NCD122263825_19870914_JFD Electronics - Channel Master_FRBCERCLA SPD_Hazardous Waste Manifests-OCR

I
E
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D o l
Form A
2. Page 1
of
Bureau of Solid A Hazardous Waste Mgt
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88 ·
Information in the shaded areas is not
required by Federal law, but is by State law.
3. G~:~~~~•~:;~~~ing Address 1:1;;:~~\~ :li::l1I:)11l:i:,
r'"-· "'-:"'."'~'"-'""'~"';f_,s'-'!-"~"o:e,e:..1...1 _4_,_!..,!-'9:..J.s_m_9,,_i=-~"'~-=-'!'-';"i'-f"--• _N_c_2_1_5_1_1--------------1Fc•~+J,;~;;;,,,~:~~~;;::f '.f;'.;'f '';1':;ii'S:1'.~1~)z: !~}
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255.
Pinewood SC 29125
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name. Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Untt ,'l,\Wall~ifr
No. Type· 'MNrJ. ?£W{kbM:fH)4)}£\f{
a.
b.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 l D T
~~~1~:~!:~:,~~Jj/~~~i~-!~~i~~~1i;~:i~i1il~r~!i~~!~i!!!liif 1Eii1
a.lE..Jlij-!012171714i-ild10121\tnz!h;!i!0·l..J.J-I I I I I 1-1 I I I lw
b:.~.::L .. I 11llll~!ll:!ll~;W:J ,,,,J ..... • tJ' ,, .... ,L.Jl!11
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72183
1 e. GENERA TOR'S CERTIFICATION: I hereby declare that the conlents of this consignment are lully and accurately described above by proper ahlpplng nam• and are cla..,lled,
packed. marked, and laheled. and are In all respects In propercondlllon for transport by highway according to applicable international and national government reoutation1 end
!he laws of the State ot Soulh Carolina.
111 am a large quanlily generalor, I certify that I hiiva a p~ogram In place lo reduce thavolume and to:dcllyol waste generated tothedegree I have detarmined to be economically
practicable and that I have selected the practicable method of treatment. storage, or dlspoaal currently avol1ab1e to me which minimizes the preaent and future thr-1 to human
health and the environment; OR, 111 am a small quantity generator, I hove made a good lalth eNortto minimize my waste generation and select the beat waate management method
that is available to me and that I con aNord.
Printed/Typed Name ROGER L COAT$
17. Transporter 1 Aca<nowledgement ol Receipt of Materials
Printed/Typed Name , /. /,f <,.,., , /912.,£--:5 2>017/// ,_,,J! _ye,,/TI ···
18. Transparter 2 Acknowledgeme'nt of Receipt of Materials
Printed/Typed Name
19. Discrepancy Indication Space
Signature Month Day Year
0 s, / i./ J",
Month Day Year
1/lr/
Month Day Year
8 .._! ....._...__........,!Iba. c LI L..L..1...1...J..J!lba.
b I pbs. d I pt>s.
20. Facility Owner or Operator, Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
South Carolina Department of Health
and Environmental Control
E PRINT or TYPE {Form des! ned for use on elite 12· itch writer
UNIFORM HAZARDOUS 1. Generator·• U.S. EPA ID No.
WASTE MANIFEST N c D
Form A
2. Page 1 of
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30·88
Information in the shaded areas is not
required by Federal law, but is by State law.
1 G;h~~~~~a~;~~ ~a;ing Address ~i,;,t=:;~:{fjt"8W7~@:~'f~{~~J§~
.:;'·c;G::;~:::~:::e::r~:;:IO::..r::.•:...!h:::OO:;;::::e.,_1_4_·~'-6"-l"--9__,_s_m..,!"~'-~'-:--"-!-'-;-'i..,f~·-N_c __ 2_7_5_7_7 ___ ---'-__________ +·•,.,~+~;~~t~!~'yz~,~~(·:-:''l;'\)l~{!~;f'.~-;~
5. Transporter 1 Company Name 6. U.S. EPA ID Number
Willms Truckin Co Inc. SC DO 7 3 7
7. Transporter 2 Compan_y Name 8. U.S. EPA ID Number
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
11. U.S. DOT Description '(including Proper Shipping Name, Hazard Class, and 10 Number}
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72184
16. GENERATOR'S CERTIFICATION: I hereby declare that !he conlents of this con•lgnmanl are tully and accurately described above by proper shipping name and are cluaified.
packed, marked, and la'beled, and are In all respects In proper condition tor transport by highway according to applicable international and national government r~ulat!ona and
the laws ol the State ol South Carolina.
If I am a large quantity generator, I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be ec:onomlcalty
practicable and that I have setected the practicable method ol treatment storage, or dlspoaal currently available to me which mini mites the presenl and future threat to human
health and the environment OR, Ill am a small quantity generator, I have made a good lailh effort to minimize my waste generation and select the beat waste management method
that la available to ma and ti:,at I can afford.
Printed/Typed Name RO.GER L. COATS
T 17. Transporter l AcKnowledgement ol Receipt of Materials
Print~T yped Name
,{/0,qoz/4
18. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name
19. Discrepancy ln~ication Space
Signature
Signature
Signature
20. Facility Owner or Operator; Certification of receipl ol hazardous materials covered by this manifest except as noted in Item 19.
,,-1. Printed/Typed Name Signature . . . 1 .
EP.A, Form,.e~~~i~,?i_(B,~v;,~f,86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
• ' • ...... --~ --♦--~-•• • ·-
•I .............. .,...
b lu...L..L.l...J.
Month
Month
Month
!lbl. e I
pt,,. d I
Month
Day
Day
Day
Year
P.7
Year
Year
!lbl.
pbs.
Year
South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desi ned for use on elite 12· itch writer
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N C D O 7 l
Manlreat
Document No.
0 0 1
Form A
2. Page 1
of
Bureau of Solid & Hazardous Waste MQ't
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 E.t ires 9-30-88
lnlormalion in the shaded areas is not
required by Federal law, but is by State law.
f-=4"-. .o:::•:::~".r"'~"to::..f:.•.:.!:..c~o"~"•:..,._
1
_
4
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2
_
7
_
5
_
7
_
7
_______________ ...,f;:;tilt/~ft!ff:ifi1i1\!~~;it~[JZffj~,,!~}t\::
5. Transporter 1 Company Name 6. U.S. EPA ID Number
Willms Truckin Co Inc. SC DO 7 3 7
7. Transporter 2 Company Name 8. U.S. EPA 10 Number
9. Designated Facilify Name and Site Address
GSX Services of SC, Inc.
Route, I Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
SCDO7O
11. U.S. DOT Description (including Proper Shipping Name, Haza.rd Class, and ID Number)
a :NfF'';O'!i~'9t~ Hazardous Waste, Solid, nos ORM-E ~ l-.!:N~A2_9~18~9:._ _____________________ _j_J....L'.l+D...1:.T-I-.L.L~2:..1'.:0+.:y--12i[jll:, ::f::' O~• 0::::1 6::•~1::;if
6 ~b-. ----------------------------------J-...L-1-jc_L-!-.L..L-1-L-!---l,,:+i,!:';;;~,,:;:~:.:..~; ,:;:..::~~;;;• ...... ·;j;.,;;;.~:~;:~·
T
ii'.! "j-~';'··~-,,,it:
d, , I I ,W: ,· ......•....•. Jt
C.
d. :¥:·~"f'f1'"1i
g·'f.
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 72185
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents ol this consignment are fully and accurately described 11bov• by proper •hipping name and are clas~flect
packed. marked. and le°beled.and are In all respects in proper condition lor lranaportbyhlghwoy according to applicable lnt1unalionel and national government r9Qulatlons •r'ld
tho laws ol tho State ol South Carolina.
111 am a large quantity generator, I certify that I have a program In piece to reduce the volume and to:icicltyol waste generated to the dog,_ I have determined to be economM;.ally
practicable and that I have selected tho practicable method ol treatment. storage. or dlspoaal currently available to mo which minimizes tho preaont and lutur• throet to nunwan
health and tho environment OR. II I am a small quanlity generator, I have made a good faith effort to minimize my waste generation and aelecl tho boat walle management method
th.al la available to me and that I can afford.
Printed/Typed Name RO.GER L. COATS ~ ~ Month Day Year
0
17. Transporter 1 Ac.:1mowledgement of Receipl of Materials
Printed/Typed Name · -,;J J -, /J7n~S, . JJ-1, X---' {) . (). ~ ."::,__
, 8. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name Month Day Year
19. Discrepancy Indication Space
I I !lbL CI jibs.
b I libs d I libs
20. Facility Owner or Operator. Certilicalion of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86))
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull S•ee\ Columbia, SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N c D
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generatofs Phone [phone]
5. Transporter 1 Company Name·
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3
8. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
a.
Emergency & Holidays: [phone]
. Form A roved. 0MB No. 20S0-0039 Ex ires 9-30-88
2. Page 1 Information in the shaded a,eas is nol
of required by Federal law, but is by Stale law.
Hazard~us Waste, Solid, nos ORM-E
N NA 9189 l D T 2 0 Y
b.
C.
d.
