MONTHLY WASTE RECEIPT SUMMARY

R / 1

(6 - 7) (7)

TEXAS COMMISSION ON

ENVIRONMENTAL QUALITY

Registration & Reporting Section

(MC-129)

P.O. Box 13087

Austin, Texas 78711-3087

(512)239-6413

Site Address: Street City State Zip

Mailing Address: Street City State Zip

STATE MANIFEST DOCUMENT NUMBER / STATE GENERATOR=S ID / US EPA ID (GENERATOR)
If no EPA ID print the Designated Facility Name / WASTE NO.
(TEXAS WASTE CODE)
15 / 16 / 17 / 18 / 19 / 20 / 21 / 22 / 23 / 24 / 25 / 26 / 27 / 28 / 29 / 30 / 31 / 32 / 33 / 34 / 35 / 36 / 37 / 38 / 39 / 40 / 41 / 42 / 43 / 44 / 45 / 46 / 47
EPA HAZARDOUS WASTE NUMBER(S)
Four character code starting with D, F, K, P, or, U (i.e., D001) / QUANTITY
Decimals must be in their own box / U
O
M / HANDLING (SYSTEM TYPE ) CODE / DATE RECEIVED
MMDDYYYY
STATE TRANSPORTER ID / STATE
TRANSPORTER ID
48 / 49 / 50 / 51 / 52 / 53 / 54 / 55 / 56 / 57 / 58 / 59 / 60 / 61 / 62 / 63 / 64 / 65 / 66 / 67 / 68 / 69 / 70 / 71 / 72 / 73 / 74 / 75 / 76 / 77 / 78 / 79 / 80 / 81 / 82 / 83 / 84 / 85 / 86 / 87 / 88 / 89
H
H
H

Quantity Unit of Measure (UOM) (All wastes must be reported in POUNDS (P), KILOGRAMS (K), OR TONS(T))

Prepared by: Authorized by: ______

Print NamePrint Name

______

Signature Signature

______

TelephoneDateTelephoneDate

TCEQ-0113A (Rev. 11/2005)Page 1 of 2

ADDITIONAL INFORMATION AND INSTRUCTIONS FOR COMPLETING THE MONTHLY WASTE RECEIPT SUMMARY

State Generator=s ID: If the generator is a Texas Facility, then use the ID on the manifest. If the generator is in another state, use the code from this table.

State Generator=s ID (Out-of-State Foreign Countries)

MexicoF0061
JapanF0062
CanadaF0063
EnglandF0064
SpainF0065
DenmarkF0067
GermanyF0068 / Belgium F0069
FinlandF0070
NetherlandsF0071
Pacific Is.F0072
VenezuelaF0073
FranceF0076
MalaysiaF0077 / AustriaF0078
HollandF0079
Hong KongF0080
NorwayF0081
PanamaF0082
GreeceF0084
PeruF0085 / BrazilF0086
Off-shore beyond
12 milesF0087
Saudi ArabiaF0088
JamaicaF0089
ItalyF0090
BelizeF0091 / LuxembourgF0092
HaïtiF0093
NicaraguaF0094
AustraliaF0095
SwedenF0096
El SalvadorF0097
Trinidad/ TobagoF0098 / TaiwanF0099
CambodiaF0001
Bahama IslandF0002
ColumbiaF0003
South AfricaF0004
ChinaF0005
IndiaF0006
STATEGENERATOR IDCESQG CODE
AlabamaD0001ALCESQG
AlaskaD0002AKCESQG
ArizonaD0004AZCESQG
ArkansasD0005ARCESQG
CaliforniaD0006CACESQG
ColoradoD0008COCESQG
ConnecticutD0009CTCESQG
DelawareD0010DECESQG
Dist. of ColumbiaD0011DCCESQG
FloridaD0012FLCESQG
GeorgiaD0013GACESQG
HawaiiD0015HICESQG
IdahoD0016IDCESQG
IllinoisD0017ILCESQG / STATEGENERATOR IDCESQG CODE
IndianaD0018INCESQG
IowaD0019IACESQG
KansasD0020KSCESQG
KentuckyD0021KYCESQG
LouisianaD0022LACESQG
MaineD0023MECESQG
MarylandD0024MDCESQG
MassachusettsD0025MACESQG
MichiganD0026MICESQG
MinnesotaD0027MNCESQG
MississippiD0028MSCESQG
MissouriD0029MOCESQG
MontanaD0030MTCESQG
NebraskaD0031NECESQG / STATEGENERATOR IDCESQG CODE
NevadaD0032NVCESQG
New HampshireD0033NHCESQG
New JerseyD0034NJCESQG
New MexicoD0035NMCESQG
New YorkD0036NYCESQG
North CarolinaD0037NCCESQG
North DakotaD0038NDCESQG
OhioD0039OHCESQG
OklahomaD0040OKCESQG
OregonD0041ORCESQG
PennsylvaniaD0042PACESQG
Rhode IslandD0044RICESQG
South CarolinaD0045SCCESQG
South DakotaD0046SDCESQG / STATEGENERATOR IDCESQG CODE
TennesseeD0047TNCESQG
UtahD0049UTCESQG
VermontD0050VTCESQG
VirginiaD0051VACESQG
WashingtonD0053WACESQG
West VirginiaD0054WVCESQG
WisconsinD0055WICESQG
WyomingD0056WYCESQG
Navajo NationD0057NNCESQG
Puerto RicoD0060PRCESQG
Virgin IslandD0066VICESQG
GuamD0075GUCESQG
American SamoaD0083ASCESQG

Generator=s EPA ID: If the generator has been assigned an EPA ID number, always provide it. If no EPA ID has been assigned, as may be the case with nonhazardous waste, provide the first 12 digits of the company name. If the generator is a Conditionally Exempt Small Quantity Generator (CESQG), provide the state postal code and the letters ACESQG@ in lieu of an EPA ID.

Example: State Generator ID number D0022, Conditionally Exempt Small Quantity Generator from Louisiana, would record the EPA ID number as LACESQG. If the waste is hazardous or nonhazardous and the generator is from a foreign country, the EPA ID must always be provided by the facility that is accepting responsibility of the waste in Texas known as the - Importer of Record (IOR).

EPA Hazardous Waste Numbers: These numbers ONLY apply to hazardous waste and can be found in 40 Code of Federal Regulations Part 261. If more than four waste codes apply, use the four that best describe the waste.

No Shipments Received: If no hazardous or Class 1 nonhazardous industrial waste was received during the reporting period, mark Box 14 on the front of this form.

HANDLING ( System Type) Codes: For reporting purposes, the Handling code selected should be for the final disposition of the waste, even if the waste is stored prior to disposal.

If you have questions on how to fill out this form or about the Industrial and Hazardous Waste Program, please contact us at 512/239-6413. Individuals are entitled to request and review their personal information the agency gathers on its forms. They may also have any errors in their information corrected.To review such information, contact us at 512/239-3282.Administrative changes must be made on the TCEQ Core Data Form (TCEQ 10400).

TCEQ-0113A (Rev. 11/2005)Page 1 of 2