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TEXAS COMMISSION ON ENVIRONMENTAL QUALITY P'0. Box 13087 Austin, Texas 78711-3087 Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039. 171 p - 74 t -� 1 , i �' t I '_1 B ) ' 2 CWKae1--b5jKa-1 Pink-TSID)F�ia' TC�d- E '.0 1GV0 'i I . �j �'; f, .1-lP11.1T1- , 1-�� E ) 0 (0 4:.') 0 �: '.� I E" I 01�� . J.- UNIFORM HAZARDOUS 1. Generator's U9 EPA ID No. Manifest 2. Page I Information in the shaded areas �:pjZ 0 r) Q 1 2 2 3 0 9 ' . . . . . . Z . . . . . _"unon, I WASTE MANIFEST . I I of I - is not required by Federal law. I 3. Generators Name and Mailing Address C H E R O V E E FREI,--,H'P LINES X State Maniifesrt 06cument Number 5463 CHEPOVEE RD S 0123043.8...".��" �A 9S215- 1 19 8 B. State Generatces ID. 4.�eneratGes-Phona Ci 9 31_ 3" IYQ4t76 6. 1,1u� �,�TRN'",TEMS, IN,- TXR688 per C. -Stat6 Transpo rtaft ID1 r s1 Aizit*40boneS 0 0 6 6 9 - S 7 4 0. . . . . . . . . . . .Il 7. Transporter 2 Company Name 8. US EPA ID NumberQ ID i rEQ s 1 alle . . . . . . . . .Trans 9. Designated Facility Name and Site AddressOj i 0 G 1. 8 10. US EPA ID Number G. State Fdcilityl D SAFETY-KLEEN SYSTEMS, INC 1722 COOPER CRUEV ROAD - '76208 Phone. L)EMTON. TX TXD.07'7603371 . . . 4Q 443-.-52 0 11A. 11. US DOT Description (including Proper Shipping Name, Hazard Class, ID 12. Containers 13 HM Number and Packing Group) No. Type Total Quantity Unit Wt/Vol Waste,No. " P-4701 5 G �19 E N E b. RQ WASTE GASOLINE R X 3 UN1203 PGII (D001- DO 18 J ERG* 128 i M P WTS 2 11", A T 0 R C. WA'TE OIL AILD ABSORBEIIT MIXTtiRE NOT RCRA kEGULATED )m V T S 3 101""' d. Fyi Handling Codes for 7astesTiTted Above`` '''2 ti, r. 6 D01,-8 '2 12 N01W;.15 2 jv q-- Wjr�$iong 8i� A qdZig"2'MORV4 HR IF UNDELIVFRABLE RETURN ro GENERA-FoP, SK CORP AUTH'D TO USE 'SUBSEQUENT �ARRIERS: 40343. 41038,8-1-681 821i"49. el( -256 SKDOT4 A-. B: 1086 C: 108480 01 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 classified, packed, marked, and labelled/placarded, and are in all respects in proper condition for transport by highway according to applicable international and national government regulatio u, jn clu ding applicable state regulations. 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 economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and -future threat-ta-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 — the best waste management method that is available to me and that Ican afford. Printed /Typed Name Signature Month Day Year A T 17. Transporter I Acknowledgement of Receipt of Materials Date R A N Printed nfypecl Name Signature Month Day Year s A/ P 0 18. Transporter 2 Acknowledgement or Receipt of Materials Date R T Printed / Typed Name Signature Month Day Year E R 19. Discrepancy Indication Space F A c I - 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. I T Y Date F - Printed / Typed Name Signature Month Day Year 171 p - 74 t -� 1 , i �' t I '_1 B ) ' 2 CWKae1--b5jKa-1 Pink-TSID)F�ia' TC�d- E '.0 1GV0 'i I . �j �'; f, .1-lP11.1T1- , 1-�� E ) 0 (0 4:.') 0 �: '.� I E" I 01�� . J.-