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SAFETY—KLEEN SYSTEMS, INC. <br /> v_ <br /> . CALIFORNIA CONSOLIDATED MANIFESTING <br /> ADDITIONAL GENERATOR RECEIPT INFORMATION <br /> iER4°ICE DOCUMENT CUSTOMER : X, <br /> 'ENERATOR COMPANY NAME: I nd � /V1- r <br /> 'ENERATOR CONTACT NAME: <br /> ALIFORNIA ,STATE WASTE CODES <br /> LINE. ITEM (A) : <br /> LINE ITEM (B) : <br /> LINE ITEM (C ) : <br /> LIME ITEM (D) : <br /> RANSPORTER #1 NAME/ADDRESS: <br /> RANSPORTER #1 SIGNATURE: _ DATE: " U <br /> ENERATOR CERTIFICATION AND SIGNATURE <br /> HAVE ESTABLISHED Aa PROGRAM TO REDUCE THE VOLUME OR QUANTITY AND TOXICITY OF <br /> HE HAZARDOUS WASTE TO THE D GREE T BE ONOMI LY PRACTICABLE. <br /> ENERATOR SIGNATURE: _ LATE: <br /> COPY 1. — GENERATOR RETAINS COPY 2 — TRANSPORTER RETAINS COPY 3 — OPTIONAL <br /> 5'1'7GF"—R65&4 PRT DATE: 04/03/07 <br />