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TEXAS NATURAL RESOURCE PTE pF, •
<br />CONSERVATION COMMISSION ~ ~ ~ ~ ~^.'r,.+wli..r~ , ~ ~,\ ~ `~
<br />P.O. Box 13087 ~ ~ ~ _ ~ 'r~v~7r x ~`I _
<br />Austin, Texas 78711-3087 /
<br />Please Or,nt or type. tFprm designetl for use on elite (12-pitch) rypewritec)
<br />Form approved. OMB No. 2050-0039
<br /> `~ UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest 2. Page 1 Information to the shaded areas
<br /> WASTE MANIFEST ~Q~YrQi ~t~° of is not required by Federal law
<br /> 3 Generator's Name and Mailing AddressITEC Mineral Gold H111 ~Mi 11
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<br /> Boulder, Colorado 80302 B. State Generator's ID
<br /> 4. Generator's Phone (303) 478-1898" ' " " ' - "' " 99908' "'""
<br /> 5. Transporter 1 Company Name 6. • US EPA ID Number ~ • ~ .. C,~State Transporter's ID 30271 1
<br /> Eltex Chemical D,rrensporter'sPnone 71
<br /> 7. Transporter 2 Company Name ~~~ ~ 8. US EPA ID Number ~, E. State Transporters ID y
<br /> 7 0 ('an5 %Ot` LC, ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ F Transporters Phone 03- 76 3
<br /> 9. Design led Facility Name d Site Address 10. ' US EPA ID Number G, State Facility's ID ' '
<br /> Eltex Chemical ~~ o to..l,::.,i~ „~ .I• ..,..lir , n~i,.t,.; Io~R~lr ~u +Irs, .
<br /> 4050 Homestead Road H. Feclllty's Phone
<br /> Houston, Texas 77028 .'' '"~713J674.'2406
<br /> 11 A. 11. US DOT Description (including Proper Shipping Name, Hazard Class; ID t2. Containers
<br />~ ~ roaial unit I-
<br /> HM Number and Packing Greup) Nd.
<br />Type puantity WI/V01 Waste No.
<br /> XX aRQ, Waste Gasoline, 3, UN1203, PGII.. DM G OUTS~~09H
<br /> D001 D008 D018 '
<br />~ (-1'016) d
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<br />E XX d.RQ, Waste Hydrobromic acid (49%), 8, J G OUTS003H
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<br />a UN1788, PGII. D002 ~,~/ i
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<br />o (~-007) (~ CyvS ~
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<br />B XX c.RQ, Waste Flammable Liquid, NOS lab pac G OUTS. H
<br /> 3, UN1993, PGIII. D001 D008 DO18 ^~
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<br /> (10.1-4~ [/'
<br /> XX dRQ, Waste Flammable Liquid, NOS lab pac HF' G OUTS003H
<br /> 3, UN1993, PGIII. D001 ~ ~
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<br /> J. Addilio~1 al qq~~~~r~I n atenals Listed Abava ~ ' ~ ~ ~ " ~
<br />(A) ~K'4Y~~ ~' ~~ ~,
<br />~ K-Handling Codes for Wastes Listed Above
<br />(A} M141 (D)..M141
<br /> ... B M141
<br /> (C) (C) M141
<br /> 15. Special Handling Instructions and Additional Information
<br /> (A) ERG #128 (B) ERG #154 (C) ERG #128 (D) ERG #128
<br /> MGY #713.674.2406 Eltex, Contact John Black.
<br /> 16 GENERATOR'S CERTIFICATION: I hereby tleclare that the contents of this consignment are lully antl accurately describetl above by proper shipping name antl ere
<br /> ciassdied. packaged, marked. antl labelled/placartled, and are in all respects in proper condition for transport by highway according to applicable imernaiionai antl
<br /> nauonai government regulations, inclutling applicable state regulations.
<br /> II I am a large quantity generator, I certity that I have a program in place to reduce the volume end toxicity of waste generated to the degree I have tletermined tp be
<br /> econpm,cally practicable antl that 1 have selectetl the predicable method of treatment, storage, or disposal currently available to me which minim¢es the present and
<br /> fuWre threat to human health and the environment; OR, it l am a small quantity generator, I have matle a good faith eflort to minimize my waste generation antl select
<br /> the best waste management method That is available to me and that I can eflord.
<br /> Prin edlTyped Name
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<br />a 17. Transporter 1 Acknowledgement of Receipt of Materials Dale
<br />a Printed Name Signal i Month Day Year
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<br />18. Transporter 2 Acknowledgement of Receipt of Materials ' ~"' "' ' ~ ~ -' ' '' ~ ~ ~ ~ ~
<br />Date
<br />i PrintedlTyped Name Signature ~ ' ~ ~ Monfh Day Year
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<br /> 19. Discrepancy Indication Space
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<br />i 20. Facility Owner or Operator: Certlflcation of receipt of hazardous materials covered by this manifest except as noted in Item 19.
<br />y Date
<br /> ted/T pad Name /~ ,. ~ ~.., .
<br />N~ ... " . Signet M n
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<br />TNRC~~0311 (Rev. 07/01/97) White -original Pirfk-TSD Facility Yellow`Transpor[er Green-Generator's first copy ~
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