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� 7 <br /> 3i_- SK SHIP# 2i'?54.258 <br /> 006 / 001035 K5 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.Ol No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number �s t z-.�,� 2.Page 1 of Erq, y f}egnss Phoae 4.Manifest Trackin Number <br /> ..1 �.,.-; 1 . 006160103 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> RO i Rubber Co. Inn. <br /> 88 .0 W F_i nn a Rd <br /> rAr,{. CA 95304--9109 <br /> Gererater's Phone: 209-836-0965 <br /> 6.�laf'� o",ff&r SYSTEMS INC U.S-EPA ID Number TXR000081205 <br /> 7.Transp er 2 Company Name US.EPA ID Number <br /> fi:l-EA J HF R?4CRS ENVIRONMENTAL SERVICES 'INC MAD039,3c?r.�SPI <br /> 8.Designated Facitity Name and Site Address SAF ETY_KLEEN SYSTEMS, I NE. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO , CA 95828CA0000084517 <br /> 31115-386-4913 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13-Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1. I'dO*-RCRA HAZARDOUS WASTE LIQUID 6 134 <br /> o <br /> (AQUEOUS PARTS WASHER S(1LUTION) ` 20 <br /> l <br /> w <br /> z 2. <br /> W <br /> CJ <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information Tr - ( , 7 3521196 ROJ542? <br /> i24 Hid EMERCEN'CY #1- 800-468-1760 (SK / TFT) <br /> ,IUT!! ;4S `P.77FNT--l BY SEN TO RETAIN LICENSED SUB CARRIERS. AF NIECESSPRI! <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 classified,packaged, <br /> marked and labeledlpiacarded,and are in all respects in proper oandition for transport according to applicable international and nationat 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 EPA Acknowledgment of Consent. <br /> I certfy 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 small quantity generators is true. <br /> Generator'sl0fferors PrintedlTyped Name Signature Month Day Year <br /> o� og r 7 <br /> -1 16.International Shipments <br /> Ill ❑Import to U.S. ❑Export from U.S. Port of entrylexit: _ <br /> — Transporter signature(far exports only): Date leaving US <br /> IX 17.Transporter Acknowledgment of Receipt of Materials <br /> OTrans rter 1 PrintedfTyped Name Signature ` Month Day Year <br /> Q Transporter 2 P ntedTy erne Signature Moe Day Year <br /> 3 <br /> 18.Discrepancy <br /> 18a Discrepancy indication Space ❑ i ❑Full Rejection <br /> Quantity Type Residue Partial Rejection <br /> Manifest Reference Number; <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> c.� <br /> Facility's Phone: <br /> C1 18c.Signature ofAltemate Faality(or Generator) Month Day Year <br /> Q <br /> Z <br /> o19.Hazardous Waste Ropod Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 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 /> ed Name Si re <br /> nth D Yea <br /> EPA.Form,8700-�2 �v -05) Previous editions are obsolete. <br /> DESIGK01ED FACILITY TOC INATIpN STATE(IF REQUIRED) <br />