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TEXA9 COMMISSION ON <br />ENVIRONMENTAL QUALITY <br />P.O. Box 13087 <br />Austin, Teikas 78711-3087 <br />Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />G <br />E <br />N <br />E <br />R <br />A <br />T <br />0 <br />R <br />L <br />I <br />T <br />y <br />Eng ho <br />Form An*roved. OMB <br />UNIFORM HAZARDOUS1. Generators US EPA ID No. Manifest <br />2. Page 1 Information in the shaded areas <br />D <br />WASTE MANIFEST . CAD 982501736 <br />4 <br />0. <br />Of is not required by Federal law. <br />1 T <br />3. Generator's Name and Mailing AL TRANS DIVISION 1 <br />A. State Manifest Document Number <br />1603 S BAddre7p ST <br />01203731 <br />STOCKTON CA 95206 <br />B. State Generators ID <br />209 274-6834 <br />D0006 <br />4. Generator's Phone( ) <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID 87109 <br />SAFETY-KLEEN SYSTEMS, INC TXR000050930 <br />D. Transporter's Phone <br />7. Transp&Ker2 Company NaMp 8. US EPA ID Number <br />E. State Transporter's ID alp <br />T Transporter's Phone <br />14 r a, a V)_Jwf <br />Z q <br />9. Desiahated Facility Name abd Site Add ss 0 0 Qt) 1 10, US EPA ID Number <br />G. State Facility ID <br />SAFETY-KLEEN SYSTEM!7, INC <br />65124 <br />1722 COOPER CREEK ROAD <br />H. Facility's Phone <br />DENTON, TX 76208 <br />TXD0776.03371. <br />. . <br />940 483-5200 <br />11A. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, ID <br />12. Containers <br />13"14. <br />I. <br />HM <br />Number and Packing Group) <br />No. I Type <br />Total <br />Quantity <br />Unit <br />Wt/Vol <br />Waste No. <br />a. HAZARDOUS WASTE, SOLID, N.O.S. <br />N <br />(TNAETRACH3077LPGIIIOROETH(ERG#YLENE1LEAD) <br />6 <br />DM <br />P <br />OUTS409H <br />9 71) <br />b. WASTE SOLIDS CONTAINING FLAMMABLE <br />X <br />LIQUID, N.O.S. (GASOLINE, BENZENE) 4.1 <br />2_DM <br />P <br />OUTS409H <br />UN3175 PG II (ERG#133) <br />C. <br />d. <br />J. f*j iorde8siripbo(y�1g, Mf g,�Is 86?ytbU6 18 OUTS <br />K. Handling Codes for Wastes Listed Above <br />69-, e(\,' (0 1 <br />A_ <br />15. Special Handling Instructions and Additional Information MFST <br />R/T#106340156 0000-3701-92 <br />EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE <br />RETURN TO GENERATOn. <br />SK CORP AUTH'D TO USE SUBSEQUENT CARRIERS: 40343,41038,81681,82739,86256 <br />SKDOT# A: 22373 8: <br />34273 C: 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 <br />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 <br />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�,l�hava>faith effort to minimize my waste generation and select <br />ARI <br />the best waste management method that is available to me and that I can afford. <br />Printej,/ T Name <br />Month Day Year <br />5- <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />PrinTyped Name <br />Signatur <br />Month Day Year <br />S- <br />18. Tinsporter 2-Ac_knowledWment or Receipt of Materials <br />If Date <br />Pliked /+T; ped Na� Signatu <br />Prted <br />M h Day Year <br />bt I- <br />U. <br />;n 7 , <br />7; Indication Sp)ae <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. <br />A i <br />Date —1 <br />Printed / Typed Name a <br />Signa <br />Mo h -Dav Y <br />5) Q 'Whife-6ri—ginal 'T5inZ-T8t�F-alcfflt-Nr--'-Yellqw-Transporter Green -Generator's first copy <br />TCEP-9jjU%EvA9fWV5b go 141.9 1 390034094 <br />' <br />