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Fro,.,.LMT, Inc. Page:5/7 Date: 1/4/2012 11:09:uo AM
<br /> PleasL'ON4kN04Rrm dcs(gnod for rree ort elite f12•pltct`)typewrfler) Form Approved.OMB No.2050.00?9
<br /> L Grnrimmr 10 Number 2.Page 1 o.' 3.Erer hey R9 mosa Phone a,Manitast Travkin N�uum(b'ee, �(
<br /> UNIFOREMNIFESHAZARDOUS l 1 Mo 4178 1 /f.rr11 0 2 3 a 2 O 6 S KS
<br /> WASTE MANIfEST
<br /> 5 7mrAtwi:Name and Mailing Address c onprators Silo Address(if different than malling irldw-,z)
<br /> TM UCHNULU61175
<br /> 10ir"c1 SHAW RV
<br /> 3eneraWrs Phone; C'.l�G� J F i FaEn:.i
<br /> 0.Tq0 C . U,$,FPA ID NumberY.. p. N' r'"',i,1-_htr, i.w-.
<br /> 169"'':
<br /> 7.Transporter 2 Company Niru? V.S.EPA IU Numuor
<br /> 8 DasigneledFacility Name anQSileAddrass SAFETY--LEEN SYSTEM!,,, IW It�f�Cg4lDNum6ar
<br /> 6000 88TH STREET
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<br /> Fac111 '^Piton?; SACRAMENTO , CR 9582©
<br /> 9, 9h,IJ.S.DOT D09cription(inrludlrrr Prop?r Sbipoiq Nanne, .M'Ga3a,ID Number, 10.Con'alnery 11.Total 12,Urit
<br /> HM and Peeking Oroup(if any)) No. Type Quaniily WII/01. 13.1JV:7sta Codas
<br /> X 1 RQ UN1993 WASTE FLAMMABLE LSDUIDS, t DMP 001 ?-t4iw
<br /> N.0.S. (P--CHLQROPENZOTRIFLUORIDE) �I ---- �y
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<br /> 3,
<br /> 4,
<br /> 16,Spnoiol Handling Instructl%1 cndAdditional lnfcrmtlion ,� ,
<br /> SK SHIP#-@529327 551L985� 314-335 LSG:
<br /> DERE#128,
<br /> 24 HR EMOBENCY 41-•804--468--1760 (SAFETY-KLEEN — CONTRACT #94.239)
<br /> 15. GENERATOR'SIOPFEROR'S CERTIFICATION; I hereby derlara that the contant9 of thls consignment are fully and atturalalydeaorihed above by the proper shippfng name,and aro clasaifiod,paaAgod,
<br /> madod and labeledlplacardrtl,mod ern in en respecln in proper Wodlllbn for Iranspvrl nwtfhg to apprlcoble Intmnatfonal and national grvammanfal regultitionr,If?xpert shipment and I nm lha P4mary
<br /> Exporter,I oerlty fhat 8rocmtenta of Ih°s consignment oomf01r1 to the terns of the attarhrxi EPAAcknow!adgment of Consent. 1.
<br /> I eedlty that the wasta miniml,silon stat?m9nt Idenlif ed in 40 CFR 262.27(a)(It I am a Inr9?quaniily generator)or(b)Of I am a amall qua.ntlty genorfitor)13 True.
<br /> Oe entornjofrmeq Pdntod oPd Neme 1 nalur9 Motilh Day Ynnr
<br /> 16,Internalional Shipments
<br /> ❑Impart to U.S. Export fmm U.S. Pod of ontryloxil;
<br /> — vansDomer signature(for o>porls only): Dale laavinq U.S.:
<br /> W 17.TmnftvAerACknow1adgmnnl of RAcalpt ce fiUndnk-
<br /> Transpnno Prntedrftrppo a Si nature
<br /> O 9 Moray 01y Yoe
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<br /> 18,-)3d'abancy
<br /> 181.Discrepancy Ink—Mion Space ❑ II��11
<br /> Duanli`y ❑Fypa ❑Roaltlue Iwl P3r1I31 Releclion ❑Full Re;edlen
<br /> ManifestRnfare mNumber:
<br /> 186.Allnrnala Facul y(or Gnng.ator) U,S.EPA t0 Number
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<br /> Fadlilyc Phone:
<br /> W 18r,.SignalureofAllem loFacility(or Qn.rmplor) Month Ony Yaa
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<br /> 10,Hszardous Waite^nd d Marta amodl Method Cad. a 7 Po g CS Rs,codas for hataMova waste ern errant,diapasal,and raeye6ng systema)
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<br /> 20.Oerlgraled Far Illy Owner rr Operator.Csmfir,,%Ifon of recelpl of h,-'Mdotls materiels covered by the mnnife31oxoapt as rderl in—107811
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<br /> EPA Parrn8700-2Z(Rav,3.05) Previo sedlIons ere sae D SIGNATED F IL T GENERATOR STAT (IF R
<br /> 1)402472/40349840
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