TEXkS NATURAL RESOURCE ,~~E OF CONSERVATION COMMISSION `^ ~' ~;1 P.O. Box 13087 Ixl ""' '' Austin, Texas 78711-3087 ~~~, nieace moot nr tuna. !Form tlesinnetl for use on elite (12-Ditch/ ivoewriter.l CS 3z~~~ Farm approved. OMB No. 2050 0039, expires 09/30/95 UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas WASTE MANIFEST N./ A Document No. of ] is not required by Federal law. 3. erat is Nagle and Mailing Address 'A. $t9te M~flst fJOCtxri(e'~nf+J7JtrA~rYr(~i~~ tg.. 7~ St[r:CL O .L 2 V ~ ~ ~ G. Seri AnTgrio, Texas 78028 8. State Qenerator's to 4. Generator's Phone (210 ) 792-2211 Attn: Bob DCna01l N/ 5. Transporter 1 Company Name 6. US EPA ID Number C. SiateTransporter^s !O O. Trans{7orter's Phone 7 Transporter 2 Company Name 8. US EPA ID Number £, State ransportarc. IF. Ttatlsporter's Phona ' 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stata aGtlita''s {O Covet Gardena Landfill 2093: 8611 Cove/ Road H, Fac~ity's P1mne San Aritaoio, Twee 78252 N / A. (2lit} 6fi~*~1 t1A. 11 US DOT Description (including Proper Shipping Name, Hazard Class, and ID 12. Containers T 3el Urnt f' HM Number) No. Type puantity Wt/Vol ~~~~ a. Waste Aslxatoa (Ftiallb~ Clans 9, NA 2212 PG lII 0 O 1 CM ddb ~ Y N/A E , N E b R A T O R C. d. J.Ae~iton 13earni ins sM ~13st~1Abo1i~ K.HantUing'COdasforWastesustedAbpva ~: ~ ~. A~132 15. S ecial Handlln Instructions andAdditional Information ~y ~teslllorise ~ # 31 Site : KerS~lt~3de11fi1~tl7Q6~sa1}ll9s~`rl nonhazardous ~ ,~, waste us~ the Texas Waste Co~d~s9rie4Qr). I[[ 711{ ,S~ I ST f'.V (C) ITEM 12 -Enter the number of containers for each waste and the appropriate abbreviation for type located in Subchapter A of [he TNRCC Industrial Solid Waste Rules. (D) ITEM 13 -Enter the total quantity of waste described on each line. (E) ITEM 14 - Enterthe appropriate letter from the table below for the unit of measure. G -Gallons (liquids only) Y -Cubic Vards P -Pounds L -Liter (Liquids Onlyl T =Tons 120001bs.1 K =Kilograms (F) ITEM I -Enter the appropriate TNRCC State Waste Code for each waste you are shipping. M -Metric Tons (1000 kg.) N -Cubic Meters (10) The Generator must read, sign (by hand), and date the cedification statement. It a mode other than highway is used, the word "highway" should be lined out and the a~jrQpf~C mode pad, water or air) inserted in [he space below. In signing the waste minimizp[igji~~jfy~tipyl "s~lerryQntjflfPRSe generators shipping hazardous waste who have not been exempted by statute or regulation from the duty to make a waste minimization certitica[ion ~ e also certifying that they have complied with the waste minimization requirements. (11) The manifest must be signed and dated by the first transporter in the presence of the Generator. If more than one transporter is to be used, the Generator m t o f tonal co ie for the r u i~n~`ic~•. ~ -rrl~'~tflltrl~.S 1~~irlx~~d •:lil IF ":~biu;) ~,~rrcx[r~~5t ~~tt~g'rsrli~l (12) Generator retain~~f~>;jt(gC~(ir{ Iending r@jA8[~jbl~chpll6gf41A1 the driver INSTRUCTIONS FOR THE TRANSPORTER (Please Type or Print clearly? (1) As driver of the transport vehicle, you are responsible for ensuring that all waste received by you arrives at the specified destination. (2) Sign and date the space provided, certifying the waste amounts in PART I were received for transport. NOTE: If you are unable to carry out the delivery of the shipment as speafied, dial the emergency phone numbers given in PART 1 notifying the GENERATOR. (3) Upon delivery of the shipment, the TSD Facility Owner/Operator is to sign for the shipment in your presence and fill in "date received" ' 14) Separate the yellow copy and retain for your records. Leave [he remaining copies with [he TSD Facility Owner/Operator INSTRUCTIONS TO TREATMENT, STORAGE AND DISPOSAL (TSD) FACILITY OWNER/OPERATOR (Please Type or Print Clearly) (1) The authorizetl representative of the designated (or alternate) facility's owner or operator must note in ITEM 19 any significant discrepancy between the waste described on the manifest and the waste actually received at the facdtly. (21 Enter date received and sign in the presence of the driver declaring receipt of the wastes and verifying the quantities in [he table in PART I. (3) Retain the pink copy for your records and reWrn the completed original (white) copy to the GENERATOR. ' U.S. EPAand TNRCC regulations regmrethatcopies of Uus Umfoim Hazardous Waste Manifest be retainedfora period of three(3)years in yourcompany records. Do ng(send to TNRCC unless otherwise notified by these departments. Public reporting burden for thls collection of information is estimated to average' 37 minutes for generators, 15 minutes for transporters, and 10 minutes far treatment, storage and disposal facilities. This includes time for reviewing instructions. gathering data, and completing and reviewing the form. Send comments regarding the burden estimate, including suggestions for retlucing this burden, to: Chief, Information Policy Branch. PM-223, U.S. Environmental Protection Agency, 401 M Street SW., Washington, DC 20460; antl to the Office of Information and Regulatory Affairs. Office of Management and Budget, Washington, OC 20503. Covet Gardens Recycling and Disposal Facility 8611 Covet Road San Antonio, Texas 78252 I~~ A Waste Management Company III PATRICIA DYE ~ erk Co ry Coun, rr Cpu N, lexa= G/J ~Ye _ ~ _ 4;',, BQ~Fi AN'Tt]V~VSSV >'S 7{, ?~'ZY:ri. ` °fwro ,may NPrtl, y5 Q ~ .e,~i ~ t,, w Z~,~ 11.2 rx P~aEna sa!tts5 ~~ ~~ ~,','L LG' ,.32~ 0 f ;. 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