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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.) <br />Form Approved. OMB No. 2050-0039. <br />UNIFORM HAZARDOUS 1. Gr o , P ID Manifest <br />2. 2. Page 1 Information in the shaded areas <br />' D <br />WASTE MANIFEST <br />of 1. is not required by Federal law. <br />3. Generator's Nara? a{td MaI:oilingAddfess ' -'' a `�" ` <br />A. State Manifest Document Number <br />60 <br />"TO ETON CA `.t5 ill"> <br />- <br />� eOC�eneiators ID <br />2 0 -02 7 4- 6 8 4 <br />4. Generator's Phone ( ) <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID 87 10 9 <br />w;At''E`TY-I LEEN-YSr-rEM'-Z TIIC T. -?P,( 70(D5l7tf S ) <br />D. Transporter's Phone 800 r5r30t--5r11td <br />7. Trans o 2 Com any Name 8. *US EPAID NumbK <br />E. State Transporter's ID q (0 3 <br />F. Transporter's Phone ' j O O 3.D- q - 113'1 <br />�(' b . . p. 1. J. . <br />9 p pj t> ted F �il � 1' ¢dress 10. US EPA ID Number <br />C S§Ift �,cility ID <br />1722 COOPER CREEK ROAD <br />H. Facility's Phone <br />DENTON. TY 76 208 <br />TXD077603371 <br />940 483-5200 <br />11A. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, ID <br />12. Containers <br />I' <br />HM <br />Number and Packing Group) <br />No. Type <br />Total <br />Quantity <br />Unit <br />Wt/Vol <br />Waste No. <br />a. HAZARDOUS WASTE , `OLID. N,0�. <br />( TETRA, HLOROETHYLENE , LEAD) <br />1 <br />MP <br />�---cl 00 <br />UT S409H <br />NA30 77 PG11I (ERG4171) <br />b. WASTE SOLIDS CONTAINING FLAMMABLE <br />f; <br />LI()irI) N, f'.:3 4 GA-OLINE, BENZENE ? 4. 1 <br />j m <br />66 <br />r <br />UTS409H <br />_11431 Jt5 P' 11 ( E}: (d i3 <br />C. <br />d. <br />I. iltiop* cri ' r!s r yfAejial lglAtL9,618 O JTS 409H K. Handling Codes for Wastes Listed Above <br />15. Special Handling Instructions and Additional Information ;SIF E T R/ T* 10 6 5 3 8 8 8 6 0000--37f-)!--q' <br />EMERGENCY RESEW 800--461,-17601, 24 HR). IF UNDE1,IVERABLE RETURN TO GE1� PA"'c::;=:. <br />JI: CORP AUTH D TO USE .ZUBSEtiUENT C_.ARRIERu.t 3'3, .v v <br />SKDOT# A: 22373 B: 34273 C: i-:: <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 envirorvnent; 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 r Sign re Month Day Year <br />o Ls <br />17. Transporter 1 Acknowledgement of Receipt of Materials Date <br />Printed / Typed Name <br />Signature Month Day Year <br />` ac <br />/ ./ 0--) Z4 <br />18. Transporter 2 Acknowledgement or Receipt of Materials Date <br />Prin Type Name Month Day Year. <br />e±L <br />19. Discrepancylindication Space <br />20. Facility wner or Operator: Certification of receipt of hazardous materials covered y this manifest except as noted in item 19. <br />Date <br />/jt]qe Na e <br />Signatur 1ATA Y <br />TC A3 ;.. fREY09/01102) ; • , :r i <br />YIIhIte Qriginal Pin -TSD Facility Yellow -Transporter Green -Generator's firs copy <br />