Texas Register, Volume 9, Number 66, Pages 4703-4756, September 4, 1984 Page: 4,717
4703-4756 p. ; 28 cm.View a full description of this periodical.
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TEXAS DEPARTMENT OF WATER RESOURCES '".
P.O. Box 13087. Capitol Station
Austin, Texas 78711
Please print or type (Form designed for use on elite (12 pitch) typewriter ) Form approved OMB No 2000.0404 Expires 7-31-86
UNIFORM HAZARDOUS 1 Generator's US EPA ID No Manifest 2 Page 1 Information in the shaded areas
WASTE MANIFEST Document No of is not required by Federal law
3 Generator's Name and Mailing Address A State Manifest Document Number
B State Generator's ID
4 Generator's Phone ( )
6 Transporter 1 Company Name 8 US EPA ID Number C State Transoorter's ID
I D Transporter's Phone
7 Transporter 2 Company Name 8 US EPA ID Number E State Transporter's ID
F Transporter's Phone
9 Designated Facility Name and Site Address 10 US EPA ID Number G State Facility's ID
H Facility's Phone
11A 11 US DOT Description (including Proper Shipping Name. Hazard Class, and ID 12 Containers 13 14
M Number) No Type a Unit Waste No
HM Number) No Type Quantity Wt Vol
c -
b
A
T
0
a -
C
d
J Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Listed Above
15 Special Handling Instructions and Additional Information
16 OGNERATOR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described
above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition for
traenport by highway according to applicable International and national government regulations, including applicable state
regulations Date
Printed/Typed Name Signature Month Day Year
17 Transporter 1 Acknowledgement of Receipt of Materials Date
Printed/Typed Name Signature Month Day Year
o 18 Transporter 2 Acknowledgement of Receipt of Materials Date
S Printed/Typed Name Signature Month Day Year
a III
19 Discrepancy Indication Space
c
L 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19
Ty _ Date
Printed/Typed Name Signature Month Day Year
I I
EPA Form 8700-22 (3-84) White - original Pink-TSD Facility Yellow-Transporter Green-Generator's first copy
TDWR-0311Proposed
RulesSeptember 4, 1984
9 TexReg 4717
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Texas. Secretary of State. Texas Register, Volume 9, Number 66, Pages 4703-4756, September 4, 1984, periodical, September 4, 1984; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth243620/m1/15/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.