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Please print or type. (Form designed for use on eli e (12-oltch) WDewriter.) -- EPA Form 8700-22 (Rev. 3-05) Previous editions are dbsolete. GENERATOR'S INITIAL COPY 4i '. - 3773 3 ) 4002-0111' 12243 4 ) 4,000" A , 18.. *2' .'� 40,02131 / 1 11 -t:ll UNIFORM HAZARDOUS WASTE MANIFEST 1 1. Generator ID Nu bar 27age 1 of 3. Eme, Response Phone �ency R " 6 4. " �' 0 61210-01 - � a 4. M 'fest Tracking Number I b02810807 SKS- 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) MC i� i_ I I L AT. PFL01-4 JRP. i 747 E MARTIN LtiTHER q. � iING 'N C 11 9 5x.:.35 Generator's Phone: 6, Transporter 1 Compapy Name . , U.S. EPA ID Number T TXol- 000550-330 1 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address '-'FETY-i4LECFN -4J T NC. �14,ES�ID Number %V1 COOPER. R -1--K I e. 0 C, ."-RM 'i:,"TON, t TX 76208 TXM77603371 Facility's Phone: 9a. 9b. U.S. DOT Description (including Proper S ipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. 1 -HP, Af. ..OAINT RELP'TED MATERIALS FiD@3 F01k)5 1001 ? t.UNI,26- T I (T, Qt Del:_: 5 21, UTS sM1 /s dr rJSlG� Z UJ T. 2. RC I-JN1--" R-OwIMASJE S; 13LI.D.3, "An F Q 0-3 F005 010 1 op's"'IN -1c., �4. 0. S. (PA NT RELOTED MATF P Tilt S I 0 3- -332 PUTS 153 T T rl, L .. e 4.1 P ( P 4e ' f 3.al RQ UN2794 wf�isl,E BA'f "R"ES. WE. FILLED I E I D002 Ell 0 0 a t WITH ACID (LEAD, SULFURIC 'ACID) OUTS rtr 8, P G 11 0 02. 1 D V, 0 i9: "NON RCRP 4AS-1'7 SOLID OUTS (ABSORSENT AND OIL) el 4 14. Special Handling Instructions and Additional Infor n1ation SK 'SHIP#20493C-057 54077GGS ,7 1,236 _�3) E 2'4 HR 01- 0 L '54-. 8-1760 (SAFETY-KLEEIN - CONTRACT V�4138) _F 4 -.14-7 1. 9 16 5:399 �-NT'QARPTFRS!41071 it]. A -73q.8 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, y marked and labeled/placarded, and are in all res rope condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary ctn proper Exporter, I certify that the contents of this consign ent conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement idepfied In 40 CFR 262.27(a) (if I am a large quantity generator) 7(b(if I am a small quantity generator) is true. Gen ors/Offeror Printed/Typed Na rV Signature I Month Day Year Itis -J16. F-- International Shipments El import to u. El Export from U.S. Port of entry/exit: 9 Transporter signature (for exports only): Date leaving U.S.: LW17. Ll Transporter Acknowledgment of Receipt of Materials Transporter Pni-ted/Typed Name,., Signatur Month D , ay Year 0 CL Z Transporter 2 Printed/Typed Name Signature Month Day Year 18. Discrepancy 18a, Discrepancy Indication Space El Quantity El Type ❑ Residue Partial Rejection El Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number LL Facility's Phone: LU 18c. Signature of Alternate Facility (or Generator) Month Day Year 0 u, 19. Hazardous Waste Report Management Method Cods (i.e., codes for hazardous waste treatment, disposal, and recycling systems) W 1 2. 3. 4. 20. Designated Facility Owner or Operator: Certification if receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(iyped Name -7 Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are dbsolete. GENERATOR'S INITIAL COPY 4i '. - 3773 3 ) 4002-0111' 12243 4 ) 4,000" A , 18.. *2' .'� 40,02131 / 1 11 -t:ll