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Please Dnnt or tvpe. (Form designed for use on elite 02 -pitch) NDewdW.) <br />Form Aooroved. CY8 No 2050-003q <br />EP grin &100.22 (Rev. 3-0% Previous editions acs otsolete, <br />1 i +r1471`ai 1 /4-• it <br />1 DESIGNATED FACILITY 0 GENERATOR <br />UNIFORM HAZARDOUS <br />1' Generator ID Number <br />CAD0047716 <br />se Phone <br />aManht Track„ing Number <br />MANIFEST <br />) F LWASTE <br />VV 7 <br />5 Generator's Name and Mailing Address Gerwators Site Address (if b Brent than mailing address) <br />f:!lLIt�OR!`ItA rPelK LINES tW: <br />PO DOX 5245 3105 5 EL DORADO ST <br />4T©CK FON CA 971206-0245 <br />Gereratces Ptwne: I=09--466-3554 <br />oa der ami U.S. EPA 10 Number <br />KA TY L EN SYSTEMS, INC. T X R0000") 0930 <br />7 Transporter 2 Comny Name U S. EPA 10 Number <br />S.DesiriatedFacility Name and SiteAddress SAFETY KLL:CN SY3TEM8 INC. U.P..M0t;ber <br />1722 COOPER CREEK t�obb <br />OENTrN, , TX 75208 <br />'J40-483—rt200 T*4D077603371 <br />FitioWs Phone: <br />9a. <br />9b. U.S. DOT Description (including Proper Sh+ppng Name, Hazard Class, ID Number, <br />0 urtainera <br />11. TOW <br />12. Unit <br />t J. 'rVas!e Cies <br />No. <br />Type <br />HM <br />and Packing Group (d any)) <br />Owitty <br />WI.Nd <br />X <br />1 RA WASTE FLAMMABLE L I QU I DS, N. 0. S. <br />DM <br />P <br />0001 <br />211 <br />OUTS <br />o <br />(P—CHLOR09ENZOTRIFLIJORIDE) <br />( 0001) <br />3 <br />g <br />3 I IN 1993 PG III <br />t� <br />2. <br />LU <br />3. <br />��201 <br />/I <br />'.4 Specie+ Handling Instructions and Addrtior !information uK S1'1IP - _ 371 L <br />Z0102171 y <br />24HR EMERGENCY 41-800-468-176@ (SNFETY-KLEEN - 94138) ' <br />r ni + Y, 113F CARRIERS'. 4 t 37a, 4147 1, 31 Sal, 112739, A53913 <br />15 GENERATOR'StOFFEROR'S CERTIFICATION: I her" declare that the contents of this cdnsgr~ are k* and accurately described above byte proper snipping name, and are cassfled, packaged. <br />marked and abeedrplacarded, and are R a# mWects in impar condition for transport according to applicable international and national govemmental req iabons. If export shvmeM and I am 7+e Primary <br />Exporter, I Certify that the contents of 69mm gl>R Binhyn form to the terns of the attached EPA Acknowledgment of Consent <br />ort fy that the waste minimization statement dentthedln 40 CFR 262.27(a) (M I am a !argb quantity generator) or (b) (if I am a snail quartity generator) is true. <br />cera s, t7 ante 'g mar <br />r <br />G t <br />18. !rtematonal Shipmerm Impodto— <br />U Export firm U.S PcR of entry!exit. ---- — - <br />Z <br />Tran er s aLue' ex Brit : Date leaving U S.. <br />Transporter <br />W <br />17. Transporter of Receipt oflyateniils ' <br />th gar <br />~ <br />p <br />Tra 1 rintedTyped t e <br />CL <br />r�' ��!! <br />N <br />Z <br />Tran yped Narne ay ear <br />18 Discrepancy <br />,aa C+screpanwy Indication Space t l Ouanbly' LJ T" ❑ Retl&. l_J Partial Refection ❑ Full Rejector <br />r--' I 4 � <br />Manifest Rderence Number <br />18b. Alternate Facility oo f US EPA 10 Number <br />J <br />U <br />LL <br />Fm:mN9 Phone' <br />w <br />13C. SgnaEre A{temate FKahrykor Generato() Morth Cay 'r•ar <br />Z <br />19 Hazardous Waste Repoli Management Method Coos(ce , codes for hazardous waste treathent disposal, and recycling systems) <br />W <br />` 3 4 <br />20 Fac* 1y a OpePatix Certs al4n of roce+pt G hazardous matenals by me matwfest except as noted n item 18a <br />Prim Name 54gralure M1 Month Day <br />i r <br />EP grin &100.22 (Rev. 3-0% Previous editions acs otsolete, <br />1 i +r1471`ai 1 /4-• it <br />1 DESIGNATED FACILITY 0 GENERATOR <br />