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SSL SK SHIP <br /> 006344631 SKS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number rt _,�� 2.Page,1 of 3.EmerpQr y Rgs�r�yse Fhgn� 4.Manifest Tracking Number <br /> •.ALU O r�-£�� 'L'- L:-� ' > 006344631 SKS <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> hU Lab Rubber Co. 1rec <br /> 8830 W Linne Rd <br /> TRACY CA 95304-` . <br /> Generator's Phone: 209-836--096S <br /> 6.Tr o n U.S.EPA ID Number <br /> '�°r�5', �..�Y� SYSTEMS �i`Ic rxr;00C<<; <br /> 7.Transporter 2 Company NameU.S.EPA ID Number <br /> (An e / <br /> 8.Designated Facility Name and Site Address F _,! <br /> 9 ty SAFE'TY KLEEN ,ryY.,.Tt.. t r: U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 9SO28 <br /> gib-_-,86--491' CAtii 0008445 17 <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 /> t NON—RCRA HAZARDOUS WASTE~ LIQUID r 1 ;4 <br /> o (AQUEOUS PARTS WASHER SOLUTION) <br /> Z 2. <br /> LU <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information .S-0. SCA 74526;?' 5'.01S4""10 201736 CSO `4 <br /> 24 HR EMERGENCY # 800-468•--i'760(SAFETY-KLEEN) l --3c�5C4 <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED, SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROR'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international 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 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 small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> X XL A A <br /> a.A ?1 11 <br /> —+ 16.International Shipments <br /> Z ❑Import to U.S. ❑Export from USof entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter Printedffyped Name Signature Month Day Year <br /> NEVE V til tel'`_" oq Z 1 17 <br /> Q Transpo a ed(r ped NameSignature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type 1:1 Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1 I f1 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 /> Name � S' na a Month Day Year <br /> 'A A <br /> Ito a <br /> EPA Form 8700-22(R -05 Previous edi ions are ob e. DESIG A D FACILITY TO (NATION STATE(IF REQUIRED) <br /> ).;14941,;'1 02_ <br />