~~~;t:~f;~,~il~i~!1~l;~~~!-!1i:1$;\~;;!!i~,!if i;;;;~~'t!%fl!l;;1,;!l11'.l1~ii1:~~i~
a.lE..ili.J-10,2r7r7r41-11,lrOr2hU;i1!\i,ti:c.LLJ-1 , , , , 1-1 1 , , lit,
b W=.l.. !c-1 .... 1~ll'!i~:·~111t~b!d::J,} ... , .. L .. L. •. LJ:J Jtlf
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72186
16. GENERATOR'S CERTIFICATION: I hereby declare that the content• of this conaignment are fully and eccuratillydoacribed above by proper ahlpplng name and are clasaill.,,
packed. mark9d, and la"beled, and are In all respecta In proporcondlllon forlranaport by highway according lo appllceblo lnlernallonal and naUonal government r.gulatlona arid
U'la laws ol lho Stale ol South Carolina.
111 am a large quantity generator, I cer1ity that I have a prc,vram In place to reduce the votume and toxicity of waste generated to the degree I havo determined to be ec:onomlcalty
practicable and that I have selected the practicable method ol treatment, storage, or disposal currently available to ma which mlnlml.te• the preNnt and future tnroal IO l'luman
health and the environment:OR, Ill am a small quantltygenorator, I have made a good lalth effort lo mini mite my waste generation and select the beat waate managemanl method
that 111 available to me and that I can &Hord.
Printed/Typed Name RO.GER L COATS Signature
17. Transporter 1 Ac.:..:nowledgemenl of Receipt of Materials
Signature~
Receipl of Materials
ame Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certiftcalion of receipt of hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature
EPA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
Month Day Year
a ~I ......_.....,_._.!lbs. c 1 ....... .._._~_,pbs.
b I !lbs. d I !lbs.
Month Day Year
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bulr"Street. Columbia. SC 29201
Phone: [phone]
E PRINT or TYPE (Form desi ned for use on ellle 12-itch writer
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N c D
3. Generator's Name and Mailing Address
Channel Master
P. 0. B_ox 1416, Smithfield, NC 27577
Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
CSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
L
Form A
2. Page 1
of
Emergency & Holiday,: [phone]
roved. 0MB No. 2050-0039 E.x ires 9-30-88
lnlormation in the shaded a,eas is not
required by Federal law, but is by State law.
12. Containers 13. Total Quantity 14. Un~ .,.l,fwastu'tifumberf½
No. Type WtNd. \;;;;:,::~~fr<<tXi;.b~·~t~
Hazardous Waste, Solid, nos ORM-E
N NA 9189 1 D T 2 0 Y
b.
C.
d.
,~\~i~ij~ilill1iii1iiiiiiil~lflt~1i1;ii~1,liiiliiaii
a.lf..Mj-l012171714l-llJ11012L•})(!;1i!';ii:<<-LLl-l 1 1 I I 1-1 I I I P;i
b-w:-:1 _ 1-1 1 1 1_J~ll1.iti\:,illdw-1 __ 1 __ 1 1 _11-1_1,,1 1,_1~i
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72187
, 6. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this cons!Qnment ere fully and accurately described abOve by proper ahlpp!ng name and are classifi.ct.
packed, markod, and la.baled, and are in all respects in proper condition !or transport by highway according to appUcabla International and natk>nal government re,gulatlons and
tna laws ol the Stale ol South Carolina. ·
If I am a largo Quanlity generator, I certify that I have a program In place to reduce ttut volume and toxicity of waate generated lo the d90ree I have determined lo be econom~lly
practicable and that I have ■elected the practicable method of treelment, storege, or dlspo-1 currently avalleblo to me which minimize• the preMnl and future th,_, to human
heellh and !he environment QA, 111 am a small quantity ganara\or,1 have made a good faith eHor1 lo minimize my wastegenerallon and select the beat waata management method
trial la available to me and that I can atford.
Printed/Typed Name RO.GERL COATS Signature
ent ol Receipt ol Materials
Printed/Typed Name Month Day Year
19. Discrepancy Indication Space
• I libs. C I .11bs.
b I pbs. d I pbs.
20. F acitity Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted in 11em 19.
Printed/Typed Name Signature Monlh Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desi ned for use on elite 12-itch writer
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D O 7 6 0
Manlfeet
Document No.
0 0 1 8 5
Form A
2. Page 1
of
Bureau of Solid & Hazardous Wa,te Mgt
2600 Butt Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays; [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded areas is nol
required by Federal law, but is by State law.
l Generator's Name and Mailing Address
Channel Master -~;1;1;:~:,yt~Mt~~~ttii:=::::~r~:~:0:ti:~~~1:i;!:f J~~;~:
P. 0. Box 1416, Smithfield, NC 27577
4, Generalo(s Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72188
IS~tl~J.t!r~:J;}~itJ~tii~!~;~l,t~ftI,~t:
1 D T 2 0 Y
i~'/t'Yo111v,1~
11, r 1 a , a, 6 1;i
1 6. GENERATOR'S CERTIFICATION: I hereby declare that the contents ot thlsconslgnmentarefullyand accurately described above by proper shipping name and areclasaili.-d.
packed, mark&<:!, and 1a·beled, and are in all respects in proper condition tor transport by highway according to appUcablo lnt1unational and natlonal government r9Qulatlona and
the laws ol the Stale ol South Cnrollnn.
111 am a lerge quanl1ty generator, I certify that I havo a program In place lo reduce the volume and toxicity ol wastegenaraled to the degree I have determined lo be economic.ally
practicable and that I have selected the practicable method of treatment, storage. or disposal curranlly available to ma which minimizes Iha pros.ant and future tti, .. 110 human
health and tho environment; OR, ii I am a small quantity generator, 1 have made a good faith ettort lo minimize my waste generation and select the be1t waata management method
mat is available to mo and that I can attord.
Printed/Typed Name
Printed/Typed Name Signature
, 9. Discrepancy Indication Space
20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by this manifest except as noted In Item i9.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)!
Month Day Year
Month Day Year
a c.l .L..L-'-'---"--'!lbs. c .._! .L..L-'-'-_,_,i'bs.
b I !lbs. d I !lbs.
Month Day Year
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street Columbia, SC 29201
Phone: [phone]
· UNIFORM HAZARDOUS 1. Generator's U.S. EPA 10 No.
WASTE MANIFEST N c D o 7 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato(s Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
a.
Emergency & Holidays: (803)734-5-424
Form A roved. 0MB No. 2050-0039 E.x ires 9·30-88
2. Page 1 Information in the shaded a<eas is nol
of required by Federal law, but is by State law.
:~1{~~~~~,:~'.;!~:~~:~:f'.\t~(;~~~~~:~~f=
lliliii~i~&fl~Jl!titl:ii~~i~t~~:ij:i)I~Wl~t~£~~~::tM
Hazardous Waste, Solid, nos ORM-E
N NA 9189 l D T 2 0 Y
b.
C.
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72189
16. GENERATOR'S CERTIFICATION: I hereby declare Iha! the contents olthis consignment are fully and accurately described above by proper ehlpplng name and are cla-,li~.
packed, marked. and 1Dbeled, and are in all respects in proper condition lor lransport by highway according to applicable International and naUonal government r9gulation1 and
tho laws ol lha Stale of South Carolina.
II I am a largo quanlity generator, I certify that I have a program In piece lo reduce the volume and toxicity ol waste generated to the degree I have determined to btl economlcally
practicable and that I have selected the practicable method of trealment. storage, or dlspoaal currently available to me which minimizes tho present and future ~r-1 to human
health and the environment: OR. II tam a small quanlity generator, I have made a good laith effort to minimize my wa:,,te generation end select the beat wa1te management rnelhOCI
tt,at is available to me and that I can afford. ·
Printed/Typed Name Signature
17. Transporter 1 Ac.:,mowledgement of Receipt of Malerials
Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification ol receipt of hazardous malerials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature
EPA Form 6700-22 (Rev. 9/86) Previous Edition! are Obsolete [DHEC 1988 (Rev. 10/86)]
a lu...Ju...J--'
bJu...~.......,
Month Day
0
~
Month Day Year
jlbl. C I jib!.
jibs. d I !'bl.
Month Day Year
I South Carolina Department of Health
and Environmental Control
E PRIHT or TYPE (Form desi ned for use on el/le 12-itch writer Form A
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7 6
Manlfe•t Document No. 0 0 1 8 7
2. Page 1
ol
1 Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
Generator's Phone 9 1 9
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX_Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
C.
d.
t,:.~~~~;~~~;~::!l~fi!:t!/!~'.~i!!il;:J\'l;'if!:1B'.:i11!j11~t!l\1~1:\\11!~P:tii~ifj!l!1!i~~!~ll'11~~
a.ltM.]-!012171714!-!1'11012hj;/f-li/;icLLJ-I I ) ) I !-! I I I bi
b. w...J-1 1-1 .... ti~:0;::Jl41:l~w~1 , ..... -.. tJ ,_ , ., __ 1I(~
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 72190
Bureau or Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 E.x: ires 9-30-88
Information in the shaded &<eas is not
required by Federal law, but is by State law.
