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TEXAS NATURAL RESOURCE <br />CONSERVATION COMMISSION'!- 18�J1 <br />P.O. Box 13087 <br />Austin, Texas 78711-3087 <br />Please pant or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />Es <br />,m•/ <br />Form appmved. OMB No. 2050-0039. 11 <br />Facility Yellow -Transporter Green -Generator's first copy <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest <br />2. Page 1 Information in the shaded areas <br />WASTE MANIFEST ° e <br />Of is not required by Federal law. <br />3. Generator's Name and Mailing Address INNOVATIVE FRAMING <br />A. State Manifest Document Number <br />AVE BLDG <br />S 00341 729 <br />P0700 BOXS1�129INLEY <br />ATTN JOE <br />J �i ! <br />B. State Generator's ID <br />LATHROP CA 95330 <br />4. Generator's Phone 209 )993-2380 <br />D0006 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID <br />SAFETY-KLE£N SYSTEMS, INC TXR000050930 <br />D.Transporter's Phone 800 669-5740 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address000618 10. US EPA ID Number <br />G. State Facility ID <br />SAFETY-KLEEN SYSTEMS, INC. <br />65124 <br />1722 COOPER CREEK ROAD <br />H. Facility's Phone <br />DENTON, TX 76 208 <br />TXD07760.3371 <br />940 483-5200 <br />11A. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, ID <br />12. Containers <br />t3. <br />1a. <br />HM <br />Number and Packing Group) <br />No. Tvpe <br />Quantity <br />WI/vol <br />No. <br />a. <br />HAZARDOUS WASTE, SOLID, N.O.S. <br />E <br />X <br />(TETRACHLOROETHYLENE, LEAD) <br />' <br />DM <br />7 <br />P <br />OUTS409H <br />N <br />E <br />b. <br />R <br />WASTE- -SOtT y <br />LI UID.—AF.^—{8i4s9t3tiT; <br />-- <br />P <br />d6�3Ei— <br />T <br />� <br />O <br />R <br />C. <br />d. <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />IA) D008 D039 I8) IICiII1 -- <br />r <br />15. Special Handling Instructions and Additional Information., iKFST R/T104181810 0002-3511-01 <br />EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVER15LE RETURN TO GENERATOR. <br />SK CORP AUTH'D TC)USE SUBSEQUENT CARRIERS738,1300,40355.,41015,40582.84815 <br />5 C: <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name and are <br />classified, 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 place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that I 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 />--Pmted/Tyti ped Nama <br />Signat/ytr �' ,� Month Day Year <br />yam/ _ <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials '�., ...__......"_ --. -� - <br />Date <br />Prime part Name , ---"' <br />Signature." '. Month Day Year <br />oTS-Transporter <br />R <br />2 Acknowledgement of Receipt of Materials-` Date <br />T <br />Printedrryped Name <br />Signature Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />1 <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 />Date <br />Printedrryped Name <br />Signature Month Day Year <br />Facility Yellow -Transporter Green -Generator's first copy <br />