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12/10/2004 10:01 9256827160 TRE PAGE 12 <br /> TEXAS COMMISSION ON RECEIVED <br /> EMIIRONMENTAL QUALITY <br /> P.O.Box 13087DEC 10 2004 <br /> Austin,Texas 78711-3087 <br /> Plsaea pdrq or".(Fam deoVied for use an ane(12-pi ch)4TVAN`a" fo <br /> •) F , APpM &J oUNn <br /> UNIFORM HAZARDOUS 1.Genaratore US EPA ID No• ManRea 2.Pepe 1 m <br /> Inlo oilon In tho sheded :RVICES <br /> WASTE MAN) ...,rT 4 1 k, . Of Is not mqu W by Fodor-d <br /> 3Genemtni N&rmwAMoAkv Add" TOM 1ChVIA.TF.RRM' <br /> -V; W FR`H:JhJT '_:T t <br /> CA 51521-J <br /> 4.Gensatore PfgM <br /> G.Transporter 1 Company Name 6. US EPA ID Number <br /> sr:r•r•,•rx-'�:i.y:FN s;1•sreP=.:>, I1J:: Trrc,��ar;-lyse- . <br /> 7,Twoponar 2 Company Nome d US EPA 10 Number <br /> 8.Deehgrlaleo FaCM Name era See Addee600081 i 10. US EPA ID Number <br /> SAFETY, If.-CEN :SYSTEM.:, INC. <br /> t,CniPEP CREE9. ROAD <br /> I'X '1G20: <br /> 11A. 11.U5 DOT O.Wdpflon(Mcludw g Props Shipping Name,Hamad Claas.ID t2 cora lk a A 14. <br /> HM Number and Padd g Group) No. I Typo Ta1Y I1,lll <br /> Oe vftw <br /> WASTE OIL AND NBSORBEIIT MIXTURE <br /> G ( NO'i' RCA& RLGULATEG; 1 kMP <br /> E <br /> V <br /> E h. <br /> R <br /> A <br /> 7 <br /> O <br /> R c. <br /> d. <br /> tti.SpeEial FIa/rcKrg kwOnlcilorq BIW AdrAgorrel 111DrnMl60rl HF n'T CJT#145 51 37 2 U <br /> ENtkGENCY RESP t10U--4r..8-.17tO! 24 HR), IP iTNDELIVERADLE ACTORK TO GENERATOR. <br /> K. <br /> ;:ORP AUTH. V TO USE ^)UaSEQUENT CRRY£R5: �U.34:1. 410:10, 91681, 027:9. R62G5 <br /> ;K1)OT A: 1'•44 B: C: D: <br /> 10.GENQRATOW9 CERFMCAINW I hmany defiers OW Me as M of Ise osriaigrerierrl w"and son W daerlead above by the props mtopng rams an <br /> draped,perked,mrlad,ra lebdkeg ecardad,ane are M At reepab in plop"otw~for arropwl M Ngtway according to apptkable bvwn fonW and ne <br /> gvnffmw l rega n".Tcealr+g epPecealerwe ropwaaora. <br /> M 1 rn s Wga qurday gan"ser.I avis+•amt I nss a proWser In p4W b red=as volume"rd toreray ol+Paola generead to Me de8ds I ram eelentdrled <br /> seorloMICOW p rd Met I have aalaeled Me praCdcoNe met"of ba"rrara,"Me,w diVoed Oun MvWt o b me Posta rMaenarea Me pnaen <br /> biaeo Mas to h+perr braid and the ru'kaananl.OR.e I am a 6nIBe q+sdily g"+relgr,l have AadB•good Wal eeoa q miriireire my walla possrsbun all. <br /> da OeM vww earagrn"a rroMod Mer N eveeape b rrw a.M 11wa 1 son mbq. - . <br /> Prl�iad/Typed,tp�ma �. ., SlgnenNe�'•''^'.`•, ,." Maom Ory <br /> .J 1 r'r <br /> a <br /> 17.TrAnsprotor 1 Aclolorl am of R W mai;; s Date <br /> A Panted I Typed Nemec w.-. SignatUge' —.—_—_ Mall ow <br /> VI <br /> A 18.Transporter 2 Admcvoolsdgevisnt or Receipt of Meterwo Date <br /> T Printed/Typed Name Signature Month DW <br /> R <br /> 19.aavepan y Indication space <br /> F <br /> a <br /> c <br /> r <br /> L 20.FedNry Ovmer a Opardor: Cartnratlon d receipt d hezerdw,e mdends cwwad t y this mvikot except as noted in item f9. <br /> TF W1s <br />