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<br />Stara of California—Envlronmer al Protection Ageney See lfl5trU6tROnS On bdCk a 6. Deportment of Toxic Substances Confto�Y'
<br />'Form Approved OMB No. 2050 0039 Kxpires 9.30.99) is, 5 U ! P
<br />Please print at type, form dosi med'Foe ulna on dtte (t2 -pitch) h'pewriler• Socromento,-California ; rc„
<br />1. Generotor'a US EPA ID No. Mpnifesl DocumanlN 2. Paga 1 Information in the shaded areas `
<br />UNIFORM HAZARDOUS TXR000050930 � � 1 is net required by Federal lbw.
<br />WASTE MANIFEST Vof
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<br />CLUSTER rI, BUILDING i.
<br />P L ANO TX 75024
<br />265-2000 ' ��� ,•'I,,
<br />vy 4. Generoror'a Pho o ( •'k^'-
<br />n A 6. US EPA ID Number C. State TransportaKs,1D (Rntserved.'�
<br />N 5. Tronaporler 1 Cc pa y,Name r --
<br />m, SRFE,i`Y-X (.LVV SYSTE KS r INC TXR0000509 30 D• Tronsporlar's Phone
<br />T—S.Nome S. US EPA ID Number E, State Traenpoeter'a ID
<br />y 7. Transporter 2 Cc
<br />F. Trampor1or : Phone ', I, ;i,1;�• ,
<br />9. Designated Focil tr Nom'e and Site Address 000760 10. US EPA ID Number G. Stara
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<br />Qz SAFETY -RLE �S�YSTEMS, INC.
<br />.{ 6000��T17Ri�.T�ipi`000QD64.�i17 H. FeeililY'3Ph9ne�
<br />°� SAORAMPTO , GA 958211
<br />12. Contoiners 73, Total IA. Unit
<br />11. US DOT Doscrif ion'Uneluding Proper Shipping Nome, Hazard Clone, and ID Numbed y r''
<br />No. Typo Quantity Wt/sol J. Wfo!'
<br />Z fiAS�AR�ous WASTE LIQUXD N— 0. S. Stofe!:'';. g�•,: ,.
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<br />9 NA304 2 PQ '111 (D039 ){ ERG#171) aF' G
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<br />Ka . Handling codes for WasteLlste`d-�'
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<br />75. Specfa4 Handli g Instructions and Additional Informalion MFS T P, /T # 10 3 G 06 S 2 1 7-1a$-01
<br />ESP 800--466-1760(24 HR). IV UNDELIVERABLE RETURN TO GENERATOR.
<br />Q Ei�#BTiGENf'Y
<br />z SIS CORP A ESPU'D TO USE SUBSEQUENT CARRIERS! 8L'343Q, 4035s`,'�la].5, 44582,
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<br />1. 16. uNERA7or! aRTmAnoN: (hereby declare that the contents of this consignment are fully and oscuromfy described abova by proper shipping nome and are classified, pabked, '
<br />Umarked, and I ibelad{ and are ;n,311 respects in oropor condition for transport by highway according to applicable international and nononaPgovernment (09001ions.
<br />If 1 oat a Iprge quanrt}y generator, I certify Ihpi I have a proggram in place to red6c0 the volume and toxicity of waste generated lo the degree I have determined to be eCoaOmiGallpp
<br />h practicable an I Ihol I qve selected the roctieoble met hpd of treatment, storage, or disposal currently available to me which minimizes ilio p'resonl and future threat ro human 6eolth
<br />and the envirc imenY OR, if I am q small quantity generator, I have made a good faith effort to min;mizo my waste goneration and select the best wosto management method dtgt.is
<br />available to m - and that I can afford.
<br />Q Month Day Yapr. =8
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<br />'Z5 T 17. an rlar aekno%W ernnent oPReeei t of Materials ^•^'"�+y' f T , '`A?.
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<br />®u 1B. Trena rter 2 keknowled meni of'Re et ref Material&
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<br />L 20. Peeili CMna or lar Cer4lication of receipt of 6azotdous malerfals covered by this martifost anca I as noted in Irorn 19. Month Dar • ' i Year ly�
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<br />DO NOT WRITE BELOW THIS LINE. '>
<br />DTSC 8622A 11/99) Yellaw: GENERATOR RETAINS,'
<br />EPA 8700-22
<br />Cold 629E8b6 Ol 089E SVG 602 T0S8TZ->iS 8d SS:21 6661 VE dSS
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