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/Lk71b 14:L�J 74 to4t7.3�•( ZDHr- I YNLLLIY b1t7 • I"PUL CIL/I3L <br /> Form Approved.QMB No.2050-0039 <br /> Pieeua print or type, Form deb( ned for use On elifa(12-RCh ewritef, 2 Fa a t of 3.Ernnrgency RraPonsa phone 4.ManitestTracking Number SKS�,Gonarator ID Numbgr CAl'321 c0f:01 G S <br /> UNIFORM WpyARDOUS �, 1—BR►0-468-1760 <br /> 00198308 <br /> WASTE MANIFEST �nneratoYs SltaAddrxss(if dilSerenithen malling addreat) <br /> s70NST&t(iliIry TRIES <br /> 1b888 MCKINL,EY CA 95:3310 <br /> L AT14ROP <br /> �Q19-85a--2010 <br /> (3enor"1143r's Phone: U,S.EPA ID Drum et TX Ri�OPJl�503343 <br /> INC. <br /> O-SA 1411 ' FeSY5T1 M5� <br /> v..,.;% PA 1D um <br /> 7.Trans mTry 41 l <br /> _ J, U.S.EPA ID Numbnr' <br /> 8,pr+.. n ed Faclity Nome and Site Addre55 1722 CD©PER CREEK ROD y TX 76208 <br /> PENTON, TXD077603371 <br /> 940-483-5 <br /> Padl a Phone: 10.Containers 11,Total 12.Unit 13.weSle Codes <br /> 9e. 96,U.S.DOT Demcripvi n(Including Proper ShiDPing Namo,Hazard Class,ID Number, No cwntity WINDI. <br /> HM and Packing Group Of aHyl) <br /> 07,71 U1,41 J <br /> O • <br /> � LA ��UA <br /> 31411 <br /> (F1a5ORBENT AND OIL) <br /> 3, �— <br /> 4, <br /> Lmn <br /> 14 <br /> 14.S I .lmctl0nsTdAddltionatlpformdGon _ , <br /> SK AUTH'D TO USE SUBSEQUENT CARRIERS: 41038, 87585, 01681, 8E7397 85399 <br /> 15, OENERATOR'SIOFFEROR'S CERTIFICATION: l hereby doldare that the wntants of thlR cor�lgnmant aro Ngy and ectumtaty desal Ad above by the proDar shippinname,and <br /> an are tsmn the Pelma ry <br /> marked end tahaladlplaoarded,and am In all respects In propor condiflon for transport nccordlng to applicable intemstlonaland natlonel ovemmental regulallon5 ll export ahlp <br /> Exporter,I eenlfy chat the contenla of thl5 consignment cordorm to live is, of the stlechod EPA Acknowledgment of Consent. <br /> I certify that the wecta minintintlon statement Identified In 2,270)(t1 I am n large quanitty generator)or(b)(III am a email quantity gen(Orrator)i3 true. <br /> igptlh Day YQear�j <br /> $t9 <br /> no 'el forgr`9 Prj d Name <br /> r+ 8.MIR lonal sillppmen Impen to U S. ❑Export tmm U Port of entrylexil: <br /> F nmIeaving U.S.; <br /> Trans iter Signehrra(far e%pOrt~S only); <br /> 17.TlanepoRar Cknowladgment of Remit of MOW S Mon1n • Day Year <br /> Signature <br /> TrenSP e P IeNTypetl u ma �—'- ( v <br /> Month Day Y nr <br /> Ignalu /� <br /> z Trans ai 2 nt y a B Zd <br /> 1 ,Dkcrepency �Pug Re]ection <br /> {8a,plsorepnncy Ind Nation Space {�uantlty <br /> ❑Tvaa ROSIdue 13 PerC�i Relectlon <br /> Manliest Reterenw Number: <br /> U.S.EPA ID Number <br /> 180,Alternate Fadlt'j(or Generator) <br /> J <br /> w Facllf0phonel Month D2Y Yea <br /> w lac.SlgnaNre of Altemata Pecillty(or Generator) <br /> 19.Hazardous waste Report Management Mothod Cods.(I e.,codes for hazardou.wa_treatmSnt,disposal,and rs0ycrng 5yslam3) <br /> 4. <br /> 20. of A racilty Ovmof or Doarator.Cenl9rAtion of romV of hazafdOtlS maledals covered try the mSignoalu x Pt octad In lie 8a Month De <br /> pe Nenra d- I <br /> RE)3.(&47ftWdit pa are obsolete, 4) DESIGNATED CILITYTO DESTINATION STATE(IF REQUIRE <br /> 11035 49 ;2)2f 13161/40338489-1 <br />