One-Time Shipment Request For Texas Waste Code Page 2
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12OTS Owner Information: (Owner or Generator of the one-time waste)
Owner Type: (Check one)
City Government
General Partnership
Corporation
Individual
County Government
Limited Partnership
Federal Government
State Government
Other:
Owner Legal Name: (If owner is an individual, print first name, last name, i.e., John Smith)
Owner Tax Information:
TX State Franchise Tax ID (11-digits):
Federal Tax ID (9-digits):
TX SOS Filing Number:
Primary NAICS Code: (5 0r 6 digits)
(North American Industrial Classification System. For a list of NAICS codes go to:
)
OTS Owner or Generator Contact Information:
First Name:
Last Name:
Mailing Address:
City:
State:
Zip:
Zip+4:
Telephone:
Ext:
Fax:
Email:
Broker or Environmental Consultant Information: (If there is no broker or consultant, leave
blank.)
Company Name:
Contact Person’s First Name:
Contact Person’s Last Name:
Mailing Address:
City:
State:
Zip:
Zip+4:
Telephone:
Ext:
Fax:
Email:
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