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TEXAS; NATURAL RESOURCE p CE OF <br />CONSERVATION COMMISSION 7-185-01 <br />5�F <br />P.O. Box 13087 y <br />Austin, Texas 478711-3087 <br />ai­ ndn, nr Nne. (Form Aeslaned Mr use on elite f 12-oitchl Noewnter.l <br />Farm approved. OMB No. 2050-0039: <br />T ".Ayf_QV� X21470— Bj02 Q2 1da1 Yfnk-TStb (5lidl40RpbiaitLdspor(�j" gl(i�t2oQgOZ/Y(fb <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br />WASTE MANIFEST, 190 of is not required by Federal law. <br />3. Generators Name and Mailing Address ADVANCED INTERCONNECT <br />P.O. 952 <br />555 CARNEGIE STREET <br />MANTECA CA 95336 <br />a. Generators Phone 209_ 24-6555 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />7. Transporter 2 Company Name 8. US EPA D Number <br />T IN0— . (�)83.Ca3 <br />9. Designated Facility Name and Site Address 000618 10, US EPA ID Number <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. <br />Total Unit <br />HM Number and PackingGroup) No. Type <br />P) Quantity WWol <br />a. RO WASTE ALCOHOLS, N.O.S. <br />X <br />(ALIPHATIC ALCOHOLS) a4ZOot7 P <br />3 UN1987 PG II (DO01)(ERG#127) d <br />E <br />N <br />b. WASTE PAINT 3 UN126 3 PG II (ERG#127) 3 <br />/ O O <br />R <br />R <br />DM P <br />A <br />T <br />0 <br />R <br />C. <br />d. W A srE ort OW ND CW'9LenJT M=-X1r- <br />(A) 0 0ZC121j 1ZQf UG/9 r -E4) <br />15-SpaGial2iaedlirlg lnsfnictionsand AdditloDal lnforrin�M4 HR), IF UNDELIVERABLE RETURN TO GENERATOR. <br />GSK CSU1BBSSEE?UENT <br />CORP AiURTEHJ'kD' TtlOVOUSE CARRIERS: 81300,40355,41015,40 <br />KDOT# A: 1963 B: 23547=C. iigy�Q <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shippfngi nainadnd tim <br />classifled,'packed, marked, and labelled/placarded, and are in all respects in proper condition for transport by highway according to applicable international and notional <br />government regulations, Including applicable state regulations. <br />If I am a large quantity generator, I cartify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have-detem fined td 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 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 />Printed/Typed Name <br />Signature Month Day -Year <br />R -*$.*f r -_-6Z_ <br />T <br />17. pornsporter .1 Acknowledgement of Receipt of Materials <br />-Date •- - <br />R <br />Printedlf Name <br />ature - Mont 'Day Year <br />5 <br />oporter <br />2 Acknowled a of Receipt of Materials <br />Date <br />T <br />Pri <br />/Typed Name <br />SI natur Month y .Year <br />R <br />"vim v <br />, <br />19. Discrepancy Indication Space - <br />A... <br />0 <br />I' <br />.. ..art r . .. ':.. . l.. .. <br />. <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 />.'A. <br />Pdi>ow ed Name <br />1 d1,.. <br />SI ° Month 'Da ;Year, <br />�. <br />T ".Ayf_QV� X21470— Bj02 Q2 1da1 Yfnk-TStb (5lidl40RpbiaitLdspor(�j" gl(i�t2oQgOZ/Y(fb <br />