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TEXAS NATURAL RESOURCE l~ `ETg DF • <br />CONSERVATION COMMISSION 5 ~„ <br />P.O. Box 13087 1 ~ ' I= ~ ~` ~ , <br />Austin, Texas 78711-3087 ,r ~~ <br />Please prior or type. (Form designed for use on elite (12-Pilch) typewriter.) <br />Form approvetl OMB No 1050-0039 <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST ~ ° of 1 is not required by Federal law <br /> 3.Generator's Name antl Mailing AddressI TEC Mineral Gold Hill Mlll A. State Manifest Document Number <br /> 9145 Sunshine Canyon Drive <br /> <br /> Boulder, Colorado 80302 B. State Generator's ID <br /> a. Generator'sPhone(303 ) 478-1898 99908 <br /> 5. Trait or1e7 <br />1 Compan Name_ 6. US EPA'ID~Number C. Slate Transporter's ID ,3 0771 ' ~' <br /> ~ <br />/ ~G ~ C I ~ w ( ~ D. Transporter's Phone 3 ff- f <br /> ame 8. US EPA ID Number <br />7. Trait porter 2 Company <br />N E. State Transporter's ID <br /> ~ <br />/ <br />.PU //QOS c.yq ~ P. Transporter's <br /> 9. Des~gnaled Facility Name and Si a Address 10. US EPA ID Number G. State Feclllry's ' <br /> Eltex Chemical ,. ),,, ,,, ... . 30271 .. <br /> 4050 Homestead Road H. Fecillry's Phone <br /> Houston, Texas 77028 713.674.2406 <br /> t rq 11. US DOT Description (including Proper Shipping Name, Hazard Class, ID t2. Containers To al Unu I' <br /> HM Number and Packing Group) Nc. Type puantdy Wt/VOI Waste No. <br /> XX any ..a,. nom.....:.. ..i2 o Tll.r1']A,L DF G <br /> <br /> ~• - ~/ <br />' UuTS zoa+~ <br />E chldt,!I -Sal iig.s:~F W79 p6U1 <br />wvi~ <br />E b urjol(11Yfrna;,Jr ltncrny yAantola)ikb( <br />B <br />A <br />T <br />O <br />B <br />C. <br /> d. <br /> J. Additional Descdptlons for Materials Listed Above ~ ~ ~ K. Handling Codes for Wastes Lis[ed Above <br /> CA)g8:05181 ,. .. (a) M141 <br /> 15. Special Handling Instructions and Additional Information <br /> (A) ERG #154, EMGY #713.674.2406 Eltex, Contact John Black. <br /> 16 GENERATOR'S CERTIFICATION: I hereby tleclare that the contents of This consignment are lully and accurately described above by proper shipping name and are <br /> ciass~lied, packaged, marked, and labelletl/placartletl, and are in all respects in proper condition for transport by nighway according to appLCable international and <br /> national government regulaliona, including appkcable slate regulations. <br /> It I am a large quantity generator, I certify that I have a program in place to reduce the volume antl tOxrcrty of waste generated to the degree I have delermined to be <br /> economrcalty practicable and that I have selected the practicable method of treatment. storage, or disposal currently available to me which minimizes the presem antl <br /> IWUre threat w human health antl the environment; OR, it I am a small quantity generator, I have made a good laith effort to minimize my waste generaticn and select <br /> the best waste management method that is available to me and mat I can aHOrd. <br /> Prin ed/Typed Name Sin nl r ~ pM n ,pDa}gE y <br /> <br />a 1 Z Transporter t Acknowledgement of Receipt of M lariats Date <br />a Print tl Na a Signatur Month Day year <br />rJ <br />5 <br />P <br />/~. / <br />L <br />/ <br />0 <br />B 1 . Transporter 2 Acknowledgem nt of Receipt of Materials - Date <br />T /Typed Name Si alur ~ Month Day Vear <br />R L `' iz r <br /> <br />F 19. Discrepancy dication pace <br />Q• COffCC{YC) BUTShtr~ll23 UCSG Iption..RdQul . • GUrr d Vu4S~c.. no <br />A <br />c <br />i <br />~ <br />t 20. Facility Owner or Operator: Certtflcation of receipt of hazardous materials covered by lhts manifest except as noted In Item 19. <br />T <br />~ , - ~- <br />Date <br /> In edli d Name ( ~ Signal r Month Da Ye ~ <br /> <br />TNRCC~0371 (Rev. 07/01/97) White -original Pir~c-TSD Facility Yellow-transporter Green-Generator's lust copy <br />