1c,, GENERATOR·s CERTI_FICATION: I horabydeclarethal the contents of this consignment are fully and accuratolyda1crl~ above by proper ahlpplng nama and are cla..,.lled,
packed. marked. and labeled, and are in all respects in proper condition tor transpor1 by highway according to applicable lntarnat!onat and national government r--.iutatlona al'\d
U'la laws of tho State ol South Carolina.
If I am a largo quantity ganoralor, I certify thal I havo a program in piece to roduca the ¥oluma and toxlCltyol wastaganou1tod tothadegr-I have delormlned to be oconomlcalty
proclicable and that I have solected the pracucablo melhod of treatment. ,tor age, or disposal curronUy available lo mo which mlnlml:tos !ho pu,-.enl and future lhr-1 to hum.an
health and the environment: QR, II I am a smol1 Quantltygeneralor, I have made a oood loith orfortto minimize mywas\o oenerallon and 11elect tho best waste monaooment me!J'\Od
that is available to me and that t can arford.
Printed/Typed Name RQCER L COATS
Signature Month Day
89{
T 17. Transporter l Aumowledgement ol Receipt of Materials
Printed/Typed Name ~ /o"'-' Y #-/4.
Signature Month Day Year
0 9;<1,t1
18. Transporter 2 Acknowledgement ol Receipt of Materials
Printed/Typed Name
19. Discrepancy Indication Space
Signature
a I._._.,__,_...__.
b I._._.,__,_...__.
11---------------T 20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
EPA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86)]
Month Day Year
jibs. C I pbs.
P"'-d I jibs.
Month Day Year
I
T
I T
South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desi ned for use on elite 12-Itch writer Form A
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o
Manifest 2. Page 1 Document No. of 1 4 0 0 1 8 8
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia. SC 29201
Phone: [phone]
Emergency & Holiday~ (803)734-5'24
roved. OMS No. 2050-0039 Ex ires 9-30-88
Information in the shaded Meas is not
required by Federal law, bul is by State law.
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
Generator's Phone 9 1 9 9 3 4-9 711
~j~~~::~t~Mtf~t~::;:::'.lf~~~;;~:~~;:~~tWi:~:~i
:t1~~t~Y:1it1i:f~~~;t:\tl;;~f n\t~i~-'.~:tJ::;\J:
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and JO Number)
a.
e.
d.
f~~,~j~~~;~:~i~i:~ii,1;l:i~i~~~~i~~~i::a;1,1::~li::[:ilii;:~i~!:l~,~f ii~~i a.1.E.MJ-10,2,1,1,41-11,1,o,21;;;-2;;c::c.u.J-1 , , , , 1-1 , , , l:w
,,,ifii
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72191
16. GENERATOR"S CERTIFICATION: 1 hereby doc1are that the contents ol this consignment are fully and accuratelydescrlbod above by proper ,hipping name and ar• clanilied.
packed. marked, and ta°beled,and are ln an respects In proper condition tor transport by highway according to applicable lnlarnatlonal and natlonal govemmenl regutatlon1 and
the laws ol the State ol South Carolina. ·
111 am a large Quantity generator. I certify that I have a program In piece to reduce the volume and toxicity ol waate generatod to the degr-1 have determlnod to be economically
practicable and lhet l have selected the practicable melhod ol treatment. storage. or dlsposal currently available to me which minimizes the presant and luture thr-t to human
health and the environment: OR. II I 8m e small Quantity generator. I have made a good faith el'lort to minimize my waste generation and select the be1t wa1ta managamanl method
thal is available to me and that I can afford.
Printed/Typed Name Signature ~ G,"{_,-1,. Month Day Year
KOGER L COATS CJ f'7
l 7. Transporter 1 Ac.amowledgemenl of Receipt 01 Materials
Printed/T / Signature #g"r I 1) 0
18. Transporter 2 Ack wledgement of Receipt of Materials
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
a I Jib!. CI Jib!.
b I pbo. d I !lbs.
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted In hem 19.
Printed/Typed Name Signature Month Day y..,
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgl
2600 Bull $tree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holiday~ [phone]
E PRINT or TYPE (Form desi writer Form A roved, 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N C D O 7 6 0 1
Manlleat 2. Page 1
Document No. of 0 0 1 8
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
CSX Se~vices of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Cfass, and ID Number)
a.
12. Containers
No. Type
Information in the shaded au1as is not
required by Federal law, but is by State law.
13. Total Quantity 14. Unil ,.(/WISIIINl.imbeii0
'MN~ ·:>;?:':t;\\;:;;>;.;0.;::d/\;'
Hazardous Waste, Solid, nos ORM-E
N NA 9189 1 D T 2 0 Y
l~~~'-F-:(ff~::,fj9~;~~
~d1F101Q161:qf
b.
C.
d.
15. Special Handling Instructions and Additional Information
CSX Work Order No.: 72192
115. GENEFIATOR•s CERTI_FICATION; I horoby declare Iha! !ho conlonls olthis con111lgnmanl are lullyend accuratelydescribed above by proper shipping n•m• and •r• cla•••lled.
packed. marked, and labeled, and aro In all respects in proper condition for transport by highway according lo appllcablo lntornat!onal and naUonal governmenl ra,gulatlon• and
U'la laws ol the State ol South Carolina. ·
111 am a largo quantity genora1or, I certify that I have a program In placo to reduce thavolumo and toxicity of wasteganarated tottiadogroe I have dalormlned to b4 economicany
practicable and that I have selected tho pracUcabla method ol treatment. storage, or dlapoaal currently available to me which minimizes the present and future thre.at to human
health and the environment;OR, If I am a small quantitygoneralor, I have made a good lalth etlortlo minimize my waste generation and select the beat waate managemantmeltlOd
that is available lo me and that I can afford.
Pri_nted/Typed Name RO.GER L COATS Signature -~ d,~ Month Year
\...-()
17. Transporter 1 Ac;Knowledgement of Receipt of Materials
Printed/Typed Name Sign8.lure '\ Month Day Year
• .,,,;!11)1-, ' . ·, 'i 's, I' . ., ,,: 1.._1 t,<-; ..:,r,,...__;1, •.• ~ •• " ;-::,,j,·). '.:.,_,,,,·' "¾.cr,.._-.,._,-'.~ _, , I
18. Transporter 2 Acknowledgemenl of Receipt ol Materials '\
Prinled/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
a I !lbs. 'I jibs.
b I Jlbo. d I jibs.
Facility Owner or Operator; Certification of receipt of hazardous malerlals covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 6700·22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1986 (Rev. 10/86)]
I South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desi
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
writer
1. Generator's U.S. EPA 10 No.
N C D O 7
P. 0. Box 1416, Smithfield; NC 27577
4. Generator's Phone 9 I 9 9 JI, -9 711
Manifest Document No. 0 0 1 9
5. Transporter 1 Company Name
Willms Truckin Co Inc.
6. U.S. EPA 10 Number
S C D O 7 3 7
7. Transporter 2 Company Name 8. U.S. EPA 10 Number
9. Designated Facility Name and Site Address 10. U.S .. EPA ID Numbel'
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125 SC DO 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
a.
Form A
2. Page 1
ol
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Hondays: [phone]
roved. 01.48 No. 2050-0039 Ex ires 9-30-88
Information in the shaded a<eas is not
required by Federal law, but is by Stale law.
~!(\\:f ·!Hf Tf ~Yt,~4 ~ 1-...'.!~:::_z_;::.r.:./:::s::_~_u_s_w_a_s_t_e_,_· _s_o_1_1._· d_, _n_o_s_o_RM_-_E ___________ _j._1-1.l:...j:D:::....iT~_J_J....Jt2:..i.::0'....j.....:Y:.._.j;;.i1.'~.!:1 ::E::•:::D::•:::D:!•;:fi:!l.:Ji~••· "2ft ••'•.:• C'•• • v,•,_•,~~-;;;
b.
61------------------------------1-.L.L-1-.L-I-LLLL.J--+):;_;J!:1 =!:=!:=!::=.Z'~~/ ::~rt•" ·<; .-.,· -'ii: C.
::::;J_ ! .. L ... ! ., },., J:t;:
d.
~~~~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: ·72193
16. GENERATOR'S CERTI_FICATION: thereby declare that the contents ol lhlsconslgnmentarelultp' and accuratelydeacrlbod abOve by proper at'llpplng name and are clHaifled.
packed. marked, and labeled, and are In all respects in proper condition !or transport by highway according to appllcabla lnternallonal and nallonal government re,gulatlona and
lha laws ol lhe State ol South Carolina.
111 am a large Quantity generator, I certify that 1 have a program In pince lo reduce the volume and toxicity ofwastoganerated lo tho dogrN I have determined lo be economk:ally
practicable and lhat I have selected the practicable malhod ol lrealment, storage, or dlspoaal currently avallablo IO mo which mlnlmi:tas tha present and lutur• thr-1 to human
l"lealth and the environment;OR, 111 am a small Quantity generator, 1 havo made a good leith eMor1 to :nlniml:te my waste generation and select the boat waa10 management method
that is available to me and that I can aMord.
