Laserfiche WebLink
TEXAS NATURAL RESOURCETE op Vjj c� FS-IY-0 lety <br />CONSERVATION COMMISSION -18 5- <br />Y.U. Box 13U87 <br />Austin, Texas 78711-3087 OSZ70 <br />_ .... Ctn qbQ2. Fnrm aoo..d. OMB No. 2050-0039. <br />Please <br />print or type. (Form designetl for use on eine tre-prim rypnwumi.r - — - <br />UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest <br />2. Page 1 Information in the shaded areas <br />WASTE MANIFEST e N ' <br />Of is not required by Federal law. <br />3. Generator's Name and Mailing Address �E LIC ATO VINEYARDS <br />A. State Manifest Document Number <br />B. State Generator's ID <br />4. Generator's Phone 09 4 39-121:'% <br />" vest' <br />5. Transporter 1 Company Name 6. . US EPA ID Number <br />C. State Transporter's IDSA <br />D. Transporters Phon (1 �p(�S._, 740 <br />FE _K KT,,m rVSTF';a� 'r ;.7i": '-'C4a _)C(C 5 c , <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporters ID <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address t; 0613 10. US EPA ID Number <br />G. State Facility ID <br />SAFETY-KLEEN S:YSTENT. "'tc. <br />65124 <br />H. Facility's Phone <br />1722 COOPER CREEK tt0k!� <br />CENTON, T:{ 76208 <br />'I'X60776-03371 . . . <br />940 483-520 <br />11A. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, ID <br />12. Cent ai <br />13. <br />Total <br />l lnl[ <br />1. <br />Waste No. <br />HM <br />Number and Packing Group) <br />Type <br />Quantity <br />Wtfvol <br />G <br />a. <br />f <br />E <br />N <br />E <br />R <br />b. <br />t» vii r .' CORBENT 11'.'T LIRE <br />(NOT USDOT HAZARD US MATERIAL) <br />�lL <br />l <br />TS4891 <br />T <br />0 <br />R <br />C. <br />d. <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />I A)—EiiP02 L11T9 J ' -2B) NONE 4891 <br />15. Special Handling Instructions and Additional Information KFST R/T4,101853847 0000-3717-53 <br />EbIERGENCY RAE-_ %'"? -1"60(^4 ?'.R). IF UNDELIVERABLE RETURN TO GENERATOR. <br />- <br />SK CORP AUTH'D TO UJ;E SUBSEQUENT CARRIERS: 8!.;00,40355,43015,40582.84815 <br />r. <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 1 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 />yl <br />Printed ped Nammee /� <br />Signature _ ; �- month Da �Yrea <br />6 rnr ` 05 <br />T <br />17. Transporter 1 Acknowledgement of Receipt of MaterialsPt <br />A <br />'Printed/Typed Name - , - t- Signature _ _= _ Month Day Year, <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials Date <br />R <br />Printed/Typed Name Signature Monfh Day Year <br />E <br />R <br />19. Discrepancy 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 except as noted in Item 19. <br />T <br />Date <br />Y <br />Printed/Typed Name <br />Signature Month Day Year <br />------- r_.ee.._naworatnr'c first ennv <br />