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" <br /> . . <br /> SAFETY-KLEEN SYSTEMS, INC <br /> ----� CALIFORNIA CONSOLIDATED MANIFESTING <br /> ADDITIONAL GENERATOR RECEIPT INFORMATION <br /> f---f~�^l�.��` / ` r� ~� /\ ~ �( � <br /> ;ERVICE DOCUMENT #� _^� ~��w`�� 'r �� CUSTOMER #� /' � w ' <br /> uN6OLlDATEL MANIFEST DOCUMEi,4T #. <br /> ;ENERATOR COMPANY NAME: <br /> }ENERATOR CONTACT NAME: <br /> ;ALIFORNIA STATE WASTE CODES <br /> LINE ITEM (A) : <br /> in— <br /> LINE ITEM (8 ) : <br /> LINE ITEM (C ) : <br /> LINE ITEM (D) : <br /> TRANSPORTER #1 NAME/ADDRESS: <br /> / <br /> TRANSPORTER #1 SIGNATURE: DATE: <br /> � <br /> ` <br /> GENERATOR CERTIFICATION {> <br /> I HAVE ESTABLISHED A QUANTITY AND TOXICITY OF <br /> THE HAZARDOUS WASTE T PRACTICABLE. <br /> / <br /> GENERATOR SIgNATURE� DATE: n <br /> COPY 1 - GENERATOR RETAINS COPY 2 - TRANSPORTER RETAINS COPY 3 - OPTIONAL <br /> K577gF-R6564 PRT DATE: 02/10/10 <br /> ° ^ . <br /> ' <br /> ' <br />