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~ <br /> °- * <br /> 0AFETY—KLEEN SYSTEMS, INC. <br /> CALIFORNIA CONSOLIDATED MANIFESTING <br /> ADDITIONAL GENERATOR RECEIPT INFORMATION <br /> ���8 <br /> SERVICE DOCUMENT #: «~ ' ° CUSTOMER #: ~~ / <br /> Wc) <br /> CONSOLIDATED MANIFEST DOCUMENT #: <br /> GENERATOR COMPANY NAME: <br /> GENERATOR CONTACT NAME: <br /> CALIFORNIA STATE WASTE CODES <br /> LINE ITEM (A) : // <br /> LINE ITEM (B) : <br /> LINE ITEM (C ) : <br /> LINE ITEM (D) : <br /> TRANSPORTER #i NAME/ADDRESS: <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 DEGREE TO BE ECONOMICALLY PRACTICABLE. <br /> GENERATOR SIGNATURE: DATE: <br /> COPY 1 — GENERATOR RETAINS COPY 2 — TRSPQRTER RETAINS COPY 3 — OPTIONAL <br /> M577QF—R6564 PRT DATE: 11/11/O8 <br />