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Frot .ZMT, Inc. Page: 3/7 Date: 1/4/2012 11:08:59 AM
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<br /> Please print or typo, Form designed for use on elite(12-pitch)typowrltec Formll� ()proved. a,2050.00991
<br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.emer4 envy Response Phone a,ManHeat hacking Number
<br /> WASTEMANIhEST Cly Qrftfl3c?555� 1 ( -$t(j�d-46A-1^rCln
<br /> 0023305 .3 SKS...-
<br /> 5,t3enaratpr's Name and Melling Address Generator's Ske Address(If difforent then mailing address)
<br /> ZPI TECHIN01-a 531 Ea
<br /> 1010 SHAW RIS
<br /> STOCKTON CA 952 IS ;
<br /> Generator's Phone: E09-••547-4965
<br /> 6.Tran^ortar 1 Com an Hama U.S.EPA 10 Number M
<br /> SA 1 TY�l;� E.ld SYSTEMS, INC. TXR�1tfi71050930
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<br /> T,7YangperlOr 2 Company Noma U.S.EPA 1D Number y
<br /> 8.dostgnat d Facilky Nnmo end Bile AddrBas SAFETY-A EEN SYSTEMS INC. NEW Number �„r
<br /> 1722 COOPER CREEK ROAD
<br /> DENTON
<br /> 940-463-5200 Tx 7r,}�Izt8
<br /> Fncllll s phone; T0077603371 --
<br /> ga. 9h.U.S.DOT Descriptlon(inckdng Prepar Shlpping Name,Hazard Class,10 Number, 10.Contalnors 11.Tbla! 12 Unit
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<br /> HM and Packing Group(f any)) Ne, Type QUantky '00vol. 13,waste Codas
<br /> a x ' RC, 01993 WASTE FLAMMABLE LIQUIDS, DM {. !' DORI 214 IJT§''
<br /> N. 0.S. (P-CIAL.C1ROBENZOTRTFUJORIDE) r p
<br /> y3 PIS III (I1oo1) l
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<br /> ,4,Spaciai Handling Inslrucdons andAddlilonol information 7 l�^ � CSB*
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<br /> ,�:4 HR EMOSE.NCYyk9� R�1171fW4�6$,x761 SAF=ETY-KL. ! -- CONTRACT #94138)
<br /> 91 4 471 �-
<br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION:I li reby declare Mot the contents of this consignment are rally and 9ccurololy described above by the proper shipping n9me,and are dessilled,packaged,
<br /> marked and Inhniedfpiacarded,and aro In all roapecis in propor corkIlon for trareporl according In applicable inlematlonal and netkumal govemmonfal regulations.If export shipment and I Fm the Primary
<br /> Exportor,I cartdy That the conionts of this consignment conform to tllie leans of the attached F.PAAekQedgmanl of Consont. 4: ;
<br /> I corll y that the Wit)miniml2atlon shtomenl Identified in 40 CFR�52.27(9)ON Am a large quantlly genaml0r)cr(b)(If I-m a smell quwity genTrue,, t�
<br /> !' n. for o8erorg P 'edrryped Name o amu^ Mow Day rade"till
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<br /> .J'18-lntarnndonal Shipments.
<br /> ❑Import to U.S, ❑ xpor
<br /> et from U.S. Port of entry/ e
<br /> Transpdrtersigpatvre(roroxpods only); DBfe leaving U.S.;
<br /> 17.TransportorAckmvledgment of Raceipt of Mnlorwa
<br /> OpTramponor
<br /> or 1 Printedllyp Name slgnalure Month Day Year,,;+,.
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<br /> co "' r 2 Prinled/iyped Nama Signature Mont'n Orly Year
<br /> 18,Discrepancy
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<br /> 14uanilly ❑Type ❑Rxidue ❑Partial Re(CCllon lJ FAN ReJootidn""�'"
<br /> Manifest Raferenco Number.
<br /> Aflarnate PaCllily(Dr GtinrlratOr) U,S,EPA ID Number
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<br /> jAN 0 6 LU11
<br /> U- Fnciliry'sFhona;;j
<br /> L�u 1- Sfgnalure-of Alternate Pachily(Or GenerA.or) Month Dny 1!ear r
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<br /> 1s,I la2ardrn,s W. a Report Manage t Method Codes(I.e.,codes for Hazardous waate heatmnnl,disposal,end rCCydIng systems)
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<br /> 20.0.gnatsd act hi Owner or OparAtar Certlilcedon of racaiot ot;tasardous mstadalg covered by Uro mrv,ifest e t as nded In Ifsm ilia
<br /> P ad a err a Signa C '�"
<br /> 4, A(IF
<br /> DE5IGNATrED .FACILITY I�F.STINATION S7A REQUI14MMI';
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