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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-pitch)typewriter.) Form Approved. OMB No.2050-0039. <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page l Information in the shaded e <br /> WASTE MANIFEST "r. ^- ' .` of is not required by Federal <br /> 3.Generator's Name and Mailing Address T014 C hL'::ATF.RR i, <br /> " 4lk'Ti'iN :A 9523.. Mgif$ <br /> '?3 6i r- ''OreB <br /> 4.Generator's Phone <br /> 5.Transporter 1 Company Name 8. US EPA ID Number <br /> tPT eil. .L'N ,Y; IPNl LAk Pi �✓c:f,•:.'.?t;s13; <br /> 7.Transporter 2 Company Name B. US EPA ID Number <br /> 9.Designated Facility Name and Site AddressGOOF i 10. US EPA ID Numberz= .� r 1 ✓T� = 9 <br /> -"AFF Y 'N LEEN ' STh MS, 1140 y <br /> !'x2.4 i C,UYe 3! CREEK ROAD <br /> DEtsjcif�. ;+f,.2;i s Z it <br /> 11A. 11.US DOT Description(including Proper Shipping Name,Hazard Class,ID 12.Containers 13. 1a. ; <br /> HM Number and Packing Group) No. Type Total Unit - <br /> Quantity I wtivol - <br /> a. <br /> WASTE; U%L AND AftSi?RCrEt1T f9L1CTUt?E . <br /> G i NO'!` RCRA REGUi.;a^,ECr ) +-� ti <br /> N <br /> E b. fix. 1 <br /> R <br /> A <br /> T <br /> R C. Rn <br /> �E ryy� "k <br /> dM2, <br /> d. <br /> 'jr�F�;r,�'1 hi >"'r6�SDYt-h�,s xiµ,a� •a�iit%� sx U;-s a ,§ �'«3 €i.4��.ym'4 i�' �x yM,�Cx�.. .,"a's- 'Z'9' j-. <br /> 15.Special Handling Instructions and Additional Information rx <br /> F:FST k: f•pltj5'i13'i2U OOQ7_ 9511-4? <br /> SM6RGk:NC' Y REST' kS00 -4td- 1'1t i ± 24 FIR ) IF UNDELIVERABLE RETURN TO GENERATOR. <br /> Sk: .CORb' AUTH I) PO USE SUBSE;1ilSENT CARRIERS: 40343, 41[333, 81681 , 32739, fI6256 <br /> SKDc�T A: 168430 B: C: B: <br /> 19. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmard are fully and accurately described above by the proper shipping name an <br /> classified,packed,marked,and labelled/placarded,and are in all respects in proper condition for transport by highway according to applicable intamational and na <br /> government regulations,Including applicable state regulations. <br /> N 1 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 1 have determined <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the presen <br /> future threat to human haalM and the environment;OR, it I am a small quantity generator,I have made a good faith effort to minimize my waste generation and <br /> the best waste management method that is available to me and that I can afford. "I <br /> Pf ted/Typed Name ,i <br /> y nature '� Month Day <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R Date <br /> A Printed/Typed Namey..,_.-.. Signatures F,::�--------- Month Day <br /> a <br /> P <br /> a 18.Transporter 2 Acknowledgement or Receipt of Materials - Date <br /> T Printed/Typed Name Signature Month Day <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> c <br /> 11 <br /> 20.Facility Owner or Operator: Certititxtion of receipt of hazardous materiels covered by this manifest except as noted in item 19. <br /> T <br /> y Date <br />