0—fify WI/Val I. Wasla Number 'r;;'
<br /> z a. USEn CLEANING COMPOUNDS, N. J. ;, D. N DM C slate 134
<br /> LIQUID (NOT USDOT OR USEPA REGULATED) EPA/Other
<br /> C' r`I1:11JEOUS PARTS WASHER SOLUTION (9. 3#GAL)
<br /> o N b' State ! j
<br /> f EPA/011W
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<br /> m R EPA/041W
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<br /> uZ.t EPA/Otltq
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<br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Womes listed Above
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<br /> i��'�n, ► �4�7-176' 24HR d;
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<br /> 1 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name Grid are d—ified,packed,
<br /> V mocked,and labeled;and ore in oil respects In proper condition for transport by highway according to applicable inlernplionol and notional government regulations.
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<br /> If I Grp a letge quonrly generator,1 grlily that 1 have a pro ram in aloe IG reduce the volume and toxicity of waste generated to the degree I hove determined to be eeonanieallY
<br /> d practicable and that I how selected the proaicobte method of treatment,3r0rege,or disposal currently ovailoble to me which minimize&the present and future threat to human health-
<br /> and the environment;OR,if I am a small quantity generator,I have made o good faith effort to minimize my waste ganaralion and select the best waste management method that I tl
<br /> cc available se me and that I can afford.
<br /> 0 Prinhd/Typed ante Signature Month Day Y
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<br /> 1 rens or r 1 Aektsowled emenl of Recei t of Mehr GIs
<br /> R t r Month Day Y
<br /> W M rinhd/T Noma 10
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<br /> Transporter 2 Ackn amen, Reeei ref Materials
<br /> TSignature Month Day Ytit
<br /> Printed/Typed Nome af' ,f
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<br /> V 19. Discrepancy Indication Space
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<br /> 1 20. FacilityOwner or O rotor Certification of mcai t of hazardous materials cowered b mpnil*st exa as noted in Item 19. ,
<br /> T Printed/Typed No � SignaNre Month Day Yate q
<br /> Y u;
<br /> p0 NOT RITZ BELOW THIS LINE,
<br /> While: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAY5.; ;,t•
<br /> DTSC 6022A 11/991 To: P.O. Box 3000, Socromonto, CA 95812
<br /> EPA 8700-22
<br /> 20 ' d S9b09C8 Ol 089E SbS 60Z TeS8TL-J1S NA 99: t7t 6661 21 Nflf
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