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r <br />"73 <br />TEXAS WATER COMMISSION <br />P.O. Box 13087, Capitol Station <br />Austin, Texas 78711-307 <br />Please print or type (Form designed for use on elite (12 -pitch) typewriter.) <br />G <br />E <br />N <br />E <br />R <br />T <br />0 <br />A <br />UNIFORM HAZARDOUS—T—. Generator's US EPA ID No. Manifest <br />2. Page 1 information In the shaded areae <br />A94 <br />of 1 is not required by Federal law. <br />.A . •0 •0.0 , <br />WASTE MANIFEST <br />3. Gene r tor' N e and M iliwin, Add ss g, <br />A. State, tai s' a r � z <br />3 <br />Form approved. OMB No. 2050-0038, res 00-30.91 <br />UNIFORM HAZARDOUS—T—. Generator's US EPA ID No. Manifest <br />2. Page 1 information In the shaded areae <br />C j� 0 4 , 3 .0. 7 . S ff±!t1p � N9 <br />of 1 is not required by Federal law. <br />.A . •0 •0.0 , <br />WASTE MANIFEST <br />3. Gene r tor' N e and M iliwin, Add ss g, <br />A. State, tai s' a r � z <br />3 <br />dt <br />975 S.Minmt A . p Lodit CA 95241. <br />a Stara sIn of 4 x , <br />209-334«3411 <br />4. Generator's Phone ( i <br />5. Trane t r t Co any N m B. U E A D �vu b r <br />C 1 6 4 fD. <br />,. <br />; _ 's <br />Y . <br />7eansp F ► <br />1. Transporter 2 Company Name $ . US EPA ID Number <br />L Stbta,'fran r`4 ifs <br />9. Designated Facility Name and Site Address 10.s== US EPA ID Number <br />Ci S i#y'a l ti <br />i <br />500 Batty P413111111iLlpwtef <br />TC 571 f .: _ 22 9 0 1 <br />�. <br />i <br />11. US DOT Description (including Proper Shipping Name,hazard Class, and ID <br />12. Containers 13. 14 .. <br />Unit <br />I t A.Torsi <br />HM <br />Number) <br />No <br />• <br />Type ;r tivantlty L"4tly .. <br />a <br />l <br />claw cm hazard= <br />$rel <br />b.g�+ <br />, a' <br />11 V .�� <br />�&. .,ra � `.,^off . 1• <br />- <br />C. <br />e, <br />d. <br />� <br />�tt�DeacPipttonaJoT'itiat'Bria%�z�t�2t'Above�� ""``.''`��``" <br />z <br />15. Special Handling Instructions and Additional Information <br />APP=Vriate PLVbWUV6 C . <br />16. GENERATOR'S CERTIFICATION: Iherebydeclarethat the contents ofthis consignment are fully and atxurateiydbstxi'ibt bbovebypr <br />epplrcabie int <br />classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway <br />arxordtt Ed <br />government regulations, including applicable state regulations. <br />in to reduce the volume and toxicity of <br />waste generated to the degree I_hasia fed <br />If I am a large quantity generator, I certify that I have a program place <br />treatment. stoutge.ordisposal currently <br />available tome which tttitilr4li <br />economically practicable and that Ihave selected the practicable method of <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, ¢ <br />the best waste management method that is available to me and that I can afford. <br />Signal <br />Pnnted5yped Name41 <br />R � r <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Printed/Typed Name Signature <br />.R k <br />18. •Transporter 2 Acknowledgement of Receipt of Materials <br />Printed/Typed Name Signature <br />*'"Morifti'"Dey7Y <br />19. Discrepancy Indication Space <br />20. Facility Owner or Operator: Certification of receipt of hazardous tnaterials covered by this manifest tas noted In item 18 F <br />Printed/Typed Name Signature �'- <br />