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Fr, LMT, Inc. Page: 1/7 Date: 1/4/2012 11:0,-. - AM
<br /> 7-185-01
<br /> P!aese prinI or type, Form des/ nod for use on ellie 12• Itch)! ewrlter, Form Approved.01,6 No,2050.0039
<br /> UNIFORM HAZARDOUS 1.Ganaretar ID Number 2.Paps t of 3.Emorga,cy R0000na8 Phone 4.Manl st TYaclrlo ber
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<br /> WASTE MANIFEST 1 1-800-46 76 nn i q 20 SKS
<br /> G,Generator'at1woandt ilingAddre9s G4tnrrstorsShaAddrMea(It differentIhenmallingaddrosa)
<br /> ZM TECHNOLOGIES
<br /> 1010 SHANT RE)
<br /> STOCKTON CA 95215
<br /> Oenera&s Phone: 209-547-1965
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<br /> Dea'glNndzltlhty Noma and Site Addddrre as SAFETY—KLCEN SYSTEMS, INC. 000618 u.8.EPAONumbnr
<br /> 1722 COOPER CREEK ROAD
<br /> 940--483-5200 DF.NTON, TX 76208
<br /> Fjriiil sPi,oro: TXD077603371
<br /> ga. 9b.U.S.DOT Dascdptlon(Inrh,ding Froper Shirpinq Ngms,Hnznrd Claes,ir)Number, 10.Cartsirem t1•Tafel 12.Unit
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<br /> No. Ty08 Quwlty Wtf/d. 13,W030 Codes
<br /> V• HAZARDOUS WASTE LIQUID, N, 0. S, DM P DO 6 D007 D00
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<br /> II I)ERG4171 0003142935
<br /> SK AUTH'D TO NE SUB5 TCA
<br /> ip, CENERATOR'31OFFEROR'S CERTIFICATION:I hereby dedmry Shat Ilia malaria of this tonslgnment aro fully and accumtofy daacrlbud above
<br /> marked and la6s!edlpfaby the propersh!ppinp,nama,std are tlnaeifiad,packaged,
<br /> cunt,and aen!a of am In all roapacta In proper conAltion for tranapoA 8a0rdlnp la appl(cablo folema!lohel and na!fannl qM enamel rprlulaQonn.M eXporf 9Poomhnt and I am tl•e Pdmary
<br /> Exporrnr, Ihot[he wntoedlfy Osconst„omen/ctnf0Tm to tho mrme of”a 9hnchod EPA AcknowlademaM of Golnnnt,
<br /> I certfly!nnt rha nasle minlmization a!al?mntH'deNifietl In 40 CFR 7.62.21(1)(if I am n t1q;a quanllty genornlor)cv;b)pf I n i a .efi uan'l noreiar)la!rue,
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<br /> FOrm 8700.22(Rev,1-06) Previous edifons are o selete. ) p IGNATE:D FACiL Y Td DESTIN STATE IF REQUIRED)
<br /> �)o003715 ?1 3) 4
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