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* e 1 3�dd �1i101 ** <br />,err,' 3 U mvo. n *V-WJV tttptres Y-JU• ,� t 8 5 _ t� 1 :Ice In11INuctions on ba page 6. <br />Please print or type. form Wiffned forum on elite 1, ypawri»r" V :J V i <br />UNIFOI M IfAZAWOUS 1. Ganaralor's US EPA ID Na Manifest Decumenl No. <br />WAS rE 41FEST TXRfa000509 30 <br />3, Generators lk omtb' Irtblli Address A Std AAalmi <br />5400 LEGA`FY' DAVE <br />CLUSTER 'U BLDG 3 <br />40 <br />® PLANO TX 75024 <br />` 4. Generator's P oma 119 7 21 26S-2000 <br />C* 5. Transporter 1 :ompahy Name 6. US EPA ID Number C. Stag! Trans <br />Q <br />SAFETY—(LEEN SYSTEMS, INC (1 I RO00051099330 I I I D. Tran.�rrr., <br />11 <br />.. E <br />o ,N <br />CD E <br />-4' R <br />C4 A <br />T <br />O <br />ft <br />sw <br />V <br />4 <br />Z <br />Q <br />C� <br />*91 <br />O <br />B. US EPA 10 Number <br />P. Designated Fa ility Nbstwand Sips Address 718501 10. US EPA ID Number <br />SAFETY—.CLE,EN SYSTEMS, INC. <br />$050 SA'.IDA BLVD CAT000613968 <br />SALIDA CA 95368 1.11 111 111 1 1 <br />11, US DOT Doerr pdon (lnchsdiag.Proper Shipping Name, Hazard Class, and ID Number) 1 <br />a. USEII CLEANING COMPbUNDS, N. 0. 1. B. N. r <br />LIQUID (NOT USDOT OR USEPA REGULATED) <br />AQUEOU.! PARTS WASHER SOLUTION (8. 3#GAL ) <br />e. <br />0 <br />1, ffotsal' i�ti� ,abaw <br />13. Special Handlir f Insffuctl6rrs•and Additional Information <br />EMERGENCY, L ZSP 800-468-1160(24 HR) <br />1. State <br />H. <br />m <br />DeparRnent of Toxic Substances Centrum <br />Sacramento, Cpfl"&, <br />2. Page I Information in the shaded meas <br />1 is not required by Federal law. <br />of <br />ZZ, 1311" <br />11 4A <br />_ 000.,95;',�, <br />b phos. <br />3 ,68' <br />am' <br />13. Total 14. Unit <br />Quantity Wt/Vol 1, lsepsfe, l <br />stop <br />store MIT- <br />K. Handling Coda frr Wmlk rived Above <br />c d. <br />MFST R/T#103216034 7-185-01 <br />IF UNDELIVERABLE RETURN TO GENERATOR, <br />SKDOT A: 941 B: D: <br />16, GENERATO111 CEUMCAMM: 'I hereby declare !fiat the contents of this cans�gtunent era fully and aceurahl described above by proper shipping name Grhi ora classified, packed, <br />marked, and b clad; and are In ail respeels in proper eondlhon for Ironspart py bighwoy according to a�Kable International and national go�r,manl regulalions. <br />If I am a 1prga volvow 1 certify drat l have a proprom in place w reduce the volume and raxIcly of wasps generated FO the magna 1 fta�te determined ro be economically <br />practicobfe and that I Irava selected 16 practicable method of treatment, sfw'age, w disporol currently available Io me which minimizes the present and future throat to human haefrft <br />and rhe pinviron sOnr; �, ff I am o small ®uaniy "mamma, I have made a good Fnlsh effort to minimize my waste generation and sailed the best wash mamsgvnent method that is <br />available to me and gates I eon offal. <br />Printed/TYPa% Signature Month Day Year <br />l/Jd•A <br />17. Trans 1 A, i of Rt Ml t of Materials or <br />Prinled/TYp� Na SI nature <br />i ® MOM Day year f <br />10 C21I <br />16 <br />18. Tronsporlar 2 Ai know ' 1 M of Receipt of Motafiels © i` <br />hinhd/Typed Name Signplure month Day Yom : <br />I I 1 I <br />0 , F 19. Diserepancy Indi mlian Space <br />Z A <br />C <br />I <br />L <br />I 2#-r FeAry Owner o OpuatGr Cs <br />Y , to �� me <br />D;'FSC ®f122A I I /M <br />EPA 8700-22 <br />629C8b6 Ol 089E SVS 602 <br />I <br />Day Year <br />�6 <br />15 LINE. / <br />Blue: GENERATOR SEND$ THIS COPY TO DTSC WITHIN 30 PAYS.' - <br />To: P,O Box 400, Sacromenio, CA 95812-OAOO <br />10981L -AS dd 9E:L0 6661 bZ d3S <br />