Laserfiche WebLink
TEXAS COMMISSION ON <br />ENVIRONMENTAL QUALITY <br />P.O. Box 13087 <br />Austin, Texas 78711-3087 <br />Please Drint or Noe. (Form desioned for use on elite (12 -Ditch) typewriter.) <br />•7 -*-()1 <br />Form Approved. OMB No. 2050-0039. <br />,N(f?(!e, nryjgigal„ Pink-j.SR FVPijy)LY-j;I?ra7orter Green -Generator's first copy <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST CAL0001944?1 - y'n8 ( <br />of 1 <br />is not required by Federal law. <br />3. Generator's Name and Mailing Address - is n n .3 � �- <br />RU <br />A. State Manifest Document Number <br />S -1X42514 <br />P03BOX 241001 <br />B.t Generator's ID <br />LODI CA 9524.1 <br />209 333-`+652. <br />6t <br />D88 6 <br />4. Generator's Phone <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter' s ID ii 7 i. CI a <br />SAFETY-KLF.E:N SYSTEMS, INC TXROC10050930 ,° <br />D. Transporter's Phone " "- x <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter'sID <br />F. Transporter's Phone <br />9. Desnet d F it yy�me ��dd gg t ddtess 3t• 10. US EPA ID Number <br />iA Eqt dFak��EN tS'YS�L�lJ, iL3C', <br />G.BtatT Fapility ID <br />b e <br />1722 COOPER CREEK ROAD <br />H. Facility's Phone <br />DENTON, TX 76208 <br />TXD0776033-11 <br />940 483-5200 <br />11A. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, ID <br />12, Containers <br />13. <br />al <br />14. <br />Unit <br />HM <br />Number and Packing Group) <br />No. Type <br />o amity <br />Wtvol <br />Waste No. <br />a. RCS WASTE PETROLEUM DISTILLATES, N.O. ,S. <br />G <br />i DIESEL FUEL, GASOLINE D <br />r � <br />OM <br />;.. � <br />P <br />C JTS211H <br />E <br />3 UN1268 PGTI (DO01)( ERG#'128) <br />Nb. <br />R <br />WASTE SOLIDS CONTAINING FL1,041ABLE <br />E <br />'• <br />T <br />LIQUID, N. O. S. ( GASOLINE, BENZENE) 4. 1 <br />DM <br />F <br />OUTS409H <br />T <br />UN 3175 PC I1 (ERG#133) <br />R <br />C. ili✓/'RUTC. ,=1,i.' � fl ,-,�U.�'� i;,>1 ^vii <br />'1)07 /i <br />6o,- <br />1 <br />.k'.' <br />d. <br />J. Addi('iona1 Aspripb8so1w Mat rials Li§tedA(yooye. 1H IH) D001- DO 1 8 <br />Jlfri�t=VUL d! <br />L_7 <br />K. Handling Codes for Wastes Listed Above <br />(t5� <br />OIJTS40r9H <br />15. Special Handling Instructions and Additional Information MF'ST R/T#106171862 01002-619Fi'-44 <br />EMERGENCY RESP 800-468-1'760(24 HR)- IF UNDELIVERABLE RETURN TO GENERATOR. <br />SK CORP AUTH'D 'TO USE SUBSEQUENT CARRIERS: 40343,41038.81681. 82734,662;6 <br />SKDOT# A: 19012 B: <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 />Printed /Typed Name <br />Signature Mogjh Day; Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials _ <br />Date <br />A <br />1Printed /Typed Norrie -� r^" (- <br />Signature - J; - Mon Day, Year <br />,t <br />0 <br />18. Transporter 2 Acknowledgement or Receipt of Materials Date <br />T <br />Printed /Typed Name - <br />Signature Month Day Year <br />E <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 />T <br />y <br />Date <br />Printed / Typed Name <br />Signature Month Day Year <br />,N(f?(!e, nryjgigal„ Pink-j.SR FVPijy)LY-j;I?ra7orter Green -Generator's first copy <br />