Printed/Typed Name RO.GER L COATS Signature
T 17. Transporter 1 Ac.;Knowledgement ol Receipt of Materials
Printed/Typed N Signature U.JLG-
18. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator, Certirication of receipt of hazardous malerials covered by this manifesl except as noted in Item 19.
Prinled/Typed Name Signature
EPA Form 8700-22 (Rev. 9/88) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/861]
Month Day Year
a ._, l..J...L..1..J..J!ibs. C j....._....._ ........ _.!lbs.
b I jibs. d I jibs.
Month Day Yea,
I
..
''A\ =="~-~
. ·~-
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D O 7 o l
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield; NC 27577
,. Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3
11. U.S. DOT Description (including Proper Shipping Name. Hazard Class, and ID Number)
C.
d.
2. Page 1
of
'.£~-~ ~'~;~~~~:~ll!:!1,1~l~~ll~'!iR1lllJ~.1Il~l![IJ~!~!loo!tl!!J!,!i1:~\~~-!rll
a!E..MJ-Jo,2,7,7141-lld,0,21:::Yi/'}}foC.Li_J-I, I I I 1-1 I I I l:;g
b. L+J:L 1-1 1il;1:ili~:''.:li'il~W:L I ... L.J-1
15. Special Handling lnslructions and Additional Information
GSX Work Order No.: 72194
lnlormation in the shaded areas is not
required by Federal law, but is by State law.
1 6. GENERATOR'S CERTIFICATION: l horeby declnro thnl lh8 content:, olthls conslgnmontare fullyond accurotely described above by proper ahlpplno nam• and are c1au1lied.
packed. ma,ked, and labeled.and oro in all rospoct:, in proper condition lor lranspor1 by highway according to applicable lnlemalional and naUona1 govornmon1 revuLaUon• and
tho laws ol the Stale ol South Carolina.
111 am a largo Quan1Ity generator, I certify that I have a program In place to reduce tho volume and toxicltyol wHtogeneralod to the dogree I have determined to be oconomicatty
practicable and lhal J have selected the practicable method of treatment. storage, or disposal currently available to ma which minimizes the present and future ttuMt to human
heallh and !he environment; OR, ii I am a small quantitygenorator, I have made a good failh eMor1 to minimize my waste generation and select the bell wa,ta management m.thOd
that Is available to ma and that I can afford.
Printed/Typed Name RO,GER L. COATS Signature
Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification ol receipt ol hazardous malerials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
Month Day Year
'.._I ......_.....,......,l'bs. ' lu...L..L.,.L..J,..Jpbs.
b I pbs. d I !lbs.
Month Day Yw
EPA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete [OHEC 1988 (Rev. 10/86)]
I ,';if/%
1 M':-~ ,£' \.
·~
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
1
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
Form A
2. Page 1
ol
Bureau ol Solid & Haz.ardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-542•
roved, 0MB No. 2050-0039 E.x ires 9-30-88
Information in the .shaded areas is not
required by Federal law, but is by Stale law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class. and ID Number) 12. Containers 13. Tot.ii Quantity 14.Unil i\\~'NumbeiW~
No. Type Wu¥~ '.:\[\%L::/J/:\i}\~8!{
a
C.
d.
~.~.~~.~?:~:~1l!~l~~tlif !~!t~;!t~lli:!1ttll!::rrt:~!~l!~l1!!,~f!!tt
al!:M.]-ID,2,7,7,4l-lli11D12bi:U"i//hc,LLJ-I 1-1 I@
b. LLJ-1 1-1 Ji'.i/!!;~!i'lil!!~:W~J , r 1-1 I[~
15. Special Handlin.g Instructions and Additional Information
GSX Work Order No.: 72195
18. GENERATOR'S CERTIFICATION: I hereby declare that the contents ot this consignment are lully and accurately described above by proper shipping name and are eluailled,
packed, marked, and la°beled, and are in all respects in prope_r condilion tor transport by highway according to applicable international and national govemmant re,,gulatlona and
t1'a laws ol the Stale ol South Carolina.
II I am a large Quantity generator, I cer1ify that I have a program In place to reducathavotume and toxicity of waste generated to the dog roe I have determined to be economic.atty
practicable and that I have selected the precllcable melhod ol treatment. storage, or disposal currently available to me which minimize• the preaenl end future thr-1 to human
health and the environment OR. If I am a small quantity generator, I have made a good laith effort to minimize my wast.& generation and select the beat we1te management method
thal is available to me and Iha! I can eMord.
Printed/Typed Name Signature
Printed/Typed Name Month Day Year
19. Discrepancy Indication Space
a I l'lll CI Pill
bl 111'' d I jibs.
20. Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manifesl except as noted in Item 19.
Printed/Typed Name Signature Monti\ Cey yea,
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-542•
E PRINT or TYPE {Form desi ned for use on ellle 12-itch · writer Form A roved. 0MB No. 2050-0039 El ires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded a<eas is not
N C D 0 0 0 1 al required by Federal law, but is by State law.
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
•· Generalor's Phone 9 1 9 9 3 4-9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number)
C.
d.
~~,~~:~t:~~l!!!;l!1!f i!~l~l!l~t~llie~!!!~~;i!l!~!i!~l~-\'1!;!~!~J11!1~~~1
~\~
a. ILMJ-1O J 2 J 7 I 7 14 1-11 J l J O I 21 d\it':i:hl C. LLJ-1 1-1 I fi
b. LLJ-1 1-1 ,;i1~:r0i~ild-w--1, , .' ,.1. 1~t .' ... iJi,!1
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72196
16. GENERATOR'S CERTIFIC/4. TION: I hereby declare th11I Iha contonts ot !his conalgnmont are lully and accurately described above by proper •hipping name and are claaa.ill..::I.
packod. marked, and 1a·beled,and are in all rospocts in proporcondilion for transport by highway according to applic-.bla lntarnallonal and national government r9"gulation1 at'ld
the laws ol the State ol Souttl Carolina.
111 am a large quantify generator, I certify that I have a program In plac·eto reduce the volume and toxicity of waste generated to the degree t have determined to be economiealty
practicable and ttiat 1 have selected the practicable melhod ol treetmenl storage, or dlspoul currently available to me which mlnlmLtea the preaent and future tnr-1 to human
health and the environment; OR, II I am a smorr quantity generator, I have mode a good lailh effort to minimize my waste generation and aelecl the beal waste management method
that Is available to me and that I can afford.
Prinled/Typed Name RO,C.ti<. L COATS Signature
17. Transporter, Ac.arnow!edgement of Receipt of Materials
Printed IT yped Name
Printed/Typed Name
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted in llem 19,
Prinled/Typed Name Signature
Day Year
Monlh Day Year
8 J.._._ ................ _.,jlbs. c l,._._..__._ ........ _,llbs.
b I pbs. d I pbs.
Monlh Day Yea,
EPA Form 8700-22 (Rev. 9186) Previous Edilions are Obsolele (DHEC 1988 (Rev. 10186)1
I South Carolina Department of Health
and Environmental Control
Form A
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manifeal 2. Page 1
Oocumenl No. ol WASTE MANIFEST N c D o 7 6 o 1 0 0 1 9 4
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
S. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facilify Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA 10 Number
10. U.S. EPA 10 Number
SCD07037
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5'2•
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded a<eas is no1
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, HaZJJrd Cfass, and ID Number) 12. Container, 13. Total Quantity 14. Uni\ ,-t\W.&1ta Nunibe,\,;
No. Type Wt!Vf}. i:/i/t:Y)\;j:{,~{}:'/ff.'
a. Hazardous Waste, Solid, nos ORH-E !:~r:~·:1'0~-,:t,;9,~
N NA 9189 1 D T 2 0 Y ';J1F1Q1Q1611t
b.
C.
d. ti~~~1:';~!~
,:'.~;
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 72197
1 6. GENERA TOR"S CERTIFICATION: I hereby declare th al the contenls of this conaignmenl ere lully end accurately de,cribod above by proper ,hipping name and ere cl-.ifl.CS.
pecked. marked, end laholed. and are In all respects in proper condition forhansport by highway according to applicable lnternallonal and national government regulation• and
trle laws ol tha State ol South Carolina.
· If I em• large Quantity generator. I certify that I have a prOQram In placo to reduce the vo1umo end IOJlllclty of waato generated to tho dog roe I have determined to be economleally
practicable and thal I have selected tho practicable method ol lreatment. storage. or dlspoaal currently available to mo which minimizes the present and future th,_! to hum11n
health and tho environment: OR. If I am a small quantity generator, I have mado a good lallh effort to minimize my waale genc,ratlon and select tho bast waste manegemoril ~!hod
that Is available to me arid lhal I cari afford.
Printed/Typed Name RO.GER L COATS Signature
. Transporter 1 Ac.:Knowledgement of Receipt of Materials
Signature
Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; 'Certification of receipt ol hazardous materials covered by !his manifest except as noted In hem 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [OHEC 1988 (Rev. 10/86)1
Month Day Year
a 1...I .L..L.u...J...J!lbs. c l._._,._._......,__.!lbs.
b I pt,,. d I jibs.
