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05/11/2005 11:19 FAX 209 932 0610 R&B CONSTRUCTION LA008 <br /> TCVAC m ON <br /> ENVIRON QUALITY 7-185-ul a <br /> P.O.BoliC13Wt <br /> Austin,Tadd 78711-3087 <br /> Please ptim or tyle.(Form designed lar use on site(12-pitch)typewriter.) Form Approved OMB No.205(a0M. <br /> UNIFORM HAZARDOUS 1.Generamr s US EPA ro No- 2.Page 1 Information in the shaded areas <br /> WASTE (FEST d is not required by Federal law. <br /> 3.Generation;Name and Mailing Address R & B CONSTRUCTION A.StAft lYpt ' <br /> 4236 S HWY 99 r <br /> STOCKTON CA 95215 <br /> a.GeneratoesPhons 209 32-0606 <br /> 5.Transporter 1 Company Name 6. US EPA-U Number C.titma <br /> SAI"ETY -KLEEN SYSTEMS, Etw- .TXR.000050930. . D}TtarlspSrt 1. <br /> 7.Transporter 2 Company Name B. US EPA ID Number E.Steli Tmamomtift ID'-, <br /> F.Transpon"PhorW..'v�}:,'.1. <br /> 9.Designated Facility Name and Site Addresso()06 i 8 10. US EPA ID Number G.Slam Facility D; --p--��- <br /> ^f. <br /> SAFETY-KLEF.N SYSTEMS, _TN<:. 65124 <br /> 1.712 COOPER CREEK ROAD . <br /> ' <br /> DEUTON, TX 76203 .Faeill"Phone. <br /> TXD07-,.603371. 940 411IS4200 <br /> 11A. 11.US DOT Description(including Proper Shipping Name,Hazard Cleae,ID 12 Ooneilam 13. 14. r' <br /> HM Number and Packing Group) No. type Total Unit <br /> mow , _ <br /> a <br /> RQ WASTE FAINT RELATED MATERIAL <br /> E X 3 UN1263 PG 11 0. iC ,Y:(2570 P <br /> N <br /> E b. <br /> nRQ WASTE PAINT RELATED MATERIALS 3 <br /> T X UN1263 PG II ( DO01) 1ERC;1281 7 <br /> 0!ZL Ike. i 360 <br /> R <br /> C. <br /> RQ WASTE TOXIC LIQUIDS, FLAMMABLE. <br /> X OtWaANIC. N. O. S. ( CRESOLS. CHLOROBENZENE ) C)0m 0 P <br /> d. w.. <br /> T <br /> ASE WS OR USEPA HAZARDOUS PIATERIALI �U• Mii/J IUP <br /> J.AddillonaLDiffecriptions for Materiels Usled Above - .. K Handing Codes for We"Listed' '.•. <br /> IA) DOIB D035 0005 0006 D007 DODO 0002 U080 U031 ., <br /> 0112 F003 FOU5 D001 D035 D005 D006 ,DOO7 D008 <br /> IC) F002 F004 D001 D006 0007 D008 D021 D026 D027 <br /> D028 ZD) NONE . <br /> 15.Special Handling lnstuctions and Additional Information MFST R/T41-05532455 0002-9417-42 ` <br /> Et4E;RGENCY RESP 60t)-468--1760i 24 HR 1. IF UNDELIVERABLE RETURN TO GENERATOR. <br /> SK COPT' AUTH'D TO USE SUBSEQUENT CARRIERS: 40343, 41038, 81601, 82739, 86256 <br /> eD <br /> 3 C. 19014 <br /> 16. GENERATOR'S cERTINCAnow 1 hemby dedare that the contents of this ronsignmem aro fully and amurately,described abnwa by ell pmpx dipping terms and are <br /> classified.packed,marked.and labelled/placarded,and are in all respects in proper condition for transport by highway according It,applicable Warnaeonal and nationel <br /> government regulations,including applicable state regulations. <br /> If I am a large quantity generator,I cenYy that I have a program in place to reduce the volume and toxicity of waste generated M the degree I have determined Io be <br /> economically practicable and that I have selected the practicable method of treatment.storage.or disposal cumi available to me which minimizes the present and <br /> future threat to human health and the environment;OR,r 1 am a smaliLquanuly generator.I have matle a good faith effort to minimize my waste generation and select <br /> the beat wase managentert method that is available to me and that I celiellord. <br /> d fY Nterle Sign Month Day Year <br /> T 17.Transporter 1 Ac11i1trMedge d Receipt d Materials C.,.,, �•--�+r�"'• Dam <br /> A .,Printed/7 ere ! ' v.y��aaRe '1, Monts DeY Year <br /> a <br /> 0 1 B.Transporter 2 Acknowledgement a Recei of Materials y Date <br /> R Month Day. Year <br /> T Printed/Typed Name Signabme <br /> E <br /> II <br /> 19.Discrepancy InnScatlon Space <br /> u <br /> F <br /> c <br /> C <br /> L 20.Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manliest except as noted in item 19. <br /> T Date <br /> v <br /> Printed/Typed Name Signature Month Day Year <br /> While-original Pink-TSO Facflow <br /> l' Yel -Transporter Green-Guleratofs first copy : <br /> Tc( 111F�a°�P719f1nntiiy �1 f: tr,annnsnis'r io�dXOOsns•;F nln!)nnncn1%d& -. <br />