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*lore or "Ilromfo—knvlrt nma*Aprowi , qp��r <br />eaim Approved OMS No. ?OSa0031 iExplree 9.36 <br />1196ese primp or type. For, &14;,wd for 4N an elite <br />RE <br />o`i E <br />O 'N <br />m R <br />.4 <br />v A <br />T <br />,or O <br />,WW <br />tv <br />rn <br />a <br />W <br />O <br />11 <br />Lu <br />x <br />F <br />'Al <br />11 <br />3, nelat0(s PNami'md MoH, Address <br />5 . 0 L" UCY Df 1 V <br />C USTE t 1.1 BLDG 3 <br />PLANO 7 <br />®, Gemeralors Phan@ 197 21 26S-2000 <br />SS, Tron�sporter C,oretany Name <br />SAFBTY••KLEEN SYSTEMS, INC <br />Sea In0mr9nne Ase fs.AL <br />v. Dedonaled I acilily Name and Site Address 71850.1 <br />1850.1 10. US EPA iD Number <br />SAFETY- 4-EEN SYSTEMS. INC., <br />5050 SI LIVA BLVDCAT000613968 <br />SALIDA CA 95368 I I I I I I I I I <br />11. US DOT pea* rlpflon I.including Proper Shipping Name, Nozord Close, and ID Number) <br />USED CLEANING COMPOUNDS, N. 0, I. B, N. <br />LIQUIE'LATE <br />AQUEOL S ( PARTS $WASHER SOLUOT OR TIONG(8.48L)J <br />b. <br />C. <br />d. <br />Intorrnal.on in the shaded area, <br />i, not required by Federal low. <br />a <br />15- Special Handl ng Ime hC11arts and Additional Information MF S T $ /T # 10 3 218 07 6 7-165-01 <br />EMERGEN,'Y RESP 800-468-1760(24 HR). IF UNDELIVERABLE RETURN TO GENERATOR'. <br />SKDOT A: 941 B; C: D. <br />I6. t9ENlRATt ': CERT KAT10M t hereby declareThai phe contents of this consignment ore Fully and accurately deutlbed above by proper shipping name and are classified, pac6d, <br />marked, and I ibeled, and are in o0 dnd <br />respects in proper ellion for honepoA by highway according to applicable international and national government regulations. <br />If f om a large gvwgly genaotor, I codify that I hem a program In place to reduce the volume and tonicity of waste generated to the degree 1 have determined to be ecoltomloallyy <br />ptacliaable an l ihal I ve seleNed the practicable method of Ireatrnent, etoroge, or dfepasal currently available to me which minimizes the prauni and future threat to hupgart Health <br />and fhe enrirc ae"i;;'OR, If I am a small quontity generolor, t have mode o good faith effort to minlmize my woos generation and sleet Ihm best waste management method Ihat,is 1 v' <br />avoilable to m and that I can afford, <br />orinted/i Nan a /w Signpturo Month Day Yeror <br />I7. ronaporrer I of Raeei of Materials <br />srinted/Typed Naas Signature Month Day, Ymar,'''%;- <br />lf4i Q c/ <br />I8, i sporter Z t ck onto Recti 1 of Meats : <br />'rinted/Typed Nam I 5grwturo <br />Month bay Yegr;y;, <br />U I I?. Discrepo ley fn, IcaGon'Space <br />C <br />L <br />I 20, Pacitily <br />y4amm 70 ihVdon of recti t of hazardous maiwidt covered bV <br />i Printecl/T am, Signature <br />Y <br />DO NOT WRITE <br />byk 111092A (1/99) <br />10A Bf0C1=-22 <br />80'd 629C8b6 Ol 089C 9b9 602 <br />maM69 except as noted fn Item 19 <br />/ IMonth Day <br />BELOW THIS LINE, <br />Blue: GENERATOR SENDS THIS COPY TO DT$C WITHIN 30"DAYS. <br />To; P.O. Box 400, Socramenlo, CA 98812.0400 <br />10981) -MS dd 9C:20 6661 b2 d8S <br />