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-TEXAS COMMISSION ON <br />ENVIRONMENTAL QUALITY <br />P.O. Box 13087 <br />Austin, Texi3s 78711-3087 <br />01-- ;M ­ h- 19:- fiacinnnii fnr j — nn ofita M 9_nitchl htnpwritpr I <br />AM, <br />Form ADDroved. OMB No. 2050-0039. <br />TCEQ- <br />wwrote- original. rink- I Z)U r-acnity T eituvv- i i ai tzipul tus U, tjvi -Py <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. st <br />2. Page 1 Information in the shaded areas <br />WASTE MANIFESTil i �7 L . . . f�ctMan <br />Of not required by Federal law. <br />3. Generator's Name and Mailing Address I , <br />B T <br />pa, op <br />P N CA 95206 <br />. . . . . . . . . . . . . . <br />911 2 '7 4 6 3 4 <br />4. Generator's Phone - <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />1'!�FETY-IKLEEN 'SY':',­1'EM'0. T Xj� Q 0 0 C� v 9.,�) <br />I ME& <br />7. Tran C p iy Name S EPA Il <br />Ituber <br />S .1 J - <br />9. Designs ed Facility Name and Site Address 0 0 0 t-, 16 10. US EPA ID Number <br />R gk"t <br />.'Af_ E T Y - il<� LIE E 11T IS' Y 3 T E M S1 11C - <br />'REE ROADZ <br />OPER L <br />6ENTCA4, TX 76208 <br />TXDQ77E?t'3 3.! vM <br />- <br />11A. 11. US DOT Description (including Proper Shipping Name, Hazard Class, ID 12. Containers 13. 14 1 <br />Total Un ;t <br />HM Number and Packing Group) No. Type <br />Quantity Wt/Vol <br />a. <br />HAZARDOUS WASTE, SOLID , <br />G <br />TrIETRAC HLOROETHYLENE . LEAb <br />E <br />ter. 30r77 4`T _r. <br />ERG4171 <br />N <br />E <br />b. <br />R <br />1WA2->TE IDS CONTAINING FLAMMABLE <br />-OLII-4E. <br />A <br />LIQUIE', (GAS BENZE1,TE 4, 1 <br />DPI <br />C. -i <br />T <br />UN1175 PG 11 (ERG#133)kis <br />Y P <br />0 <br />C. <br />R <br />d. <br />1 im <br />-ek No "M <br />,15. Special Handling Instructions and Additional Information MFST R 4 0 3 00 00 -3 0 1 9 <br />/T#105A227 2 <br />EMERGENCY RESP 800-468-1760( 24 HR), IF UNDELIVERABLE RETUR1,1 TO GF1,TF-'Z_T1jp, <br />ZA U T 1 T ISE STUBSEOUENT C ARtri 'ERS: 40343. 4 1 8� `3 6 <`.; 1 � 8 '7 39 . 3 6 2 5 <br />1,7 CORP 0 U J_223'73 <br />SKDOT# A: B. 342 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 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 />Prinjed,441ped Nan Si Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials Date <br />R <br />A <br />Printed L Typed Name <br />Signaturi/ Month Day Year <br />N <br />s73 <br />AJAII&26 c/w< <br />P <br />0 <br />18. Transporter 2 Acknowle ment or Receipt of Materials Date <br />R <br />T <br />E <br />Signaturt M Oto D y <br />ri a Name V m <br />\d�N .1% ..I V <br />R <br />I — ID, <br />19. Discrepancy Indication Space <br />L <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. <br />1 <br />T <br />y <br />Date <br />Printed / Typed Name <br />Signature Month Day Year <br />0 lcq 10,5 <br />I <br />'S .( <br />TCEQ- <br />wwrote- original. rink- I Z)U r-acnity T eituvv- i i ai tzipul tus U, tjvi -Py <br />