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JRAL RESOURCE <br />'.TION COMMISSION 7-185=01 iPTEOAr <br />3087 x Fx <br />4xas 78711.3087 y <br />1t or type. (Porto designed for use on elite (12 -pitch) typewriter.) - Foran approvedOMB No. .. <br />2050.0039. <br />. <br />UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manife .,. j 2. Page 1 <br />WASTE MANIFEST . { nformation in the shaded'a <br />-got: required. by, redera <br />-':3. Generator's Name and Mailing Address ADVANCED INTERCONNECT <br />P.O. 952 <br />555 CARNEGIE STREET <br />a. Generator's Phone( <br />2009A824-6555 CA 95336 <br />5. Transporter 1 Company Name 6. _ US EPA ID Number <br />7. Transporter 2 Company Name 8. - US EPA ID Number <br />9. Designated Facility Name and Site Address 10 US EPA ID Number <br />000618,;; <br />SAFETY—KLEEN SYSTEMS INC. <br />1722 COOPER CREEK ROAD <br />DENTON, TX 76208 <br />11A. 11,US DOT Description (including Proper Shipping Name, Hazard Class, ID 12. Containers 13. 14 :y <br />HM Number and Packing Group) - To;al UnO.. <br />No. Type <br />a. RQ WASTE ALCOHOLS, N. 0, S. Quantity wwol <br />(ALIPHATIC ALCOHOLS) ZCx� P <br />E 3 UN1987 PG II (D001)(ERG#127) <br />N - Gi'r✓"/ VVj <br />�. <br />E b. WASTE PAINT 3 UN1263PG II (ERG#127) r <br />R X - <br />A DM IP <br />0 <br />R C. _. _.. . _.... ;, <br />yr <br />J. WA.>7FUZ <br />i. 1J19LKVEiteV91 �{n Ad i'o al t�° ,t rLL: <br />SK CORP'AUTH'D TO�USE�5UBStE4UENTRCARRIERSDE81 OOA40355 4101,ST405EN2E848 k' <br />KDOT# A: 1963 B: 23547 C; <br />/�b4-oU <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 am 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 <br />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 />CO <br />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 in de 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 />PrintedrTyped Name` <br />G - u R `J ivt f(R, y Signature t Month Day Year <br />7 is <br />T 17. Tralisporter d. cknowledgement of Receipt of Materials <br />R <br />A,; <br />N <br />PrintetllType Name }/ �J,i ,_s <br />�" % <br />r� <br />l <br />Slgnature <br />• ; Date <br />Month Day <br />Year <br />0 <br />1&.Srans <br />t / <br />�7 <br />U ) <br />oiler 2 Acknowle gement of Receipt of Materials <br />T <br />Printed/Typed Name <br />Signature <br />Date. <br />R <br />Month Day <br />Year <br />19. Discrepancy Indication Space <br />F <br />A <br />`Y <br />C <br />20, Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manifest <br />T <br />. <br />except as noted in It 19. <br />y <br />Printedrfyped Name <br />Signatures <br />Date <br />Month Day <br />Year <br />