One-Time Shipment Request For Texas Waste Code
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12IHW GE/_______________________/CO/
/OTS
Texas Commission on Environmental Quality
One-Time Shipment Request for Texas Waste Code (OTS)
(For Shipments of Hazardous and/or Class 1 Waste from a Nonregistered or Inactive Generator)
Part 1: Owner of Waste and Generating Site Information
Reason for Request: (Check one)
New One-Time Texas Waste Code Request
Update One-Time Texas Waste Code
Current Registration Information: (If your facility is registered with any TCEQ program,
provide the CN and RN numbers below. If your facility has an inactive SWR Number, provide the
numbers below. If your facility has an active SWR you cannot use this form; complete Form 00002,
Part II, to update your Notice of Registration.)
Solid Waste Registration Number (SWR):
EPA Identification Number:
Customer Reference Number CN:
Regulated Entity Number RN:
OTS Site Information: (Physical address of the location where the waste was generated)
Site Name:
Site Address:
City:
State:
Zip:
Zip+4:
County:
Site Land Type: (Check one)
Private
Tribal
County
Municipal
District
State
Federal
Other:
TCEQ-0757 (Rev. 01/01/2014)
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