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66L4 _ IIIIIIIIIIIII 1111111111lIIIIlIlIIIII <br /> '2-S %So l 005571070SKS <br /> Please print or type.(f=orm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 5 r 2.Page 1 of 3„Emergency R®sp�wse Phorlei. 4.Manifest TrackNumr <br /> CrL(?()037��(�9 100551715- 70 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> RD Lab Rubutwr Co. Inc <br /> 8830 U Linne Rd <br /> TRACY CA 95304-9109 <br /> Generators Phone: 20?-836--096S <br /> 6-TMs Y-0rTars bT SYSTEMS, INC. U.S.EPA ID Number TXR00008i1201 <br /> 7 Transporter 2 Company Name U.S EPA ID Number <br /> 8,Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, !NC U-S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA Y5828 <br /> 9x.6 ..386 4'�1 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. <br /> 1 NON--RCRA HAZARDOUS WASTE, )._IOUI1) 1 Di l 2 <br /> o (€OUEOUS FARTS MASHER SOLUTION) <br /> 1 <br /> w <br /> L 2 <br /> t7 <br /> 3 <br /> I <br /> 4 <br /> 14-Special Handling Instructions and Ad&bnal Information Tei �;C� <br /> 4 HR EMERGENCY ## 800 468 x 76MAFETY—KLEEN) <br /> :,i.1TH A5 "AGENT--FORA BY GE14 TO RETAIN LTLENSFE) %rx: CARRIERS AS NECESSAK' <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are class6ed,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport acoarding to applicable international and n ional governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cenity that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if i am a all quantity generator)is true. <br /> GeneratorslOHerors Printed/Typed Name Signature Mon Day Year <br /> '54�-S45- eWX <br /> J 16.International Shipments 14 <br /> 1— ❑Import to U.S. ❑Export from U.S. Port of eritrylexit: <br /> K Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TransporterAcknoMedgment of Receipl of Materials <br /> ~ spoderi PrntedlT pad Name <br /> Ng a e Month Day Year <br /> VO <br /> a Transporter 2 PrintedlTyped Name I S nature Month Day Year <br /> tY <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantityyp <br /> ❑Type L Residue Ll Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) US.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone, <br /> LU 18c.Signature of Allemate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes 0.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> A 1. ))1 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Primed/Typed / Signature Month Day Year <br /> ell <br /> Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATIO S <br />