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• S 7-185-61-- ' Please priptior type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4 Manifest Tracking Number _ WASTE MANIFEST ` SKS j 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ORP -4LRP,1 h ; ..,.kEl-._il:TIIIA .t:� I 7't�i`.,FtI? T�.�f.�`Tt? CFS 95206 3'493 Generator's Phone: 2`t!4' 1500 6 Transporter 1 Company Name U.S.EPA ID Number ITEMS, Lids:. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address SAFETY K( E E N 'SYSTEMS. INC. l)1"ti 4,X '. U.S.EPA ID Number 172:� COOPFR, "'REEIV FtOA DENTON. TX 76208 - ? SZr7() TX tl'?'7'1033'}1 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 13.Waste Codes 1. s r:kt TE E..IQU11), il. o C ?.°TTLLPAT N F1')TTOWS )0 914. . �2 P 11 -- ELL z 2. W 3 3. 4. 14.Special Handling Instructions and Additional Information SK T 4C:K 4 S 0 9 5 5 v 3 2 5 00 0 0 37 12 81 AUT' f? r,-, '`'„F:' -,uF-,'EQffENT `r':VRi:i x. }1078 4..1471 jl,;gj, 8-`731 3x399 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments Export from U.S. Port of entry/exit: /exit: Z 11 Import to U.S. ❑ po ry Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O a rn QTransporter 2 Printed/Typed Name Signature Month Day Year Cr 1- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EP�Fp1m 8700 22(Rev..3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY