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05/11/2005 11:zz FAA Lou VOLuoao ^---------- - <br /> TEXAS <br /> - - _TEXAS COMMISSION ON t <br /> ENVIRONMENTAL QUALITY, � S <br /> P.O.Box 13087 c <br /> Austin,Texas 78711-3087 <br /> Please print or type.(Form designed for use on elite(12-psch)typevrrllef) Form ADProved. OMB No.20sPeg39. <br /> UNIFORM HAZARDOUS 1.Generelor5 US EPA ID No. Manifest 2.Page 1 Information in the shaded areas <br /> WASTE MANIFEST �'Q' (OG "-3 6 '' <br /> of is rid required by Federal law. <br /> 3.Generators Name and Mailing Address ^ (�s�U('rr II J 1 .. <br /> 99 <br /> 4.Generators Phone 7U �) 77-OdobS�o��T ) <br /> 5.Transporter 1 Company Name 6 US EPA ID Number F)ANIV 'ID <br /> s Irl lrrA 1 SY r x!�uvGr; 5 u 93u <br /> 7.Transporter 2 Company Name 6. US EPA ID Number ':m'�" IN <br /> F:7rasiMi5bRor?sPhoija <br /> 9.Designated Facility Name and Site Address to. US EPA lD Number Cx>Qata fadB -y ID.;' ya- W-4, <br /> SArrrf,�lrF,v SrsrF,..s,.rc.r ' > . b ; F <br /> /717 /oul�F�ll li.✓E"Fac���iA/, H F°W[y�erben' �- t £s-; <br /> aril <br /> 11A. 11.US DO Descnplion(including Proper Shipping Name,Hazard Cless,m 12.cortaarers 13. 14 4 <br /> HM Number and Packing Group) Nal TypeQ°�1 Una <br /> antay yyy � <br /> a. �[ h/Asr<- jie7ilrCj>rl71rofl J I� -._ <br /> G <br /> E- <br /> E <br /> R <br /> A .a.y�.. <br /> T <br /> O <br /> d. <br /> J.Additio u <br /> I Descriptions for Materials Listed Above `.C4 61)0r, K Handling Codes for Wastes Listed Above <br /> r:� fl 3 re.q5 Dow Ao35 A005 ao.G Gari7bbu8 <br /> 15.S ecial Handling Instr Ion a1i' In anon n 6 <br /> 16.GENERATORS CERTIFICATION: I hereby dedae that the contents of this c signment are July and accurately described above by the proper shipping name and are <br /> classified•packed,marked,and labeled/placarded.and are in all respects in proper condhion for transport by highway according to applicable International and naiena <br /> government regulations,including applicable state ragulaions. <br /> N I am a large quantry generator,I certify that I have a program in dace to reduce the volume and toxicity,of waste generated to the degree I have determined to be <br /> economically practicable and that 1 have serected the practicable method of treatment,storage,or disposal currently avaAable to me which minimizes the present and <br /> rel Iheat 10 human health and the er mi onmenl;OR,i1 I am a srrall quantity,generator,1 have made a good faith e6on to minimae my waste generation and select <br /> are baa waste management memod that Is available to meand ran 1 Blfprd. <br /> I I <br /> aap(n ty <br /> Print {Y.p� (�� sig arc r ( M �aY U <br /> r l.. / dr t <br /> T 17,Tragspbner 1 AckjnDwiedgernent of Receipt of Materials Date <br /> R <br /> A <br /> �fin[ed/Typed �1 /// - r 9natuUSVA M I Y yew <br /> lK ` I 0 <br /> r _ — - <br /> n18.Tran`spoder 2 Acknowledgement or Receipt of Materiels - Date <br /> T Printed I Typed Name SigneWre Month Day year <br /> a <br /> R <br /> 10.Discrepancy Indication Space <br /> F <br /> c <br /> C <br /> I <br /> L 20.Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as rioted in item 19. <br /> 1 <br /> T Date <br /> Y <br /> Printed ITyped Name Signature Mol Day Iyear <br /> TCEO-0311(RIN.09/01102) White-original Pink-TSD Facility yello*-Transporter Green-Generators first ropy <br />