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TEXAS NATURAL RESOURCE�7 <br />CONSERVATION COMMISSION— 18 5 .1 <br />P.O. Box 13087 <br />Austin, Texas 78711-3087 <br />Please print or type (Form designed for use on elite (12-pilch) typewriter.) <br />Pnr ann--i ANAP nim onan_nnln <br />T�IK��11�Fj�VV V11 J)3990 � B) 000 3 4bOl i�nal (,Pink -TSD Facility Yellow -Transporter Green -Generator's first copy <br />SM L.t ASS 0000211895 B 0000650959 �( <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest <br />2. Page 1 Yrr Information in ythe shaded areas <br />WASTE MANIFEST �M i C <br />of is not required by Federal law. <br />3. Generator's Name and Mailing AddresfELECTR IC S IGN CO <br />A. S e Panifest Document Number <br />3133 N AD ART RD. <br />S <br />ATTN PAUL BISCHOFBERGER <br />00076493 <br />B. State Generator's ID <br />STOCKTON CA 95215 <br />4. Generator's Phoned 9 ? 1- 086 0 <br />99906 <br />5. Transporter 1 Company Name 6 US EPA ID Number <br />C. State Transporter's <br />SAFETY—KLEEN SYSTEMS, INC ILD 9849082.02 <br />D. Transporter's PhorSOO 669-5740 <br />7. Transporter 2 Company Name 8 US EPA ID Number <br />E. State Transporter's ID <br />F. Transporter's Pho _ <br />9. Designated Facility Name and Site Addre00061 8 10 US EPA ID Number <br />G. State Facility ID <br />AFETY—KLEEN SYSTEMS, INC. <br />55124 <br />722 COOPER CREEK ROAD <br />H. Facility's Phone <br />ENTON, TX 76 208 <br />TXD .0776033.71 <br />940 483-5200 <br />11 A. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, ID <br />12. Containers <br />13. <br />14. <br />1. <br />HM <br />Number and Packing Group)nit <br />No. Type <br />Quantity <br />wt/vol <br />Waste No. <br />a. <br />RO WASTE PAINT RELATED MATERIAL <br />G <br />X <br />3 UN1263 PG II <br />} <br />O <br />TS209H <br />E <br />N <br />a �. <br />y l <br />E <br />b. <br />R <br />R HAZARDOUS WASTE, SOLID, N. 0. S. <br />A <br />T <br />X <br />CHR8M��M) <br />0 <br />TS409H <br />O <br />PG III (DO07)(ERG#171) <br />R <br />c. <br />d. <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wast s Listed Above <br />A) F003 FOOS D001 D035 IB) D007 OUTS409H <br /># #m� <br />Lb /I ( <br />15. Special Handling Instructions and Additional Information <br />MF S T R /T # 98874576 0001-9591-72 <br />MERGENCY RESP 800-468-1760(24 HR). IF UNDELIVERABLE RETURN TO GENERATOR. <br />K CORP AUTH'D TO USE SUBSEQUENT CARRIERS: 81300,40355,41015,40582,84815 <br />SKDOT A: 1166 B: 5850 C: 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 trea a 1. e, or dis osal 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 a at , I HN e ma good faith ffort to minimize y waste generation and select <br />the best waste management method that is available to me and that I can aff(rd. <br />z� <br />ri to T pe a e,. <br />S e <br />Month Day Year <br />QKIWI <br />T <br />. <br />1 Transport 1 Acknowledgement of Receipt of Materials Date <br />R <br />A <br />N <br />Printed/Type - ` <br />N ue—ST <br />Signature Month Da Year <br />TTI <br />I <br />s <br />P <br />0 <br />R <br />18. Transporter 2 Acknowledgement of ceipt of Materials Date <br />T <br />Printe y d Name <br />Signature Month Day Year <br />E <br />R <br />r, S -P <br />19, Discrepancy Indican n Space <br />F <br />A <br />c <br />I <br />1 <br />I <br />20. Facilit Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Date <br />rinted/Typ d qame <br />Si ure <br />M nth Day Y�r <br />T�IK��11�Fj�VV V11 J)3990 � B) 000 3 4bOl i�nal (,Pink -TSD Facility Yellow -Transporter Green -Generator's first copy <br />SM L.t ASS 0000211895 B 0000650959 �( <br />