Laserfiche WebLink
-TEXAS COMMISSION ON <br />ENVIRONMENTAL QUALITY <br />P.O. Box 13087 <br />Austin, Texas 78711-3087 <br />Dl- ­..AM .,r t.rno lGnrm riacinnari fnr i icA nn alitA N 9-nitch\ tvnewriter.l <br />Form Approved. OMB No. 2050-0039. <br />white - original mnK-IZj) u <br />Faculty TeOw-I Idi isPuVna <br />i LU i Cc-�Ul1VIJo 111.F. <br />i OL -FY <br />TCEQ-Q311(REY.Q9/A1lo���014191 E )0 2000 3 4094 <br />UNIFORM HAZARD1 •Generator's US EPA ID No. Manifest <br />OUS <br />2. Page 1 Information in the shaded areas <br />WASTE MANIFEST a 0. <br />°f is not required by Federal law. <br />3. Generator's Name and Mailing Address CAL TRANS DIVISION 10 <br />1603 S B STS <br />s <br />STOCKTON CA 95206 <br />4. Generator's Phone (2 0 9 474-6834 <br />WR <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />SAFETY—KLEEN SYSTEMS INC TXRO0.0050930 . <br />7. Tra porter 2 Company Name 8. US EPA ID Number <br />f_ <br />9. Design/ated Facility Name and Site Addres>s000618 10. US EPA ID Number <br />SAFETY—KLEEN SYSTEMS, INC.�� <br />1722 COOPER CREEK ROAD <br />22 � <br />DENTON, TX 76208 <br />TXDO7.760.3371 . <br />11A. 11. US DOT Description (including Proper Shipping Name, Hazard Class, ID 12. Containers 13. 14 i <br />Total Unit <br />HM Number and Packing Group) No. <br />Type Quantity wWol v. U,_ <br />a. <br />HAZARDOUS WASTE, SOLID, N. 0. S.A <br />G <br />X ('TETRACHLOROETHYLENE, LEAD } �-- <br />M .;� �i <br />E. <br />b. <br />R <br />RR <br />� <br />R <br />C <br />baa <br />IN <br />d.MIM��: <br />` <br />Iii <br />�T.=s�� �&�:.��'� t � �E, °`''E.. � � �•'v�? �f a$���e?< F c <br />�� r'� "� ai `c^ t= �`.S'. f'f <br />15. Special Handling Instructions and Additional Information MF S T R /T 4 10 5 6 8 2 3 91 0000-3701-92 <br />EMERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE RETURN TO GENERATOR. <br />SK CORP AUTH'D TO USE SUBSEQUENT CARRIERS: 40343,410 .81681,82739,86256 <br />SKDOT# A: 22373 BI <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 1 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 <br />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 ade a go <br />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 />Pr i ted yped Name <br />Signatu <br />Month Day Year <br />OZ 3./ 0 <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />R <br />A <br />Print Typed Name <br />Signature <br />Month Da Year <br />Y <br />N <br />S <br />-/ y� <br />A< J i C <br />./ <br />0 <br />18. Transporter 2 Acknowledgement or Receipt of Materials <br />Date <br />R <br />T <br />R <br />Printed / Type e <br />Signature <br />Month Da Year <br />G <br />19. Discrepanc Indication Space <br />F <br />A <br />c <br />I <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest <br />except as noted in item 19. <br />T <br />v <br />Date <br />Printed / Typed Name <br />Si e <br />M Dy Y <br />1, <br />white - original mnK-IZj) u <br />Faculty TeOw-I Idi isPuVna <br />i LU i Cc-�Ul1VIJo 111.F. <br />i OL -FY <br />TCEQ-Q311(REY.Q9/A1lo���014191 E )0 2000 3 4094 <br />