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TEXAS COMMISSION ON <br /> ENVIRONMENTAL QUALITY 7 -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.Generators US EPA ID No. Manifest 2.Page 1 Information in the shaded areas <br /> WASTE MANIFEST CA19t-14i q o-S' II]Vu� 1 of 7 is not required by Federal law. <br /> 3.Generator's Name and Mailing Address U141 L E V E R A.State Manifest Document Number <br /> 1400 ATTN WATRON EDILA`I ROAD S 01076907 <br /> STOC:KTON CA 95205 B.—State Generator's ID J <br /> 4.Generator's Phone 209 466-9580 DOOO6 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number C.State Transporter's ID 8710 9 <br /> SAFETY-KLEEN SYSTEMS, INC TXR000050930 D.Transporter's Phone600 66'7-777T-0- <br /> 7. <br /> b'7--' 07.Tr sporter 2 Company Name �- 8. US EPA ID Number E.State Transporter's ID <br /> v 4 - .�. .7�.� F.Transporter's Phone : �-' �;, - <br /> 9.Designated Facility Name and Ofte Address0 06 18 10. US EPA ID Number G.State Facility ID <br /> SAFETY-KLEEN SYSTEMS, INC. 65124 <br /> 1722 COOPER CREEK ROAD <br /> DENTON, TX 76208 H.Facility's Phone <br /> I .TYD0776033-il 940 483-5200 <br /> 11& 11.US DOT Description(including Proper Shipping Name,Hazard Class,ID 12.Containers 13. <br /> HM Number and Packing Group) No. Type Total unitWaste No. <br /> Quantity WtNt01 <br /> E X 7 rr 1 <br /> E b. <br /> R Ra HAZARGK14HS-tt -vrr- 1 , <br /> T <br /> O Q kl # <br /> R c. <br /> _ !.> s JULl v <br /> d. <br /> NON-RCRA HAZARDOUS WASTE, SOL'ID M —/ 7S P �jLOL� <br /> J.Additional Descriptions for Materials Listed,Above K. Handling Codes for Wastes Listed Above <br /> ;�i�,-i7ID ) NONE 14�LtI <br /> 15.Special Handling Instructions and Additional Information i4F ST 2/7-41054646-73 C.i1i 1_ g217 - 19 <br /> EMERGENCY RESP 800-468-1760( 24 HR ) . IF UNDELIVERABLE RETURN TO GENERATOR, <br /> SK CORP AUTH^D TO USE SUBSEQUENT CARRIERS: 3130U, 403!i5. 410115, 49582, 84815 <br /> SKDOT# A: �3S B: ��}--``aa4�° C ; f{,«z"e`"$$ D: 47112 <br /> 1e. 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 fadh 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 Signature Month �;yYearOtt OAG� <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> A Printed/Typed Name Signature <br /> N 9 Month Day Year <br /> s /h UF}c O. / .> 0 <br /> P <br /> a 18.Transporter 2 Acknowled went R ez c ipt of Materials Date <br /> R Printed/Ty Name �/) Signature �� Month Day Year <br /> R ¢1,S <br /> 19.Discrepancy Indication Space <br /> F / V <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 <br /> Y <br /> VFIT� <br /> Printed/Tvoed.Name n VA _ -_ ___ Signature ,(` -I th�uDpuedson bOZu)nwntliwlumsAoogjapnl-,uI EogoZ'oe'unoulVse,N'M1'N'ieel -KR- ��_L'0 _ --- � <br /> 09 V M"M S rc w,nn'hc } n,. s VU i.cv, w .... - <br />