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QIR <br /> JEXAS WATER COMMISSION i— : <br /> P.O. Box 13087, Capitol Station <br /> Austin, Texas 78711-3087 <br /> Please print or type. (Form designed for use on elite(12-pitch)typewriter.) <br /> Farm Approved.OMB No.2050.0039 Expires 9-30-94 <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No, <br /> WASTE MANIFEST 2. Page 1 information in the shaded areas <br /> . . ),0}11 of is not required by Federal law. <br /> 3. Generator's Name and Mailing Address , i r .1 1 ,•--r yI s.� <br /> �r13 A. StateManifes9ocum�entNumber <br /> :!C 1r+n!r.^„7 ' r UC 1TI7 SCJ <br /> 11 State Generator's ID <br /> 4. Generator's Phone( 209 ) 466-9.5.,t) <br /> 5. Transporter 1 Company Name >39Ct�. <br /> 6. US EPA ID Number C. State Transporter's ID <br /> jAFETY—ximop . tLu gd4SUo2G? <br /> 7. Transporter 2 Company Name D. Trans orter's Phoner'• <br /> 8. US EPA ID Number E. State?rens orter's ID <br /> F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's.ID <br /> -- <br /> .i722 C:7cjPQA .,xcex <br /> H. Facility's Phone. <br /> ."feloty Tx 7o�od Tx„ C)74C5571 017 <br /> 11. US DOT Description(Including Proper Shipping Name, Hazard Class and ID Number 12. Containers 13. 14. i. <br /> G HM. ) Total Unit Waste No. <br /> No. Type puanti Wt/vol <br /> N ..,.. ..„ F,-- Tj <br /> .., <br /> A sil 27) , <br /> T b. <br /> R 9 do -- <br /> i <br /> C. <br /> d. <br /> J. Additional Descriptions for Materials Listed AboveHHandllngCodm Listed Above. <br /> 11=a, 223,D001,tr118 <br /> 15. Special Handling l nstructions and Additional Information ��. <br /> 7-1d5'ul— 311;3 <br /> FF 4— 112. : 1rFu 2%1335/Oi?03i >-3 i1�.3; =L� u _49-2 <br /> EPttRG RESPA70d-888-4800 �4NR et TLA <br /> FCR RECYCLE SNOUTA A : 0003004u - 3001231 c: <br /> 16. GENERATOR'S CERTIFICATION'I hereby declare that the contents of this consignment era fully and accurately described shove by proper shipping name and are classified, <br /> Packed.marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicityof waste generated to the degree I have <br /> determined to be economically practicable and that I have selected the practicable method of treatment,strage,or diposal currently available to me <br /> which minimizes the present and future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith <br /> effort to minimize my waste generation and select the best waste management method that is available to me and that I can Afford. Data <br /> �.,Printed{Typed Nana Signature -• / Month Day . Year <br /> v' / 4X IV/GHo45O/V 1 ��� <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials _ <br /> Date <br /> A __Frio eoRyped.Narne r <br /> N , ,y 3 Signature s ✓J r�:j Month Day year <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials x ! .y J <br /> R Date <br /> T Printetl/Typed Name Signature Month Day Year <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> T 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printecirryped Name Signature <br /> Month Day Year <br /> EPA Form 8700.22(Rev.9-88)Previous edition is obsolWhite-original Pink-TSO Facility Yellow-Tran <br /> TWC-0311 (Rev.01101/89) 1 ACC Green-Generator's first copy <br /> .ra.. <br />