Laserfiche WebLink
SK SHIP# 21882641.0 <br /> ryd �20�D-0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) OF6'rm�'A�p v d.;dl fo. <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number SKS WASTE MANIFEST <br /> CAL000375'05i L S�r.�.-465-1 'f�(3 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address if different than mailing address) <br /> R'0 Lab- Rubbef Co. Inc. <br /> 8830 U Linne Rd <br /> TRACY CA 95304-9109 <br /> Generator's Phone: 20-836'-0961 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY-KLEEN SYSTEMS, INC. TK800008120E <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address SAFETY-li SYSTEMS :SPL U.S.EPA ID Number <br /> 6000 58TH STREET <br /> SACRAMENTO CA 91828 <br /> Facility's Phone: 916-386--4913 CA000008411:' <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,tO Number, 10.Containers 11_Total 12.Unit 13.Waste Codes <br /> HM and Packing Group('d any)) No. Type Quantity Wt.Nol. <br /> 1.NON-f'CRA hiAZARDOUS WASTE) LIQUID � D"I �1C i.:: 4 <br /> (AOUEOUS PARTS MASHER SOLUTION) U <br /> z 2. <br /> w <br /> t7 <br /> 3. <br /> 4. <br /> F-i-+- <br /> 14.Special Handling Instructions and Additional Information 3, c 'a <br /> 15D] SLA 69E?1062.3 8015429 .01617 CaL. 3'4 <br /> 1-4 HR EMERGENCY # £300--468-1760(SAFETY-KLEEN) <br /> AiltTu ll, : - r r <br /> 15. GEN ERATOR'SlOFFEROR'S CERTfFICATIQN: I hereby declareEhat the contents of this consignment ase fu 1y an accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledfplacarded,and are in all respects in proper condition for transport according to applicable intemadonal and national governmental regulations.If export shipment and I am the Primary <br /> ! Exporter,I certify that the contents of this consignment conform to the terms of the attached EFA Acknowledgment of Consent <br /> - <br /> I cerfify that the waste minimization statement identified in 40 CFR 252.27(a)(if I am a large quantity generator)or(b}(41 am a small quantity generator)is true. <br /> orator sl erors Printed/Typed Nae reC. Month Day y <br /> Y 71 <br /> -A 16.International ShiorneTs11 <br /> Impart to U.S. Export from U.S. rt of entrylexk: <br /> onl <br /> Z Transporter signature(for exports y): ate leaving U.S.: <br /> W 17.Transportergcknowiedgment of Receipt of Materia#s <br /> Trans r PrintedlTyped a Signature Mgrtl1 Day Year <br /> EL <br /> �7 �G <br /> Z Transporter 2 Printyped Name Signature Month Day Year <br /> a <br /> sr <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial RejectionFutl Relill <br /> ltio <br /> ❑ <br /> Manifest Reference Number. <br /> 18b.Alternate Facility{or Generator) U.S.EPA ID Number " <br /> J <br /> U <br /> rai Faciilty's Phone: <br /> W 16c Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding systems) <br /> G 1. 2. 3, 4. <br /> H14.1 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as holed in Item 18a <br /> Printe ed Name Signature Month Day year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1)14941/156023 <br />