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09/14/2004 11:15 9404935257
<br />TE%AS NATURAL RESOURCy„
<br />CONSEIRY ATI ON COMM1SStaN. 185-01
<br />P.O, Bax 13081
<br />Atislln; Texas 70711-3087
<br />a
<br />p'.! MI n. NM GNw Ar nM 1wI i
<br />SAFETY KEEN COPP
<br />PAGE 01/51
<br />rwlarnnal»ua,.esmlmp�._� ,,.,,,,,,Xk'tiAa�S(jgipat oiak•TBC:'*acilily Yallow•Tswrgorfal-0tacn�e.aerator's+.'ru�gp�y,t �y�
<br />UNIFORM HAZAROOLLIS Gonelobeti USE f0 No Mall ew 2, age Inlennatlpn In INa ahetletl araa9
<br />WASTE VANNIFM'T
<br />nI No of a trs. requ+ca 5y Feda.al )aw.
<br />3. Generators Name and Melling AddresspELICATO VINEYARDS r
<br />A. State MANIesl Dpoument Number
<br />12001 s HWY 99
<br />S 00599503
<br />MANTECA CA 95336
<br />e. State Oeneralor'e t0
<br />4.Gentimprs PinwafOs 2PS-1215
<br />9906
<br />S. 7-ra15porfer 1 Company Name d u5 F9A ti Mumber
<br />v.Sfa e 1 randporferb
<br />AFETY-K EEU SYSTEMS, INC SCRafwo75.t50.
<br />a.Tra a4asr'sPhnn900 549-51140
<br />7. 7ranappne('2 gonlFairry Nam` 8. e tJ5 EPG D Numtl/er
<br />E. State Trancponsra
<br />F. Tlanapori Phone j�Qu, CIr
<br />I('� OfJd. �//✓ /
<br />9. Designated Facility Name and Site AddraW 616 18. US EPA ID NuYnbarG.
<br />Stale Facility ID - -
<br />AFETy.-KGEFN SYSTZ14S ,INC,
<br />5126
<br />022 COOPER CREEK ROJkD
<br />H„ Fadlliy, a Phone
<br />'.ENT016, TX 75208
<br />1
<br />TXD077601371
<br />1940 4835200
<br />11A.
<br />'nTn1
<br />11. US DOT Oescdptlon pnciuNng Proper Shipping Name. Hazard Cdass, ID
<br />1z. r.,ontalne,
<br />is.Tow
<br />ra
<br />Number and Packing Group)
<br />No Tinto
<br />wIl
<br />QuUenu
<br />Una Waste No.
<br />YhN
<br />a.
<br />4
<br />a
<br />b.
<br />AUSDT11.
<br />0
<br />ZAROOMERa (NOTOMADUSATIAL)
<br />M
<br />,;i.�/�
<br />�1a;0
<br />UTS4891
<br />a
<br />c.
<br />d,
<br />J. dltional Dosed Ions for star els to ve
<br />YQS NflAtIG 484i
<br />K. Fiendinp Codes lot Wastes L109d Above
<br />,�
<br />15. Spedel Handling lnsinu1tons and Additional Information 2Ti'ST R
<br />t 1 453 01704 3 ODD- 971 7 - 5 3
<br />AXEC0 4CAUTY A t11
<br />UD4iNTRC71IF
<br />s-. 613fyLE
<br />VSLBSVBSE S1y I
<br />D, SO15Tg9GENERATOR.
<br />OTI 2k4gij AM 13;03
<br />16. GEN[RATOA'9 CERTIFICATION, I hereby deaaro Inal the obnwis of mis en' ars fully and a Curately daedrlend obwa by the Prow"Ping name and We
<br />r•Iasslhep.Fal:ked,mer`Ned,3,Y6 M1;edViwwded. a^y lie In aN rrr'scls s..ro r egaGhrca lot t%WM*n❑Y rV ay atrMNg mendnlamai
<br />gnyammanl "taffOnk Including ANa✓aele atalA ragulalMa
<br />and tadnaN q a cane I hand a program heyada to rbeU<B the rdLme and asposa gum,wil 9 g' to the mq I nage m le tw
<br />eounoIII ilarge
<br />and mat d e!
<br />d that aetecled Ih0 dapaaal
<br />isttec wbb n610
<br />lmat phuman
<br />httc
<br />l
<br />c valW a tome whkh minl masa the Aland
<br />I" p e and
<br />hlu� 1d
<br />futum i e s R, it I V"11 t.1, pn I hoi t IMM 11,
<br />Nreaf b human 1tMllh drld ate amrMgnmanl; OR. It am a Small QYan1Ay OwrerBiT, I M1aye Mntlp g "WIMM Ig mInIMZe my WPelp ganeiakon and 861aC1
<br />s
<br />note"
<br />the aa91 waste menapelnani method that la eyW101a 10 me and that 1 Can an0A1.
<br />P!+. /i' pod me $ignatu
<br />MarrN1 Day Year
<br />► c.
<br />*
<br />17.7ran TIerl Adcnowleog mental Receip[ot Materials
<br />Date
<br />Nrir�aAl�yped
<br />'
<br />%�,T u
<br />y' Mor Day Year
<br />o.,�,,,
<br />0< r.�/ o..
<br />`0
<br />18. Transp Acknowledgem4 of Receipt Materials
<br />Date
<br />I Y
<br />Pnnt Typed N)"a Signalu
<br />Math Day 1'EBr
<br />19.^Jbcrepar y indoritu. Space '
<br />F
<br />A
<br />FEB ! 6 2002
<br />20. Facility Owner or Operator. CeNtIcalion or raceipt of hazardous mdledal5 CCvered by t la nlamfest eaeept 29 noted In Item 19.
<br />I
<br />r'-
<br />- 'I Dale
<br />Signature
<br />` . . ! Ma Y
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