Month Day Year
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
LEASE PRINT or TYPE (Form desi ned for use on elite 12-itch ewriter Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST c D O 9 7 6 o 4 7 1 4
2. Page 1 Information in the shaded a<eas is not
of 1 required by Federal law, but is by State law,
i G~~r=~~:im~~: ~:i~ng Address ~~~~ t~~zi~,~'.'.:~'.!~'.S~~:\~~l~:fi~t
r'::·..:G:.;:::".:::::.r•:::•o:::o'-r:s=-· '-PB"ho:::
O
"e:::..i.._
1
-'~"~'-~"--'-'-s-m--'!"~:.~::....~-'!'-;'-"i-'~=-•-· _N_c __
2
_
7
_
5
_
7
_
7
___ ~------------IP:~~~,.)~f:~;:::;~~::;;~~":~:::;;::~t~;f~;~;;~~ij!;~:jt~;~;}j~~~,~~.{~J1;{;:ft~~i!~~{
5. Transporter 1 Company Name 6. U.S. EPA IO Number
Willms Truckin Co. Inc. SC DO 7 3 7
7. Transporter 2 Company Name 8. U.S. EPA ID Number
10. U.S. EPA ID Number 9. Designated Facility Name and Site Add~ess
GSX Services of SC, Inc.
Route 1, Box 255
Pinewood SC 29125 S C D O 7 0 3 7 5 9 8 5
11. U.S. DOT Description (includfng Proper Shipping Name, Hazard Class, and ID Number)
a. Hazardous Waste, Solid, NOS ORM-E
NA 9189
1 S. Special Handling Instructions and Additional Information
GSX Work Order No.: 72197
1 C M
.:;.'❖' '~-~~ --·~\~''.····::x-
'--'-..L....I.....JI :L
"t' rF<
16. GENERATOR'S CERTIFICATION: I hereby declare lhat1heconten1:, cl lhla conalgnmentare fully and accurately dncrlbod above by proper ahlpplng nama and ara claH•fled,
packed. marked. and 111.beled,and are in all respecls in proper condition lor transpor1 by highway according lo applicable JnternaUonal and national governmanl reQulatlon• and
tne laws ol lhe State of South Carolina.
II I am a large Quantity generator, I certify thal I have a program in place to reduce the volume and loKlcltyof wastageneralod to thedegroa I have determined to ba aeono,,,lcatly
praclicabte and thal I h11ve setecled the practicable melhod of treatment, slorago, or dlspoael currently available to ma which minlmlza1 the pre~nt and future U'lreal 10 hu~n
health and the environment: OR, 111 am 8 smi;,tl quantity generator, I have made a good laith effort to minimize my waste generation and select the bc•I wa110 management method
that is available to mo and lhal I cen atford.
Printed/Typed Name RO.GER L. COATS Signature ~ ~ Month Day Year
ment of Receipt of Materials
18. T ransponer 2 Acknowledgement of Receipt of Materials
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
a I libs. C I jibs.
bl jibs. d I jibs.
20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by this manifest except as noted in llem 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
I
iei ,
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardou, Waste Mgt
2600 Bull S~ee~ Columbia, SC 29201
Phone: [phone]
Emergency & Holiday,: (803)734-5'24
LEASE PRINT or TYPE (Form desf ned for use on elfte 12-itch writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
N C D
2. Page 1
ol Information In the shaded areas is nol
required by Federal law, but Is by State law.
1 G~::::~an;;:;~ ~~ing Address iil~~i~/~11~1lflfjt
l-4"~-'-~"'~""~"'."'~;:;to:;.·~-=•.:.:.;;~.::;0~;:;•:...
1
_
4
..,!:..~::.9._·_,__s_m~!=;-':_:_,!:_;:..
1
... 1.,f_·_N_c __
2
_
7
_
5
_
7
_
7
_______________ 1''.r .. ·;;;,.11~11i111~~~~f~~lfflii~
5. Transporter l Company Name
·Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Slte Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
·11. U.S. DOT Description (including Proper Shipping Name. Hazard Class, and ID Number)
a. .
, .Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormalion
'GSX Work Order No.: 72281
12. Container, 13. Total Quantity 14. Unit :i.'.Wale~pi.
No. Type WVVrJ {fft.0{tlJShtli#.fl
1 T
lttF=~tfffi~~~4.
2 o Y l1ErDrD161I
1 G. GENERATOR'S CERTIFICATION: I hereby declare th al Iha contents of this consignment are fully and accurately doacribed above by proper ehlpplng name end aro claaa,fl.cl,
pack ad. marked, and 1a'beled, and era In all respects In proper condition for transport by highway according to appUcabla lntarnatlonal and national govamment r-oulation, and
the laws of the State of Soulh Carollna.
It I am a large quantity genera1or, I certify that I have a program In place to reduce the volume and toxicity of wa1te generated to the degrM I have determined to be ec:onomiealty
pracl1Cab1a and that I have ■elected lhe practicable method of treatment, storage, or dlapoaal curranUy avallable to ma which mlnimlzas the pra-nt •nd lutur• thr-t to human
: health and the environment OR, If I am a small quantity generator, I have made a good lalth effort to minimize my waste ganeraUon and select th• be•t wa•t• m.an•gam.,,t method
· · that Is available 10 ma and thal I can afford .
. . • Printed/Typed Name RO.GERL CO~T§ Signature Month Year
0
17. Transporter 1 AcKnowledgemenl ol Receipl of Materials /
Printed/Typed Name Signature ,6}_ --4 ..# ~ ~ Month Day Year
gemenl of Receipt of Materials
Signature Month Day Year
19. Discrepancy Indication Space
• ... I ........... .. jibs. C I libs.
bl .............. .... I Pbs. d I pbs.
20. Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manifest except as noled In Item 19.
Prinl~/Typed Name Signature Month Day Year
EPA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
I ~ South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stroel, Columbia, SC 29201
Phone: [phone]
Emergency & Holiday~ (803)73-4-5424
LEAs°EPRINTorTYPE (Formdesl nedforuseonellte 12· itch writer Form A roved. 0MB No. 2050-0039 Ex ·res 9-30-88
, UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D
Manifest
Document No.
0 0 1 9 7
2. Pago 1
of Information in the shaded areas is not
required by Federal law. but is by State law.
i G~~:ra~~:~an;::;dt~a;ing Address ~il~s~lt:;~;~v:~:t~~~~~
r4".·-', G:.P•:::~.::•::.ra:::~::;'-~':.B;..P::.~o:::~:::•:...
1
_
4
_!<-=~-'9'-'s'--m-'!'-;=~'-:_!"-'-;..,i"f'-•-N_c __
2
_
7
_
5
_
7
_
7
________________ +tf.~~izl$~i~ill4ft1fl~l~?N~li~§
5. Transporter 1 Company Name 6. U.S. EPA ID Number
Willms Truckin Co Inc. CD O 7 3 7
7. Transporter 2 Company Name 8. U.S. EPA ID Number
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Cfass, and fD Number) ,.
.Hazardous Wast~, Solid, nos ORM-E
NA 9189
, 5. Special Handling Instructions and Additional Information
····csx Work Order No. : 72282
12. Containers 13. Total Quantity
No. Type
1 T 2 0 Y
:,jtrtalf~ l,F 1Q1Q16,I
1 e. GENERATOR'S CERTIFICATION: I hereby declare th al the content• of thl11 con•lgnment are fully and accurately deacrlbed above by pro~r •hipping name and are c.lU&ifted,
packed, marked, and 1a·beled, and are In all respects ln proper condition for transport by highway according to applicable International and national govemmont reguladon• and
the laws ot tho Stale ol Souui Carolina.
If I am a largo quantity generator, I certify that I have a prooram In place to reduce tho volume and to1dclty of wa•te generated lo Iha dogr-I ha.,,. determined to be econo,nlcalty
, .• pracllcable and that I have aelectod the pracllcable method ol treatment, atorage, or dlapoNI currently avallable lo mo which mlnlml:rea the preaent and future thr-1 lo human
· ,, health and Iha environment; OR, If I am a small Quantity generator, I have made a good faith effort to mlnlmlr.e my was la generation and select Iha be•t waate management mothOd
•t that Is available to me and that I can aNord.
Printed/Typed Name RO.GER L CQA.Th
Signature ~
Signature
Signature Month Day Year
19. Discrepancy Indication Space
• I I libs. C I jibs.
b I pbs. d I jibs.
20. Facility Owner or Operator; CertifiCa!ion of receipt of ha.iardous materials covered by this manifest except as noted in hem 19 .
. Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete IDHEC 1988 (Rev. 10/86)]
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Streel Columbia. SC 29201
Phone: [phone]
LEASE PRIHT or TYPE (Form desi ned for use on elite 12-itch writer
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D O 7 6 o
3. Generator's Name and Mailing Address
Channel Master
, P. 0. Box 1416, Smithfield, NC 27577
4. Generato(sPhone 919 · 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description /including Proper Shipping Name, Hazard Class, and ID Number/
a.
-,Hazardous.Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
· GSX Work Order No. : 72283
Form A
2. Page 1
ol
Emergency & Holidays: [phone]
roved, 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded a<eas is not
required by Federal law, but is by State law.
