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Jul 10 06 05:13p <br />I'. <br />TEXAS COMMISSION -ON <br />,ENVIRONMENTAL QUALITY <br />PCO. Box 13087 <br />-Austin, Texas 78711-3087 <br />Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. h <br />WASTE MANIFEST (- R nnorl 3 -;18-7. . . ¢ <br />3. Generator's Name and Mailing Address SWIFT TRANS PORTAT ION <br />901 D -ARCM 'PKWY <br />LATHROP Ctrs 95330 <br />4. Generators Phone 209 858-7027 <br />10 <br />/-i85-01 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />SAFETY-KLEEN SYSTEMS, INC.TXROQOO50930. <br />7. Transporter 2 Company Name �` 8. US EPA IO Number WDesiguated acility Name and`STe Address000618 10. US EPA ID Number <br />SAFETY-KLEEN SYSTEMS, INC. <br />1722 COOPER CREEK ROAD <br />DENTON, TX 76208 <br />TXD077603371 <br />11A. 11. US DOT Description (including Proper Shipping Name, Hazard Class, ID <br />HM Number and Packing Group) ' <br />a.'° ---RQ WASTE F.LAMIMABLE LIQUIDS, N.O.S. <br />G X (MIRERAL SPIRITS, PETROLEUM DISTILLATES) <br />E 3 U 11993 P6 III { D001) (ERG 128-11"; <br />p.2 <br />Form Approved. OMB No_ 2050-=9. <br />Page 1 Information in the shaded areas <br />of 1 -T is not required by Federal law. <br />State Manifest Document Number <br />B. State Generators iu <br />C. State. Transporter's:ID 87109 <br />D. Transporters Phone800 . 669- <br />E: State -Transporters. ID' f - <br />G: State`Facility iD. - -' <br />:6.�-x.•2:4.-:.: ,.' <br />H•.Facilitys Phone.; <br />x:940" 4 3-520€i <br />12_ Containers 13. 14. <br />No.Type Total Unit---asteTTo: <br />Quantity w✓Wol <br />�PN;4_i <br />t T.k ..:,�.. <br />)a G' . .0 <br />N <br />E <br />b <br />R <br />A <br />T <br />R <br />C. <br />d. <br />nal pti for M Listed Abave ' <br />K. Handling Codesfor <br />Wastes Lister! Ab&6--v'-= <br />::�.1ye ;i,t.(� . .. '��e, s3'�.iJ'b, .,a•j�t .�.�.Y.Sr'. s <br />e <br />W. <br />a� r, " <br />ts,'yt, <br />a�'t' <br />,� a <br />i <br />:.: <br />A 5. Special Handling Instructions and Additional Information <br />E <br />R /'P 1 O1 R g 9 6 9 9 0 00--3709-11 <br />EMERGENCY RESP 800-468-1760(24 HR). <br />IF UNDE <br />IVERABLE RETURN O GENERATOR. <br />SK CORP AUTH'D TO USE SUBSEQUENT CARRIERS: <br />43,41038 ' 1,82739,86256 <br />SKDOT# A: <br />52030 <br />8: C: <br />D: <br />16. GENERATORS CERTIFICATION: 1 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, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br />economically practicable and that 1 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, t 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 Month Day Yea <br />SCID <br />T 17. Transporter 1 Acknowled-g-ement of Receipt of Materials Date <br />R i�rinted /Typed Name > T- ( Signature Month Day Y� <br />N —2 Day <br />s <br />0 18. Transporter g Acicnowledgemi <br />R <br />E <br />=.'Printed / Typed Name <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />or Receipt of Materials <br />� Signature <br />Date <br />/J Month Day Yea <br />L 20. Facility weer or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. <br />I / <br />y / Date <br />Y <br />/tented / yped N.+ Sig Lure / ' 1 Month �?ayf Y.ea <br />White - original ' Pink --TSD Facility Yellow -Transporter Green -Generators first copy <br />TC5W-11 00542 30 <br />