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----_ ---------- ----- <br /> ----- --- <br /> EXAS WATER COMMISSION <br /> O. Box 13087, Capitol Station <br /> ustin, Texas 78711-3087 '1 - <br /> :ase print or type. (Form designed for use on elke(12-pitch)typewriter.) Form approved.OMB No. 2050-0039, expires 09/3054 - <br /> 1 UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST A .6 .5 7 2 3 9 0 5 1 9 tMj of 1 is not required by Federal law. <br /> 3.Generator's Name and Mailing Address A.State Manifestc m n N r <br /> NATIONAL GUARD - OMS #24 ll 68 <br /> 0010 S. AIRPORT NAY STOCKTON CA 95206 B.State Generator's ID <br /> 4.Generator's Phone(209 ) 932-4416 , 99906 <br /> 5.Tra NS I N m r 1 State Transporters ID <br /> W110 ��Y IUCOVERY SERV. A D P 3 5 8 9 D.,TransportersPhone 310-427-7277 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number E.State Transporters ID <br /> . F. Transporters Phone <br /> 9.Devinr d FeG�I�and Site Address 10. US EPA ID Number G.jdj5 Zacility's ID - <br /> 4050 HOMESTEAD ROAD 33U11// <br /> HOUSTON,TX 77028 T ( 0 0 7 4 1 9 6 3 .3 ..8 H.Facility'YM-1674-2406 <br /> 11A. 11.US DOT Description (including Proper Shipping Name, Hazard Class, and ID 12.Containers Total13. 14 Unit 1. <br /> HM Number) No. Type Quantity Wt/vol Waste No. <br /> HAZARDOUS WASTE SOLID, n.o.s., 9 NA 3077 0007 <br /> G III (DO07) (CHROMIUM) JD M !ad, P OUTS310H <br /> 1 <br /> r <br /> 1 c. <br /> d. <br /> J.Addif nal io f ti 4K. andling-Codes for W stes Listed Above <br /> Jia �� t �� �t �1(ISTERS <br /> C D <br /> 15.Special Handling Instructions and Additional Information <br /> EMERGENCY CALL CHEMTREC 1-800-424-93CO ** BILL TO ENVIRONMENTAL RECOVERY SERVICES <br /> USE PROPER SAFETY EQUIPMENT ** EMERGENCY GUIDE 3 31 <br /> 16.GENERATOR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are <br /> classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national <br /> govemment regulations,including applicable state regulations. )y. <br /> 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 <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 heaffh 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 Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials -1 Date <br /> A P' ted/Typed Name / Sign re '� Month Day Year <br /> Na ! a z / f 7/ I r+./ <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials FF)FDate <br /> A Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> A JAN 2 5 1995 <br /> c f <br /> I ,. <br /> L20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as'V1 <br /> oted Item 1 <br /> I NVIRONMEinN AL199 Date <br /> T nrMAtT1QMi.11= -C <br /> v <br /> Printed/Typed Name Signature � Month Day Year <br /> ��� <br />