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12/01/2004 16:50 <br />TEXAS COMMISS110114 ON <br />.KVIAONME!NTAL OYALrFY <br />;ii.6. Box- 306? <br />31000e prlrit or type., (Faun d!!!bnW R <br />JT -7 -UNIFORM H <br />9404113% SAFETY KLEEN PAGE 01/04 <br />use on elite (12 -pitch) <br />3. Generator's Name and Mailing Address SNOP <br />38'W SONORA ST <br />PO BOX 1:849 <br />STOCKTON <br />4. Generators Phone ( 209 ) 947-1451 <br />5. Transporter I Company Name <br />SArETY-KLEEN SYSTEMS, INC. <br />7. Transporter 2 Company N211710 <br />CA 95201-1849 <br />B. US EPA 10 Number <br />. TXROG0.00,9130. <br />a. US EPA ID Number <br />Form Approved. OMB No, 205041M., <br />PPage I Information in the shaded aremb <br />Is not required by Federal law. <br />&RW Man uMbet. <br />.0shistatbru ID <br />9, C)eSignated FacIlity Name and Site AddressUOU0 i U 10. US PA ID Number <br />SAFETY-KLEEN SYSTEMS, INC, <br />1722 COOPER CREEK ROAD <br />DENTON, TX 76208" <br />11A. 11. US DOT Omoription (including Proper Shipping Name, Hazard Clow, ID 12. CordaInent 13. 14. <br />HM Number and Packing Group) NO, Type Total unit <br />Ouentity win Lot b, <br />a. WASTE COMBUSTIBLE LIQUID, N.O.S. <br />G X (PETROLEUM NAPHT11A FILTERS)NA1993 PGIII Dr P <br />E <br />N RQ(,D0OU(9RG#128)(D039,DQ40j__ <br />E b. <br />R <br />A <br />T <br />C. <br />I t <br />tjdf oftd rditln of?e Listed AWVa. <br />Z <br />15, Special Handling Instructions.ari.d Additional IWi;r=o-; MFS T#10519&77?, �1000-- 96 29- 7 4 <br />JET S.F <br />EMERGENCY RESP 000-468i1760( 24 HR IF UND I RABLE RETURZ TO GENrRA-T0R,.,:--- <br />0 <br />AIL <br />:C) <br />-'I) TO USE UBSEQUElTrI CARRIERS: 6 13 40 3 5 5, 4 1 <br />SK COPP ,U 'FI S. 40582, 848kS' <br />SXDOTj A 13969 bz <br />16. oF-Nr=RAToFrs CUMFICATION- I hereby declare that the contents of this consignmont are fully and accurately deacribe6 atxwp 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 rogulaVolm. <br />If I orn A large quantity generator. I certify that I have a program in place to reduce the volume and toxicity of waste gonerated to the degree I have determined to be <br />economically PTACUCMble and that I hwn selected the practicable method of treatment, storage, or disposal currently available to me which minimizes thp. present and <br />future threat to human health and the environment; OR. I I am a small quantity generator. I have made a good faith effort 10 minimize my waste generation and select <br />the D" waste management method that is avallable to me and that I can afford. <br />W1 pripted /1 Typed Nre Sign lure Month Day Year <br />gk- <br />T 17. Transporter I Acknowledgement of Receipt of Materials Date <br />R <br />A <br />N <br />Printed / Typed Name <br />5 <br />P <br />010- 6 'V- <br />0 <br />R <br />1 a. Transporter 2 AcknowledgeM <br />T <br />E <br />r t I/Tvnedhire <br />-R <br />19. Discrepancy Indication Spam <br />T <br />A <br />c <br />I <br />L 20. Faoility Owner or Operator: <br />I <br />T <br />Y L— <br />Printeu i Typed Name <br />TCE040311 (REV.09/01102) <br />or Receiot of Materials <br />&bon of reoelpt of hazardous materials covered by this manifest except as noted in <br />White - original ..- Pink -TSD Fad Y-eIIc*,T-ransporte(-.q"-< <br />ors first -dopy <br />0 P -y- <br />Date <br />Month <br />Day Year <br />422J22 <br />LE <br />2 8 2.004 <br />9. <br />I <br />Date! <br />Month <br />Day Year <br />) A( lo -V <br />ors first -dopy <br />