12. Contalne,. 13. Total Quantity 14. Unit \l\:-'(.all'.,~kl
No. Type WWr:J. t1n\h}t4ft%'N}Pi
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment era lullyand accurately described above by proper shipping name and are classified,
packed, marked. and la"beled, and are in all ,aspects In proper condition for transport by highway according to appllc.able lntornalional and national govommont regulatlorui and
ITIO laws ol tho State ol South Carolina.
If I am a rargo Quantity generator, I certify th al I have a program In place 10 reduce the volume and toxicity of waste generated to the degr-I have determined to be economleally
practicable and that I have aa1ected tho pracllcable method ol treatmant. storage, or dlapoa.al currently available to mo which minimize• tho praMnl and future lhr-1 \0 human
health and tho environment; OR, If I am a small quantity generator, I have made a good la Ith eNor1 to minimize my waste generation and 1eloct the beat waate manego~t metnod
that la available to me and that I can afford.
Printed/Typed Name RO.GERL CO~
Signature Year
T 17. Transporter~ Aucnowledgement of Receipt of Malerials
I N
R: t---::-,-,-':-:::--:-:-:----''-----'--------,--:,--------'------.,.,-------------,-,--,--:--".":-"-i
Printed/Typed Name
Pb::----,,--=--{B,~IZA~~~~--...L-~"7#-~£#-~~~:!!j;'{:::=.=:::.. ____ _J~lJ...l'.12:kll4
\,: 1-1..:8:.. . ..:T:.:ra..:n;_spo:..:crt:.:e:..r 2::..:.:A;_ck:..n:.:o..:w..:led=ge::m..:e::n..:t..:o;_I R..:e:.:c:.:e:.:iP::.t o::l..:M..:a=='----r:---,,t.'-,<'---'-------==-------------------~
·~i-+ __ P_n_n_led_/T_y_p_ed_N_am_e ______________ .... ________ ...,; ________________ ...,l.,_._.._..1,,_,,...l'-4
19. Discrepancy Indication Space
1i
Month Day Year
I I llbl. C I lib!.
b I pt,,. d I !lbs.
L 11---------------
1~~2:.:o..:·=F..:•;_ci..:lify~O..:w..:n:.:e~ro7r..:O:.:P:.:•..:'a::ro::r.:..,C..:e::rt..:ifi..:•<:.:a..:lio::n:..o::l..:re::c:.:e:.:ip:.:t..:ol;_h:.:==r..:d..:ou::•:.:m..:art=•r~ia=l•:.:c=o~v=•r=~~by~th=i•:.:m=•=n..:~=·•=t~•=xc=e~p~t•=•:.:"=o=ted~l~n="=•m~1=9· _______ ~~-,--
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgl
2600 Bull S~ee\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5-124
Fonm A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
2. Page 1
of lnlormatlon in the shaded a<eas is not
required by Federal law, but is by State law.
i G;~:~~~~•~;;dt~~ing Address l{illl\'i~t~'~jlrlltft~f
~~::.-::,:,::.~.:::•c.:r~:::lo::..f::..• B:..:P~.:::ox::.c"e::..i...1_4..::!..!~..::9:....1..s_m_,~ea;e..:~:.,=-'~~;:..i!..d!..1 _' _N_c_2_1_5_1_1 _____________ +.~;;;1;t;!.:~~;t:i:iJ~T);~~!;:2)l~'.·J!~!,t;t~2•
5. Transporter 1 Company Name 6. U.S. EPA ID Number "'·i[j,'.'.JN.t!/JrrLSUthRF\k½i
Willms Truckin Co Inc. SC DO 7 3
7. Transporter 2 Company Name 8. U.S. EPA ID Number
9. Designated Facility Name and SIie Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
,·csx Work Order No.:
~~ l": 72284
12. Containers
No. Type
l D T
,~,'F';ii~'!'fgf~
2 0 Y ;,F,0,0,5,I
16. GENERA TOR"S CERTIFICATION: I hereby declare lhat the contenls ol this consignment are fully and accurately described above by proper ahipplng nama and are cl~tled.
packed. marked. and ta'beled, and are in all respects in proper eondilion for transport by highway according to applicable lnlernallonal and natlonal government regulations and
Iha laws ol the State of Soulh Carolina.
111 am a largo quanlity generator, I certify that I have a program In place to reduce the volume end to11lclty ol waategenerated to !he do,gree I have determined to be econorrdcally
~••practicable and that I have selected the pracdcable method of traalmant, storage, or dlspoaal currently available to me which minimizes the present and lutura th, .. 1 to human
• "health and the environment OR, ii I am a small quantity generator, I have made a good la Ith effort 10 minimize my waste generation and select the best waste management mothOd
! ' U"\al is available to me and that I can afford.
r.; Printed/Typed Name ' RO.GER L. COATS Signature
17. Transporter 1 Acamowledgement ol Receipt ol Materials
Signature
Prinled/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt of hazardous materials covered by this manifest except as noted In Item 19.
, Prinled/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolele {DHEC 1988 (Rev. 10/86)]
Month
C)
Year
~?
Monlh Day Year
• IL..L..L.L-'-1..Jl'bs C IL..L..L..L..,_....,I lbs
b I pbs d I !lbs
Monlh Day Year
, ,•·
I r-ri
'. . ,_
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo. Manlfeat Document No. WASTE MANIFEST N c D o 7 6 o 1400200
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
S. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc .
. Route, 1 Box 255
Pinewood SC 29125
6. U.S. !:PA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
of
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers
No. Type
a..
C.
d.
15. Special Handling lnslruclions and Additional Information
·· GSX Work Order No• : 72285
Bureau of Solid & Hazardous Waste Mgt
200) Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded arees is not
• required by Federal law, but is by State law.
'.({'i~,-.-.~-;~-11~~
~~! .. , .. L) MY!•YY!.:~,
, e. GENERATOR'S CERTIFICATION: I hereby declare that lhe contents of this consignment are fully and accuratoly described above by proper ahlpplng name and are cl a-fled.
packed. markod,and la°baled,and are in all rospects in proper condition tor transport by highway according to applicable international and national government reQulatlonaa/'\d
tl'le laws of the State ol South Carolina.
If I am a large quantity generalor, I certify that I have a program In place lo reduce the volume and loxlclty of wa•le generated to the degr-1 have determined lo be economically
practicable and that I have Hlecled the practlcabla method of treatment, atorage, or dlapoul currently available to me which minlmlzea the preNnl and future threal lO human
· health and Iha environment: OR, ii I am a small quantity generator, I have made a good faith effort 10 minimize my waste generation and ae1ec1 the be al waate managemenl method
·,t that Is available to me and that I can afford. ·
• Printed/Typed Name .RO.GER L. COATS
Signature Month
6J
Signature
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
a I libs. C j jibs.
b j jibs. d j jibs.
20. Facility Owner or Operator: Certification of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Oey Year
EPA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86))
I South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desi ned for use on elite 12· itch writer
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIONo.
WASTE MANIFEST N c D o 7
Manifeat
Document No. 0 0 2 0 l
Form A
2. Page 1
of
Bureau of SoUd & Hazardous Waste Mgt.
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5"24
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded ateas is not
required by Federal law. but is by State law.
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato~s Phone [phone]
:~1=::;~1:~r:~~r~:~~1,ri
illi;~JJlll111fiit4fffjff~-
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
· 9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
scn0737
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
C.
d.
is. Special Handling 1nslructions and Additional Information
'" GSX Work Order No. : 72286 ~ 'j ·
16. CEHERATOR·s CERTIFICATION: l hereby declare !hat the con1en1s of this consignment are lully and accurately described above by proper shipping name and are cl-...illed.
• packed. marked. and lahelcd.and are In all respects in proper condition !or transport by highway according to applicable International and national governmen1 regulation• and
the laws ol the State ol South Carolina.
111 am a large quantity generator, I certify that I havoa program In place to reduce the volume andtoxlcltyolwaslegenerated tothedegroe I have determined to be economically
practicable and that I have aelected the practicable method ol trelllmenl. storage. or dlspoul currently available to me which minlml;iea the present and lutura lhreol lO human
health and Iha environment: OR, 111 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the beat waste management methOd
that is available to me and that I can afford.
Printed/Typed Name O,GER L COAIS Signature
17. Transporter 1 At;Knowledgement of Receipt ol Materials
P~ITyped Name
J A !'{\ >1 r(\ If\ o
PMnted/Typed Name
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifesl except as noted In Item 19.
Printed/Typed Name Signature
Month Day
CJ
Month Day Year
a ._I ,_,_.,__._..,_,jibs c lu....1...,1...J...J...Jjlbs
bj pbsdj jibs
Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous EditiOns are Obsolete (D~EC 1988 (Rev. 10/86)]
South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desi ned tor use on elite 12· itch wriler
. UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIONo.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
-P. 0. Box 1416, Smithfield, NC 27577
4. Generato(s Phone 9 1 9 9 3 4-9 7 11
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
a. ' .Hazardous Waste, Solid, nos ORM-E
NA 9189
·.'
