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<br />5ee Instructions an
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<br />SAFETY-KLEEN SYSTEMS, INC
<br />TX 75024
<br />6. US EPA ID Number
<br />71850.
<br />INC.
<br />10.
<br />COMPOUNDS, N. 0. I. H. NLL.
<br />>aR SOLUTION 8, 3#GAL
<br />page 6. Deparnneni of Toxic subs ;
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<br />IS- Special kandI1 e Indrvctiene and Additrotecel Information
<br />'MERGENC t RESP 800-468-1760( 24 HR ), IF UTNDEY.IVERABLEOSRETURN8TO GENERATOR
<br />16. TM'S qffRWA11M1 I hereby declare that the ca tiopeant on frllr car �mibed abate b pro r shi p
<br />maw, end k ieled, and one in all ryepege in preper Condi ion r fivn rt fii9hWpy o n 10 table intnmat{onafym'8 cl.; a) ggernment and
<br />foffe fionsifiad, Paek®d,
<br />If I am o large lua generator, I certify that I have a pr m in place to nedvce the volume and kwieiry of wash generated to the degree t
<br />Proeticable one that 1 are uJachd Na arodica610 method of treatment, storage, or di I 9 hors determined to be economicallyy
<br />and the 010 me andY, I if I ora o emo gtwM�ty generator, 1 hose made o good Follh �rtu4wme nlmize my waste 9 erotion�and eeleczas lteifis 6dt wasteend uture lbrVal to Nyman
<br />management melhod'tF, is
<br />ere:b6le to me and Ihor I can afford.
<br />Print,d/T�ip�0�� t Signature
<br />// / i L % ar"'tt , it..r-/-" l'' — Month Month Day rept .
<br />PrlMed/Typed Nome
<br />Name
<br />.. Ind. ;otion Spoto
<br />DT� {1l99!
<br />EPA iM-22
<br />Signolure
<br />NOT WRITE BELOW
<br />90'd 62908VG 01 0896 SVS 602
<br />month Day Yaar,,
<br />Mauh Day Year
<br />r5 L`ItVE.
<br />Blue! GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS.,
<br />TO: P_O. Box 400, Socromente, CA 95012-0400
<br />10S812 -AS Nd EEsZO 6661 V2 dSS
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