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PI, •---int or type. I --2--� Form Approved.OMB No.2050-0039 L. M HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number W. 'ANIFEST r 1 `tr JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: "1 6.Transporter 1 Company Name U.S.EPA ID Number fan. T - C- 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Ci-EA 'frzCH ENVIRONMENTAL INC 5820 I4 kRTIN ROAD IPM111110A.LE,GA.'91 TOO USA Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. � ''1'3i'�1-Rcir z 2. MOTAL OIL SALTERS) Ll 3. ` v n,�Y `°JA AlK-1 f0 S WASTE,SOLID(USED AbSt7RI?FPJT i 4. 14.Special Handling Instructions and Additional Information ._.-.--_92d)PROFILEN_ __936)PFit;7HLE# tJ:SE C>'1.<311�'S AND C-CJ G1_�S T3+t\th'F' :- (F4t-'�FiL: i (mz:TAL FvrE-K (USI:I:'!Ae :MBENI.) c,o.l,f- . '!" •,��} '. _ `' ..-- 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 EPA Acknowledgment 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. Generators/Offerors Printed/Typed Name Signature Month Day Year 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: K Transporter signature(for exports only): Date leaving U.S.: of UJ 17.Transporter Acknowledgment of Receipt of Materials I- Transporter 1 Printed/Typed Name Signature Month Day Year a / 0 17 Transporter 2 Printed/Typed Name Signature Month Day Year F 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 Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 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 7ped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY