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TEXAS COMMISSION ON <br /> ENVIRONMENTAL QUALITY 7-1� 01 <br /> P.O. Box 13087 <br /> Austin,Texas 78711-3087 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved. OMB No.2050-0039. <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page 1 Information in the shaded areas <br /> D current No. of is not required by Federal law. <br /> WASTE MANIFEST lfA "i0� 0^ 1 <br /> 3.Generator's Name and Mailing Address UN I L E VE R ' A.State Manifest Document Number <br /> 1400 WATERLOO ROAD $ 01076906 <br /> ATTN RON NOACK <br /> STOCKTON CA 95205 B.State Generator's ID <br /> 4.Generator's Phone 209 466-9580 D0006 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number C,State Transporter's ID 87 109 <br /> SAFETY-KLEEN SYSTEMS, INC TX2,000.0509N. D.Transporter'sPhone 800 669-5740 <br /> 7.Transporter 2 Com any Name 8. US EPA ID Number E.State Transporter's ID <br /> 'Ini / . .n. .7.y.� F.Transporter's Phone <br /> 9. Designated Facility Name anckSite Address000618 10. US EPA ID Number G.State Facility ID <br /> SAFETY-KLEEN SYSTEMS, INC. 65.124 <br /> 1722 COOPER CREEK ROAD <br /> DENTON, TX 76208 H.Facility's Phone <br /> TXQ077.6Q3371. 940 483-5200 <br /> 11A. 11.US DOT Description(including Proper Shipping Name,Hazard Class,ID 12,Containers 13. 14 Total Unit 1. <br /> HM Number and Packing Group) No. Type Quantity wt/vol Waste No. <br /> a RQ WASTE FLAMMABLE LIQUIDS, 11I. O. S ,So�Jr <br /> G X ( ALIPHATIC AND AROMATIC HYDROCARBONS ) � M Z. )UT S211H <br /> E 3 IINIcI93 PC OO 8 ) <br /> Nb. <br /> E cc,rn n S <br /> R <br /> A X T AROMATIC H n c ' 1-r�� <br /> R C. <br /> RQ WASTE FLAMMABLE LIQUIDS, N. O. S . <br /> X ( ALIPHATIC AND AROMATIC HYDROCARBONS ) I M / Sp P )UTS696H <br /> 993 C ( ) ( E Git <br /> d. I'lt - - - 7 <br /> J.Additional Descriptions for Materials ListedAbove K.Handling Codes for Wastes Listed Above <br /> IA) D001 1B ) IC ) D001 lit N-�L f41G) H�Wp <br /> 15.Special Handling Instructions and Additional Information MF S T R/T#10 5 46 46 5 4 0001-91.17 -19 <br /> EMERGENCY RESP 800-468-1760( 24 HR ) . IF UNDELIVERABLE RETURN TO GENERATOR. <br /> SK CORP AUTH • D TO USE SUBSEQUENT CARRIERS : 81300. 40351. 41015, 40582, 84488115 <br /> SKDOT A: 3004 B: C : 3004 D; <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 /> classff ed,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 me Signature Month Day Year, <br /> T 17.Transporter 1 Acknowledgement ofeceipt of Materials Date <br /> A Printed/Typed Name Signature Month Day Year <br /> s / .l O. <br /> 0 18. ransporter 2 Acknowledgement or eceipt of Mat ials , Date <br /> R <br /> T Printed/Typed IN //71 Signature / Month Day Year <br /> R 1457 <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20.Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. <br /> T Date <br /> Y <br /> Printed/Typed Name n Mo th Da Year <br /> I White:origina -_ ink-TSD Facility,_Yel w,Ttansporter Green-Generators first copy^ / <br />