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SSL SK SHIP# 225646968 11111111111111111111111111 oil I IIIII IIII <br /> 006098435SK5 <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 CAL000375S09 2.Page 1 of 3 EIrgeAy 791anse1P.t3opP� 4.MM ni est Tragking Numbel <br /> WASTE MANIFEST 1 1 tfitli 4Gii b 6 0 9 8 4 $K$ <br /> 5.Generator's Name and Mailing Address Generators S e Address(if different than mailing address) <br /> RD Lab Rubber Co. Inc. <br /> 8830 W Linne Rd <br /> TRACY CA 95304-91179 <br /> Generator's Phone: 209-836-0965 <br /> 1.gapgff+f oktte Y1eSYSTEMS INC U.S.EPA ID Number TXR000OCt1.20S <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> W-un aVLO Oq�a�ff6 <br /> 8.Designated Facility Name and Site Address SAFETY—KL EN SYSTEOft I NC, U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 <br /> 916-386-4913 ,000004;17 <br /> Facility's Phone: C <br /> 9a 91b.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)) No. Type Quantity Wt.N0I. 13.Waste Codes <br /> 1 NON—RCRA HAZARDOUS WASTE, LIQUID � —HF G 134 � <br /> o (AQUEOUS PARTS WASHER SOLUTION) _ <br /> VK. i <br /> Z 2. <br /> w <br /> 3. j <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD: SCA 77065243 8015429 2018226 CS6:24 <br /> 24 HR EMERGENCY # 800-468-1760(SAFETY—KLEEN) ( Y v 7-0 " 4� <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'S/OFFEROR'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 natio emmental 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 identi ed in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I i a ntily gen r)is true. <br /> Generators/Offerors��Pl+nitd Typed Name Sign pre Month DayIx <br /> Year <br /> -�j 16.International S pments 7 96t� <br /> IF- ❑Import to U.S. ❑Export from U.S. Po of entry/exit: <br /> Z Transporter signature(for exports only): D e leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> OTransporterlPrntedType / Signature Month Day Year <br /> CL <br /> U) <br /> z nnted7Typed Name Si ture Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j <br /> ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facil,ty's Phone, <br /> w 18c.Signature of Alternate Facility(or Generator) - Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Uj c 1 H141 2. r <br /> 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 /> Printed/Typed Nam Signature Month Day Y'ar <br /> /� �� <br /> EPA Form 8700-2 ev.3-05) Previous editions are obsolete. DESIGNATED FACILITY Y6 DES ATION STATE(IF REQUIRED) <br /> 1)14941/156023 <br />