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Fro....LMT, Inc. Page:4/7 Date: 1/4/2012 11:0b.,d AM <br /> 7,142 Ili III111111011111111101111fill IIIIIII <br /> Please print or IyTpa. Form designed for use on elite 12-pifol)typawrlfer,) d 0 2 5 9 d G 8 h 9 K 5 <br /> FormAoproved.OM8 No.205o.M38 <br /> UNIFORM HAZARDOUS t GQnomta ID fdumhar CALI�O� e�5J62 2,Pa 1 Of E g ns P' 4,Manifest rrnekin Number <br /> WASTE MANIFEST � �`f —� � O 02596486 <br /> - �r+ <br /> 5.G ra mB and Mall gddress 4 8 6 S KS'7'.',� <br /> 7' E NO1 C) E9 Generators SltGTdit,a(If difforvt 113n rhal'Ing addrez) <br /> 1010 SHAW Ria -- <br /> STOCKTON CA 9$215 <br /> Ganerator's Phone: 211019-547-1%5 <br /> fITeSYSTEMSI INC. U.S.FPA it)Number TXRO00050934 <br /> ",Trans ori 2 Company Neme U.S.EPA ID Number rn'~ <br /> b.Deafg atgd Facility Name and Site AddrnGs 5prTY--KLEENINC. <br /> 1722 COOPER CREEK ERafx1D ��+3.0 Dlumher <br /> DENTON, , TX 76208 <br /> 9k0--4l33-5?(b0 <br /> Y's Phone: TXD@77603371 <br /> Facllk <br /> qn. Bb.U.S.OOT Descr011on(including PMW Shlpping Nnmo,Hanrd Class,ID Number, <br /> 10.Conlalnors •1,Total 12.Unit r I <br /> pg� and Packing Group(If any)) I.I.Waste Coda <br /> No. Type Cuenlily W jvol. <br /> WX I- RG WASTE FLAMMABLE' LIQUIDS, N.O.S. DM P D(A01 214 CUTS(P—CHLOROHENZUTRIFLUOR IDE) <br /> 3 UN 199a PG 111 (0001) / -- *( <br /> z 2. <br /> w <br /> 3, <br /> - F <br /> t -- <br /> 14.Spsalal Handling Instrucliona andAddlgonal In!ormation SK SHIP,,#• � � "' t <br /> 3142935 CSG' <br /> 1)ERG#128• y �'3f <br /> 24 HR EME40LNCY #1-800-_468-176 (SAFETY--MLEELCIONTRACT #94134)SK AUTHs1� TQ UaE 91,IDaE(�UENT CA RIERS.4161 Cs6f. ( ✓739 t353`3�J <br /> 15. GEtvERAroR'SfoFFEROR'g cERTIFICATIDN;1 hgroby declare the ., 13 of t`d;Guru'yuiiieni my iu!iy and accNltQry d9acnaad above by the proper shipping name,911tl 91A ClaGeli ad,packaged, y <br /> marked and labe'edlplaeardad,and are in all respacia in proper condltlon for tranapol according to applicable International and natlonat govarrroantal raguladons,If oxpol sNpmcnl and I am the Primary <br /> bporler,I Codify that the romsnts of this consignment conform to the terms of the attached EPAAcknowtedrmant of Cq%ont. <br /> I Certify that the waRlo rNrimlzadQn Statamgrll(dentlllad In 40 CFR 262,27(a)Of I am a large quanllly flonerator)a if I Am e s tall qua y generator Is true. j <br /> &ie-molions! <br /> r'r.Printed. ed Name, ra <br /> Mon Day YW; <br /> lrpmanis <br /> ❑Import to U.S. ❑Expon(Am U.S, Port of ertry/oft <br /> tureporoxpodsonly); OatOWngU.S,; <br /> Luc 17,Transporter AeknowledQmaniofRpcolpiofVwnrlala i <br /> OTrarapo 1 PrintedlTypod P e Slgnalure <br /> Tran-orlrr 7.Pdntedr antn <br /> Gc7J� S lure month Day Year, <br /> r11aDI,,c,'opn'y'n"cAf'Dn <br /> repancy �. <br /> „�. <br /> oSpate <br /> ❑Ouan6ty Orlpo A r' f�'� <br /> ❑Residua -, ❑Panlnl R01661ion Did'Rojaclion "=• <br /> rate FeclNly,er Generator) <br /> Mantleal Relerorlcg Num %:.,- <br /> U US,EPA ID Number <br /> W FacJlly'a Phoncr <br /> 18c.Signalufg of A@grnala Faefilly,(or Generator) <br /> Month Day vaarw. <br /> 14.Hazardous Waste R <br /> opat ManaAamant MQGnod Codes(i.e.,ICodes for hazardous waste treatment,disposal,end recycling systems} "" ` <br /> p 1. 7 cava r <br /> 3, d <br /> 20.Designated Faclliry OunQr or Operator.CarflgcaPr fTyped 110r of receipt of hazardous materials Cov@Md by the morifest oropi aq noted N tram tam t <br /> grla r� '.. 1 �nlh Day Yr..ar <br /> EPq � <br /> F 7 <br /> �f oua ed ons Are o solata.. / G <br /> 1) /40�4�8 DFS CtiN �,t7�rsCfl.tTYro a� •'t' 1ATf�ON sxnT� F�� r `� i <br /> ( JlF2EL7. : <br /> This fax was received by GFI FAXmaker fax server. <br />