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TEXAS COMMISSION ON <br /> ENVIRONMENTAL QUALITY - <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 /> Documenpp of <br /> WASTE MANIFEST ;`'ti i Y�*hrinr�alx 1 "I!,i f is not required by Federal law. <br /> 3.Generator's Name and Mailing Address - U1,(I L.EVF111 ,/ In" 1 f A.State Manifest Document Number - <br /> 1400 IdATERLOO ROi U) $ r013 3 4 :` 6'-y <br /> ATT14 E-014 NOAC K <br /> S="iOCKTON CA 95205 B.State Generators ID ; <br /> 4.Generator's Phone 209 466-•9560 D01006. <br /> 5.Transporter 1 Company Name 6. US EPA ID Number C.State Transporter's ID x,•. I n,;� <br /> SAFETY-KLEEN SYSTEMS. 714C' TXP0000509.30 D.Transporter's Phone '£t,i t tSf;4;-•57a(? <br /> - 7.Transporter 2 Company.Name-. . _ __—__._.__ ___8._. US EPA ID_Number__._._. E-State Transporter's..ID,_. <br /> F.Transporter's Phone <br /> 9.Designated Facility Name and Site Address OCtt.16 1 g 10. US EPA ID Number G.State Facility ID <br /> S'r`XFF`1Y KLL'1.':N SYZTEMS, i.I3c. t 512 <br /> 1722 COOPER CR EY. ROAD <br /> DENT N. TX 75208 H Facility's Phone <br /> TXD0775.033.% 9aO 40 5200, <br /> 11A. 11.US DOT Description(Including Proper Shipping Name,Hazard Class,ID 12.Containers 1a. 1 a. 1, <br /> HM Number and Packing Group) No. Type Tl t <br /> Quantity WWoI Waste No. <br /> a. <br /> 1,1014-DC"RA &iAZAIIPOUfi 4niASTE, SOLID <br /> DM <br /> N <br /> E b. <br /> R <br /> A <br /> T <br /> O <br /> R C. <br /> d. <br /> J.Additional Descriptions for Materials Listed Above - K.Handling Codes for Wastes Listed Above <br /> IA.) 1,700M <br /> 15.Special Handling Instructions and Additional Information ,itR,,.,. t . 2 1 ,J, 7 :i.,`! P. ".d'Sr1� Trki�7G'1R Uot/1- <br /> EMERGE14CY RESP 800- 468-1760( 24 HR ). IF t3NDE1.1VERABLE RJ,�.1 TU F, N TO GEAiIE:F?ATri ., <br /> SI{ C`02P AUTH' D TO USE .03OBSEQUENT CARRI1:Ra; =p; 62Str <br /> . 7i'C97TA .A- 4 17 'Si - (`, : 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 /> 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 certity 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 - Signature I Month Day Year <br /> � Lk _r. 6(> 0(, <br /> T 17.Transporter i Acknowledgement of Receipt of Materials _ Date <br /> R <br /> A Printed/Typed Name Signature Ps_F _ „�,-.., ' Month Day Year <br /> s ! .li ,; rlil/ (r yk" f/� �n�" - <br /> P `l, \ <br /> R 18.Transporter 2 Acknowledgement or Receipt of Materials ! '^----- Date <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space - <br /> F <br /> A <br /> C <br /> I <br /> L 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 Date <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> TCEQ-Q311:(REVo9/01/02).._„ . . White-original Pink-TSD Facility Yellow-Transporter Green-Generator's first copy <br />