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Y TEXAS COMMISSION ON <br /> ENVIRONMENTAL QUALITY - <br /> P.O. Box 13087 <br /> Austin,Texas 78711-3087 <br /> Please print or type.(Form designed for use on elite(12-p%ch)typewriter.) Form Approved. OMB No.2050-0039. <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page 1 I Information in the shaded areas <br /> WASTE MANIFEST n o Of 1 is not required by Federal law. <br /> 3.Generators Name and Mailing Address A.State Manifest Document Number. <br /> S 01273056 . <br /> B.State Generator's ID <br /> 4.Generator's Phone <br /> f-1.r C O- <br /> 5.Transporter 1 Company Name 6. US EPA ID Number C.State Transporter's ID 87 11(! <br /> D:?ransporter's Phone.',. _ <br /> 7 '[Met 2 jornpany Na 8. US EPA ID Number E.State Transporters IfJ.r - <br /> Y/rt/ 9.0.0 0.6. .O.Z. F.Transporters Phon <br /> 9. Designated Facility Name and Site Address,. l 10. US EPA ID Number G.State Facility ID <br /> "9124 <br /> - - _ - H.Facility's Phone <br /> 11A. 11. US DOT Description(including Proper Shipping Name,Hazard Class,ID 12.Containers- 13. - ` - 14. <br /> HM Number and Packing Group) No. Type Total <br /> Unit yyaste No. <br /> Quenu W(Nol <br /> a. <br /> I ��� 'iF' ,. . ... <br /> G )PI iii:2 <br /> N --Z - Voo f0 <br /> E b. <br /> R <br /> A <br /> T <br /> O <br /> R C. <br /> d. <br /> J.Additional Descriptions for Materials.Listed Above K.Handling Codes for Wastes Listed Above <br /> 15 Special Handling Instructions and Additional Information F1 T 1 K i+i"7 I r, 1 = ?i11- 9 21'7 - L`1 <br /> 2dDELIVEFc51 R -of-of <br /> 'PO 63217- <br /> ..4 - 'c23A } : ,: 7 � <br /> 7 ; . �ii125(, <br /> .it !-.: 47117 Ft: f_ ).!( <br /> Is. 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 /> It 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 treatment,storage,or disposal 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 generator. I have made a good faith effort to minimize my waste generation and select <br /> the best waste management method that Is available to me and that I can afford. <br /> Printed/Typed Name IV I Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> N Pri /Typed Name Signature Month Day Year <br /> a �� <br /> P <br /> R 18.Transporter 2 Acknowledgement or Receipt of Materials Date <br /> T Printed/Typed Name Signature <br /> R . , _ I`P 1 1Monthz 10 ' D� 0ear <br /> 11-6 <br /> 19.Discrepancy Indication Space t <br /> F <br /> A <br /> .0 <br /> "I <br /> 20.Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. <br /> T <br /> y Date <br /> Printed/Typed Name Signature Month Day Ye r <br /> ec� <br /> TCEQ-0311(REV.09/01/02) � .- - �(v White-ori mal Pink-TSD I Yellow-Transp er Green-Generators firs copy <br />