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Jun 07 04 01 : 31F, NEWARK SIERRA PAPERBOARD 209 464 9215 P. 2 <br /> TEXAS NATURAL RESOURCE 0 1' <br /> CONSERVATION COMMISSION ,�P•ce Dp7_151 j_0.t <br /> P.O. BOX 13087 K <br /> Austin, Texas 78711-3087 r <br /> mease print or type.(Form designed for ose on elite(12-pitch)Typewriter.) <br /> UNIFORM HAZARDOUS 1.Generator's US,EPA ID No. Fom approved.OMB No.2050-0039. <br /> WASTE MANIFEST Manifest 2.Page t Information In the shaded areas <br /> rpo u of Is not required by Federal law. <br /> 3.Generator's Name and Mailing Address NEWARR SIF IRA <br /> 800 WEST CHURCH ST, «R �1l9sh,�B Lt g1Ber.`.:waY_' <br /> STOCKTON <br /> 4. Generator's Phone 209 66-7088 r•'`� 95203 55 eggwjZ,tD > w <br /> 5.Transporter 1 Company Name <br /> SAFETY-KLEEN SYSTEMS INC 6. USEPAIDNumber 1y ELiatpotldfs ``" T , _ <br /> 7.Transporter2Compeny Name .T}t'R0tOO50930. . . . .�^4Ab..... <br /> 8. US EPA ID Nurnberg - , � 8eaF <br /> V.Designated Facility Name and Site Addres4h0061 AS 10. US EPA ID Number <br /> SAFETY-KLEEN SYSTEMS, INC. <br /> 1722 COOPER CREEK ROAR <br /> DENTON, TX 76208 A <br /> TXD07.7&03371. <br /> 11A. 11.US DOT Descriptlon(includin Proper Shipping <br /> HM Number and Packing Group) 9 p pping Name,Hazard Class,ID 12.Containers 13. <br /> a. No. Type Total Unit rare' .f.lh.� d, <br /> Ouandry WWoI <br /> o R(� WASTE PAINT RELATED .MATERIAL <br /> E X 3 VN1263 FG TI : 4 <br /> N <br /> E b' � <br /> R R4 WASTE BATTERIES, NET, ;FILLED WITH _ <br /> T <br /> X ACT[) GEAR SVLFURIC ACID t <br /> o r tr P <br /> C. .�.z .z <br /> WASTE OIL AND WATER MIXTURE 1"a <br /> ( NOT RCRA REGULATED) #�w <br /> M .6 0 i� <br /> d WAs'1rE OIL, AND ABSORBENT MIXTURE � 1 z,_ <br /> ( NOT RCRA REGULATED) )Mf•' <br /> r . <br /> k Y° <br /> 15.Special Handling Instructions and Additional Information <br /> E:IAECORP Y RESP 800-468-1760(SE 24 fidlt } IP UNDELT�RAEILF9RETURNOTO GENERATOR, <br /> SK CORP AUTH`L7 'L'O USE SUpSE�SUENT, ARRSE:RS: 81300, 40355, 41015, <br /> KDO 1 B: ,451 7(1582, 848180 <br /> 5 <br /> 16.GENERATORS CERTIFICATION:1 hereby declare that the contents oi'the consignment are fully and accurately described abo a bytheproper shipping name and am <br /> classlfled,packed,marked,and labelled/placarded,and are in all respects in proper condition for transport by highway According to applicable international and national <br /> government regulations,including applicable state regulations. <br /> If I am a large quantity generator,I certify that I have a program In plana to reduce the volume and toxiclty of waste generated to the degree I have determined to be <br /> economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and <br /> future threat to human health and the environment;OR,If I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select <br /> the best waste management method that Is available to me and that I can afford. <br /> Printed/Typed Name Signature <br /> rl _ Month Day Year <br /> f�r A <br /> T 17.Transporter 7 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Signature Date <br /> N ure <br /> v Month Day Year . <br /> R 18.I ransporter 2 Acknow edgement of Receipt of Materials - }!•v /• - c <br /> E PdntewI yped Name SI nature - Date <br /> R .1 g Month Day Year <br /> 19..Discrepancy Indication Space <br /> F <br /> A <br /> } 20. Facility Owner or Operator.Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> V <br /> Printed/rypod Name Date <br /> Signature Month Day Year <br /> T lr ki�l,r;i1 YLC+d'UVV:Y eS$52 13 �a2nn�,t4r"soRTo RI PiPk-..T�`D naIleren�alleQ n. nsporterrQan-S'gRQr�ttpr's jlrgt eoPV <br />