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TEXAS NATURAL RESOURCE <br />CONSERVATION COMMISSION ` <br />P.O. Box 13087 <br />Austin, Texas 78711-3087 <br />Pleas. mint nrmnu (P— <br />..vvw�xk nV v7,v,4m.p �._ _ .9nc-.vuy��mt Pink -TSU racinv YRIInw-I moan,`., r,nnn-rnn,..-.n.:-,:.-.-...-.. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest <br />Form approved. OMS No. 2050-0039. <br />e <br />WASTE MANIFEST - .pocumentNo-s <br />.formation in the shaded areas <br />3. Generator's Name and Mailing Address ADVANCED INTERCONNECT <br />not required by Federal taw. <br />e Manifest Document Number <br />555 CARNE3IE STREET <br />00773545 <br />MAZiTE `A : +. 9 y 3 36 <br />a <br />e tors ID <br />4. Generator's Phone 2 �' )'3 2 4'- 0 5 5 5 <br />906 <br />5. Transporter 1 Company Name 6. - US EPA ID Number e rter's ID:A?FTY-KLEEN <br />;S� <br />M <br />SYSTEMS. INC ii>R00 kFJ`t� 4fsPhone gOD 669-51 07. <br />Transporter 2 Company Name 8. US EPA ID Number e rters IDspPhone9. <br />Designated Facility Name and Site Address r100t: 1,3 10. US EPA ID Number <br />e IDSAFETY-KLEEN <br />SYSTEMS, INC1 <br />1"72'2 COOPER :REEK ROAD; <br />NTOti, Tg �,a _;,:g e <br />TXD077.603371 5200 <br />DOT Description (including Proper Shipping Name, Hazard Class, ID 12. Containers 13. 14. <br />mber and Packing Group) No. Type Total Unit t. <br />YP Waste No. <br />Quantity WbVol <br />WA.'TE TOXIC, LIQUIDS. ORGANIC, N.J. <br />E.ROMOPROPANE. <br />CHROM.T.UM) DM ? OUTS219H <br />1b. <br />N <br />' <br />ERQ <br />WASTE FLAMIMABLE LIQUIDS, N.:).oI- <br />:PROPANC:L ! <br />OM <br />P <br />OUTS219H <br />R <br />C. <br />d. <br />J. Additional Descriptions for Materials Listed Above <br />) K. Handling as for Wastes Listed Above <br />IA) D007 IB) F003 D001 <br />15. Special Handling Instructions and Additional Information <br />EMERGENCY RESP 310- MFST R/T$102732799 0002-3386-`9 <br />4b3 -1^,5r.)(24 HR). IF UNDELIVERABLE RETURN TO <br />GENERATOR, <br />SK CORP AUTH D TO USE SUBSEQUENT CARRIERS: 81300,40355,41015,40582,84815 <br />�KDOT <br />755 E3:y 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 <br />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 lobe <br />economically practicable and that I have <br />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 <br />the best <br />generation and select <br />waste management method that is available to me and that I can afford. _ <br />Printed/Typed Name <br />Signature _ , r Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials ' <br />R <br />Prints Typed Name Signature - Date <br />n <br />s <br />- Month Day, Year <br />._ <br />P <br />r -' <br />0 <br />78. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Date <br />Printed/Typed Name Signature <br />E <br />Month Day Year <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19, <br />r <br />Y <br />Printed/Typed Name Date <br />Signature Month Day Year <br />..vvw�xk nV v7,v,4m.p �._ _ .9nc-.vuy��mt Pink -TSU racinv YRIInw-I moan,`., r,nnn-rnn,..-.n.:-,:.-.-...-.. <br />