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72287
Form A
2. Page 1
of
12. Containers
No. Type
1 D T
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded areas is nol
required by Federal law, but is by Stale law.
1 e. GENERA TOR'S CERTIFICATION: I hereby declare th al tho conlents of this conalgnmonl are fully and accurately described above by proper shipping nam• and ar• claaadl9d,
packed, marked, and la.baled, and are In atl respects In proper condition for transport by highway according to applicable lntarnallonal and natlonal govommant ra,gulatlona and
the laws ot Iha State ol South Carolina.
lfl am a largo quantity generator, I c6rtity that I have a program In place to reduce !he volume and toxlcltyol waategenaratad to !he degree I ha.,. determined to btl aconomlcalty
practicable and thal I have selected the practicable method of treatment. storage, or dlsposal currently available to me which mlnlml:z:oa the preMnt and lu!ura threat to hum.in
_ health and the environment OR, If I am a smnll quantity generator, I have made a good laith eHo'rt to minimize my waste genera!Jon and select the beat waalo managamanl melhod
that is available to ma and thal I can nttord.
• , Printed/Typed Name , ROGER L. COATS Signature
Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator, Certification of receipt of hazardous materials covered by this manrfest except as noted In Item 19.
Printed/Typed Name Signature
EPA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
ac.l .L.J._._.._.
b c.l J...J....L.J...1
Month
<'.}
Montn i°"t gU: uct
Month Day Year
Jibs. C I Jlbo.
Jibs. d I Jibs.
Mootn Day Year
I South Carolina Department of Health
· and Environmental Control
UNIFORM HAZARDOUS 1. Generalor'sU,S.EPAIDNo.
WASTE MANIFEST N c D 7
3. Generator's Name and Mailing Address
Channel Master
Form A
2. Page 1
ol
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone] ·
roved, 0MB No. 2050-0039 EJ: ires 9-30-88
Information in the shaded MHS is not
required by Federal law, but is by State law.
4. :.~.r~;~,!~o~e 14!~9 Sm!~~:!;i~' NC 27577 ~J,~;~t'.~!i';''i;£}~'~!:;;;t~:G\~W~:'j\' ~=="""-="'---""'-"-L---".:c:!.-"-'-"-"---------------➔~;;;;,;,
5. Transporter l Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6, U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. u.s.· DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number)
a.,~ ";.,;
=lit=t,ilrl.il~~~,li1~ill~it,ll~li~tlii!ti~!~:
:lilitlli~lt1ii~l~fB~!f~1111!11
E ",,Hazardous Waste, Solid, nos ORM-E
N NA 9189 1 D T
~;~~~ro111ri~
2 0 Y l,E1Q1Q161!
15. Special Handling Instructions and Additional Information
•GSX Work Order No. :
t;t~ ..
72288
~~-~~--~,,-~-~'"'',!
t'h ( I I ,I
1 e.' CENERATOR'S CERTIFICATION: I hereby declare that !he conlonls ol thls consignment are fully and accurately described above by proP41r ■hipping name and are clanilled.
pack.eel, mark.od. and la bated, and aro in all respects In proper condition tor transportbyhlohwayaccordlngto applicable lnlarnatlonal and national oovarnmen1r99ulatlons and
the taws of Iha Slale of South CaroUna.
111 am a large quantity generator, I certify that I have a program In place to reduce the volume and toxicity of waata generated to the degree I have determined to be economically
~·1-practicable and that l have selected !he practicable method of lreetment. storage, or dlapoaal currently available to me which minimize• the preNnl and future thrNI to human
" health and the environment: OR, 111 am a smatl quantity ganeralor, I have made a good faith effort ID minimize my was to generaUon and select the beat waste management method
~: lhat is available to me and that I can afford.
·=-~ Printed/Typed Name RO.GER L COATS Signature
17. Transporter 1 At;Knowledgement of Receipt of Materials
Prinled/Typed Nam~
1
, / / j f kt ft !{S Signature
18. Transporter 2 Acknowledgement ol Receipt ol Materials
Prinled/Typed Name Signature
19. Discrepancy Indication Space
20. Facilify Owner or Operator; Certification of receipt ol hazardous materials covered by !his manifest except as noted In Item 19 .
. Prinled/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete {DHEC 1988 (Rev. 10/86)]
Monlh Day Year
a ._l .L.L.J...J...L-JJlbs. c .._l ,...._.._._.__.libs.
b I jibs. d I !fbs.
Monlh Day Year
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
E PRINT or TYPE (Form desi ned for use on elite 12-itch writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS·
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D O 7 6 0 1
l Generator's Name and Mailing Address
Channel Master
~-0. Box 1416, Smithfield, NC 27577
4. Generator, Phone 9 1 9 9 3 4-9 7 11
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, ·Haz.ard Class, and ID Number)
C.
t
d.
15. Special Handling Instructions and Addilional Information
'' ·csx Work Order No. : . ' 72289
Information in the shaded areas is not
required by Federal law, but is by State law.
15. GENERA TOR'S CERTIFICATION: I hereby declare that lhe con1en1s of this con•fvnment are lully and accurately da■crlbed above by proper •hipping nam• and ara cla•••lled,
packed, marked, and la'beled, and ere in all respects In proper condition lor trensport by highway according to appUc.ble 1n1arnatlonal and national govarnmant ra,gulatlon• and
the laws of the State of South CaroUna.
If I am II large quantity generator, I certify that I have a program In place to reduce tho volume and toxicity of waste generated to the dagr-1 have determined to be economlcally
practicable and Iha! I have selected the practicable method of treatment, storage, or disposal currently available lo me which minimize• tha pn1Nnt and lutura thr .. t to humain
· heat1h and tho environment: QA, ii I am a small quantity generator, I have made II good faith effort to minimize my waste generation and select the be al waata management n>ethod
1r''i that Is available to me and that I can afford.
, . Printed/Typed Name RO.GER L COAT~ Signature 1< ~~ Month Cay Year
<1
17. TransPorter 1 Ac;Knowledgement ol Receipt ol Materials
, Printed/Typed~ /; Se Signature q>~ ~ ·.-:J:l:::j7t! ... d tJ 11 ~a41~
18. Transporter 2 Acknowledgement of Receipt of Materials ,,:.,'
Printed/Typed Name Signature Month Cay Year
19. Discrepancy Indication Space
• I libs. C I libs.
bJ libs d I Jibs.
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manttest except as noted In Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/66) Pr_evious Editions are Obsolete [OHEC 1988 (Rev. 10/86)]
I
•--
, ...
' ,, ::
-r,, ---
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Wasle Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-542•
LEASE PRINT or TYPE (Form desi writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
F
UNIFORM HAZARDOUS -
WASTE MANIFEST
1. Generator's U.S. EPA ID No. Manifest
Document No.
NCDO 7 0 1 0 0 2 0 5
3. Generator's Name and Mailing Addre53
Channel Master
:•:P. O. Box 1416, Smithfield, NC 27577
,.:·Generatofs Phone [phone]
5 .. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
B. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
a. . ., ....
. ,Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
•··GSX Work Order No.: . ,· .. ,. 72290
2. Pago 1
ol
1 D T
Information in the shaded areas is not
required by Federal law, but is by State law.
16. GENERATOR'S CERTIFICATION: I herebydeclarothal !he contents olthls conalgnmonl are fully and accurately described above by proP4»r •hipping nama and ar• claaa,li..:t.
packed, marked, and 18beled, and are In all respects ln proper condlllon for transpor1 by highway according to applicable lnternallonal and natlonal govemmont r~ulatlon• and
U'le laws ol the Stale ol South Carolina.
111 am a large quantity generator. I cer1ify that I have a program in place lo reduce the volume and toldclty of wHte generated lo the da,gree I have determined to be economically
practicable and thal I have selected the practlcable method ol treatment storage, or dlspoael currently avo.ilable to ma which minimizes the present and luture thtNt to human
health and the environment OR, If t am a small quantity generator, I have made a good lalUi eNor1 to minimize my waste generation and select the best wuta managemenl method
• that Is available to ma and that I can aNord.
•. Printed/Typed Name ROGER L. COATS Signature Vear
eceipt of Malerials
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
Ir ,-· a IL...L...1....L-"--'--'llbs. c .... I .1....L-"--'-..._.!lbs.
bj jibs. d I jlbL
11---------------T 20. Facility Owner or Operator, Certification of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
IV~--:-:-:--'-'-~==.;_~~===~-___,,.,.....,..~
Printed/Typed Name Signature Month Day Yea,
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)1
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generelor'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7 6 o
3; Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
,. Generator's Phone 919
5. Transpcrter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box ·255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
of
Bureau of Solid & Hazardous Wa,te Mgt
2600 Bull Street Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex Ires 9-30-88
Information in the shaded a<eas is not
required by Federal law, bu! is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Cfass, and ID Number) 12. Containers 13. Total Quantity 14. Unit-il\WatlNumberiW
No. Type WtNrJ. f/h%tWi%;S;~1f:f"
C.
d._
15. Special Handling Instructions and Addiliona1 Information
.. ,. GSX Work. Order No. : 72291
1 6. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are lully and accurately described above by proper ■hipping name and are clasaiffed.
packed. marked, and 1a°beted, and ore in all rospocts in proper condition tor transpor1 by highway according to applicable lnlernational and national government reQulatlons and
tho laws ol lhe State ol South Carolina.
