TCEQ   Page of  BIENNIAL REPORTING FORM FOR USED OIL PROCESSORS RE REFINERS AND FILTER HANDLERS Please return completed form to the T Q by JANUARY   Any administrative changes must be made on the T Q
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TCEQ Page of BIENNIAL REPORTING FORM FOR USED OIL PROCESSORS RE REFINERS AND FILTER HANDLERS Please return completed form to the T Q by JANUARY Any administrative changes must be made on the T Q

Q Registration A ID Name of Facility Facility Contact PersonTitle Facility Mailing Address Facility Location Address Phone Please review the above information Any necessary corrections and changes are to be m ade on the TCEQ Core Data form Please

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TCEQ Page of BIENNIAL REPORTING FORM FOR USED OIL PROCESSORS RE REFINERS AND FILTER HANDLERS Please return completed form to the T Q by JANUARY Any administrative changes must be made on the T Q




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Presentation on theme: "TCEQ Page of BIENNIAL REPORTING FORM FOR USED OIL PROCESSORS RE REFINERS AND FILTER HANDLERS Please return completed form to the T Q by JANUARY Any administrative changes must be made on the T Q"— Presentation transcript:


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TCEQ 0648 (4/2011 Page of 2 BIENNIAL REPORTING FORM FOR USED OIL PROCESSORS, RE REFINERS AND FILTER HANDLERS Please return completed form to the T Q by JANUARY 25, 20 Any administrative changes must be made on the T Q Core Data Form (TCEQ 10400). Q Registration #: A ID #: Name of Facility: Facility Contact Person/Title: Facility Mailing Address: Facility Location Address: Phone: Please review the above information. Any necessary corrections and changes are to be m ade on the TCEQ Core Data form Please complete the information as applicable: Used Oil Re refiners Report Total

Gallons Re refined: Describe Re refined Method: Used Oil Processors Report (Indicate each processing method on a separate line.) Total Ga llons Processed: Describe Processing Method: Directions to Complete Annual Report for Filters Please complete the information as applicable: NOTES: Please report total used oil filters in pounds or 55 gallon drum volumetric equivalents. Provide TCEQ Registration # for recipients. Please attach additional pages as necessary to provide complete information. If you have questions on how to fill out this form or about the Used Oil Recycling Program, please

contact us at 512/239 6832, option 2. Individu als 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. Any administrative changes must be made on the TCEQ Core Data Form (TCEQ 10400). To review s uch information, contact us at 512/239 3282.
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TCEQ 0648 (4/2011 Page of 2 sed Oil Filter Transporters Report Total Used Oil Filters Transported 55 gallon drum volumetric equivalents lbs lbs lbs SUM TOTAL TRANSPORTED Transpo rted to (Recipient Name and TCEQ Registration Number): NAME:

Q# NAME: Q# Used Oil Fil ter Storage Facility Report Total Used Oil Filters Stored 55 gallon drum volumetric equivalents lbs lbs lbs SUM TOTAL SHIPPED Shipped to (Recipient Name and TCEQ Registration Number): NAME: Q# NAME: Q# Used Oil Filter Processors Report (indicate each processing method and number of filters on a separate ine) Total Used Oil Filters Processed 55 gallon drum volumetric equivalents lbs lbs lbs SUM TOTAL PROCESSED Describe Each Pro ce ssing Method: Processing Method: Processing Method: Used Oil Handled (Generated) From Filters Total Gallons Used Oil From Filters Total

Gallons Total Gallons Total Gallons GRAND TOTAL GALLONS Grand Total Gallons A ID Number of Recipient Q Registration Number of Recipient Failure to disclose to the Commission any of the required information may result in loss of state contracts, non issuance of registration or non renewal of registration. CERTIFICA TION STATEMENT I certify that the above information is true and correct to the best of my knowledge and that I will abide by TCEQ rules governing the recycling of used oil , the collection, management and recycling of used oil filters. Signat ure: Signat ure Line Da te: Name (Type or

Print): Any changes will have to be reported on the TCEQ Core Data Form, TCEQ 10400 and/or form TCEQ 10062 and attached to this report. We appreciate your coopera tion in completing this report which is required by the Texas Health & Safety Code 371.026 and 40 Code of Federal Regulations Part 279, Section 279.57(b). Texas Commission on Environmental Quality Used Oil Recycling Program P.O. Box 13087, (MC 129) Austin, Texas 78711 3087