Environmental Quality

TEXAS COMMISSION ON

ENVIRONMENTAL QUALITY

Registration & Reporting Section (MC-129)

P.O. Box 13087

Austin, Texas 78711-3087

(512)239-6413

TCEQ FOREIGN WASTE SHIPMENT SUMMARY

F / 1

(6 - 7) (7)

Foreign Generator=s Site Address: Street City State Zip Country

Importer of Record: Name ______

Mailing Address: ______

Street/P.O. Box City State Zip Country

STATE MANIFEST DOCUMENT NUMBER / STATE FACILITY=S ID (RECEIVER) / US EPA ID (RECEIVER)
If no EPA ID print the Designated Facility Name / WASTE NO.
(TEXAS WASTE CODE)
33 / 34 / 35 / 36 / 37 / 38 / 39 / 40 / 41 / 42 / 43 / 44 / 45 / 46 / 47 / 48 / 49 / 50 / 51 / 52 / 53 / 54 / 55 / 56 / 57 / 58 / 59 / 60 / 61 / 62 / 63 / 64 / 65
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
BOX K / DATE OF CERTIFICATION
MMDDYYYY
66 / 67 / 68 / 69 / 70 / 71 / 72 / 73 / 74 / 75 / 76 / 77 / 78 / 79 / 80 / 81 / 82 / 83 / 84 / 85 / 86 / 87 / 88 / 89 / 90 / 91 / 92 / 93 / 94 / 95 / 96 / 97 / 98 / 99 / 100 / 101 / 102
H
H
H

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true, accurate and complete.

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

Prepared by: Authorized by: ______

Print Name Print Name

______

Signature Signature

______

Telephone Date Telephone Date

TCEQ-0449 (Rev 11/2005) Page 2 of 2

ADDITIONAL INFORMATION FOR COMPLETING THE FOREIGN WASTE SHIPMENT SUMMARY

If the receiver is a Texas facility, then use the ID on the manifest. If the receiver is in another state, use the proper from this table.

State Facility=s ID (Receiver) for Out-of-State Facilities

Alabama D0001
Alaska D0002
Arizona D0004
Arkansas D0005
California D0006
Colorado D0008
Connecticut D0009
Delaware D0010
Dist. of Columbia D0011
Florida D0012
Georgia D0013 / Hawaii D0015
Idaho D0016
Illinois D0017
Indiana D0018
Iowa D0019
Kansas D0020
Kentucky D0021
Louisiana D0022
Maine D0023
Maryland D0024
Massachusetts D0025 / Michigan D0026
Minnesota D0027
Mississippi D0028
Missouri D0029
Montana D0030
Nebraska D0031
Nevada D0032
New Hampshire D0033
New Jersey D0034
New Mexico D0035
New York D0036 / North Carolina D0037
North Dakota D0038
Ohio D0039
Oklahoma D0040
Oregon D0041
Pennsylvania D0042
Rhode Island D0044
South Carolina D0045
South Dakota D0046
Tennessee D0047
Utah D0049 / Vermont D0050
Virginia D0051
Washington D0053
West Virginia D0054
Wisconsin D0055
Wyoming D0056
Navajo Nation D0057
Puerto Rico D0060
Virgin Islands D0066
Guam D0075
American Samoa D0083

Foreign Generator=s Reference Number

Mexico F0061
Japan F0062
Canada F0063
England F0064
Spain F0065
Denmark F0067
Germany F0068 / Belgium F0069
Finland F0070
Netherlands F0071
Pacific Is F0072
Venezuela F0073
France F0076
Malaysia F0077 / Austria F0078
Holland F0079
Hong Kong F0080
Norway F0081
Panama F0082
Greece F0084
Peru F0085 / Brazil F0086
Off-shore beyond -
12 miles F0087
Saudi Arabia F0088
Jamaica a F0089
Italy F0090
Belize F0091 / Luxembourg F0092
Haïti F0093
Nicaragua F0094
Australia F0095
Sweden F0096
El Salvador F0097
Trinidad & Tobago F0098 / Taiwan F0099
Cambodia F0001
Bahama Island F0002
Columbia F0003
South Africa F0004
China F0005
India F0006

Texas Waste No.: Begin entering waste code in column 58. Foreign generators should use AOUTS@ as sequence numbers for eight digit code.

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

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. Administrative changes must be made on the TCEQ Core Data Form (TCEQ 10400). To review such information, contact us at 512/239-3282.

TCEQ-0449 (Rev 11/2005) Page 2 of 2