It I am a largo quantity generator, I cer1ity that I have a program In place lo reduce tho votumo and toxicity of waste generated to tho degree I have detarmlned to be economically
practicable and that I have selected tho practicable method ol treatment. storage, or disposal curronlly available lo me which mlnlmlu,1 tho pres.ant and tutura thr .. 1 lo hu"'8n
health and the environment; OR, If I am a small quantity generator, I have made a good laith effort to minimize my waste generation and select the bo•I wa•to management method
that is available to mo and thal I can afford.
.\·Prinled/Typed Name
Signature
. 19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt ol hazardous malerials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev.10186)]
Month
tJ
Day Year
57?,7
Monlh Day Year
8 .__I .._._ ....... _.__.!lbs. e lu...L..L.J.-L.J!lbs.
b I libs d I libs.
Month Day Ye.at
I
T
. ~:~,
'"'~-''""' •..-..:' ~ -··
South Carolina Department of Health
and Environmental Control
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generate~, Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
· GSX Services of SC, Inc.
· Route, 1 Box 255
Pinewood SC 29125
1
Manlfeat
Document No. 0 0 2 0
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
S C D O 7 0
t 1. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
C.
d .
. '
15. Special Handling Instructions and Additional Information
,GSX Work Order No.: 72292
Form A
2. Page 1
ol
Bureau of Solid & Hazardous Waste Mgt
2600 Boll Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734•5'2'
roVed. 0MB No. 2050-0039 E.x ires 9-30·88
Information in the shaded 1teas is not
required by Federal law, but is by State law.
16. GENERATOR'S CERTIFICATION: l hereby declare !hat the co"ntenls of this conslgnmenl are fully and accurately described above by proper ahlpplng name and are cla.»1fled.
packed. marked. and laheled,and are in all respects in proper condition tor lransport bYhlghway according to applicable International and national governmenl rogulatlon•and
the laws ol the State of South Carolina.
II I am a large quantity generator, I certify that I have a program In place to reduce the volume and toxicity of waste generated to the dogr-1 have determined lo be economically
practicable and that I have selected the practtcable method or traatmenl storage. or dlapoaal currently available to me which minlml:tes the pre.en! and lutura thr-1 to human
health and the environment: OR, ii I am a smart quantity generator, I have made a good faith effort to minimize my waste generation and a elect the beat waate management method
, that la availablo to me and that I can afford.
~ Printed/Typed Name RO.GER L COATS Signature ~ Caa.k_ Month Day
17. Transporter 1 Ar.:.Knowledgement ol Receipt ol Materials
Printed/Typed Name Signature
~ ·w £
18. Transporter 2 Acknowledgemenl of Receipt of Materials
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
I I jibs. C I I jibs.
b I jibs. d I jibs.
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Prinled/Ty~ Name Signature Monlh Day Year
EPA Fprm 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
E PRINT or TYPE (Form desi ned for use on elite 12-itch writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
Manlteat 2. Page 1 'boc/tz"' 0.08 of
Information in the shaded areas is not
required by Federal law, but is by State law.
4_' :e~er~~rs !~o~e 14
;~ 9 Sm~~~=~;ii' NC
27 577 ~lrt.s~t:,c¥~~1~i:'.!1i~~f~~tr;~)r~r~ p..;==c..::..:..;="-~"--'-~""'--"'-'-"-"---'-----,--------'-----+;.;;:
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name 8.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number)
a.
,Hazardous Waste, Solid, nos ORM-E
NA 9189
d.
1 D T
}Y~X:~:,m;~fi~&/;;~ii!!;~!::,~~1il~:l'z;~J)!:1~~m1~!1~f1!!!!~1fJ;f?5!:t!i!;f!1i:!l!!
a.lE..MJ-I012171714l-l11l10121''''"""''""''c-w-1, I I I 1-1, I I lh,
b,L+J:I 1 1 1 1 1-1 1 , , 1ittli!!ii)i~,l~J..1_J-1 , __ J:J 1[\~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72293
2 0 y
;~if ,Otitii•,;j
:ff1E tD 1016 tv)
1 e. GENERA TOR'S CERTIFICATION: I hereby declare th al tho contents ol this, consignment are fully and accurately doscrlbod abOve by proper shipping name and are clasait19d.
packed, marked, and la holed, and are In all respects In proper condilion for trans,por1 by highway according to applicable International and national govarnmanl regulation.a and
the laws ol tho State ol South Carolina,
It I am a largo quanhty goneralor, I cor1ify that I havo a program tn place to reduce tho votumo and loi,;lclty ol waslo gonoratod to Iha do,gr-I ha110 detormlnod lo be ecOf'\Omlcally
prBCIICable and Iha! I have 11etected the practicable method ol treatment. storage. or dlspoul currenlly available to me which minimizes the presont and lutvro thr-1 to human
health and the environment: OR, 111 am a small quantity generator, I have made a good lailh effort to minimize my waste generation and selactthe be1t wa1te management melhod
that is available to me and that I can afford.
Printed/Typed Name RO.GER L. COATS Signature
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator, Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Ed_ilions are Obsolete [DHEC 1988 (Rev. 10/86))
• L.I .L.J....LL.J.
b._l ............ ~
Month Yea,
cl
Month Day Year
P, I ::i' cf'.}
Month Day Yea,
jibs. C I jibs.
jibs.. d I jibs.
Month Day Year
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous w .. 1e Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holiday,: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS 1. Gene,ator's U.S. EPA ID No.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
· P. 0. Box 1416, Smithfield, NC 27577
,: Generator's Phone 9 1 9 9 3 4-9 7 11
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Ser.vices of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SC D ·o 7 0
1\_U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
,J:GsX Work Order No.: 72294
2. Paga 1
of Information In the shaded a,eas is nOt
required by Federal law, but is by State law.
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of !his consignment are fully and accurately described above by proper 1hlpplng name and are cluadled,
packed. mark&d, and 1a·beled, and are in all respects in proper condition for transpor1 by highway according to applicable lntarnatlonal and national govammant r-.gulation• and
1:t1a laws 01 tha Stale or South Carollna.
If I am a large quantity generator, I cer1ify that! have a program In place lo reducatha volume and toxicltyol waataganarat&d lo the degree I have determined to btl economlcalty ~ J practicable and that I hava aelected the pracllcabte method ol treatment. storage, or dlspoaal currently available to me which mlnimiza• tha present and future thrNI to human
health and the environment; OR, ii I am a small quantity generator, I have made a good faith effort to mlnlmlze my waate generation and select Iha beat waata management method
• -th.al Is available to me and that I can afford .
. , . Pri_nted/Typed Name . ,RQ.CER L. COAT.§
Ac,mowledgement of Receipt ol Materials
ame f /'I () A., f ?-/ • .,,
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator. Certification Of recelPt of hazardous materlals covered by this manifest except as noted In Item 19.
Printed/Typ~ Name Signature
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
Month Day Year
CJ
Monltl Day Year
Month Day Year
a IL..L.L.L...W...Jjlb& C ._! ......_..._......_.jib&
bi jlb&dj pb&
Month Day Year
I
I
I
I
I
I
F
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generetor·,u.S.EPAtDNo.
WASTE MANIFEST N c D o
1 Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
_GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
15. Special Handling Instructions and Additional Information
.GSX Work Order No.: 72295
Form A
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street, Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (803)734•5424
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded Meas is not
required by Federal law, bu! is by Stale law.
18. GENERA TOR'S CERTIFICATION: I hereby declare that the conlents of this consignment are fully and accurately described above by proper shipping name and a,a claSS1fled.
p11ck11d, marked, and la°heled,and are In all respects in proper condition lor transport by highway according to applicable lntern11tlonal and national government r-.gulatlona arid
u,e laws ol lhe State of South Carolina.
111 am a large quantity generalor, I certify that I have a program In place to reduce the volume and toxlcltyofwastegeneralod to the d&QrN I have determined to be oconomlcally
practicable and that I hava selected the practlcable method ol lteetmenl, storage, or dlapoaal currently avaltable to me which minimizes the presenl and luture thrut to human
heat1h and the environment; OR, 111 am a small Quantitygenero.lor, I have made a good faith effort lo minimize my wasle generation and select the best waste managemenl method
,that is available to me and lhal I con allord,
Month Day Year
libs.
I ~~ •:..•i·
~ •' l
I f--,--------~~---
• I l'bs. C I
b I l'bs. d I !lbs.
::: 20. Facility Owner or Operator, Cer1ificallon of receipt of hazardous materials covered by this manifest except as noted In Item 19. I Printed/Typed Nama Signature
EPA Form B700~2·2 (Rev. 9/86) Previous Editions are Obsolete [OHE~ 198B (Rev. 10/86))
Month Day Year
I South. Carolina Department of Health
and Environmental Control
E PAINT or TYPE (Form desi ned for use on elite 1·2. Itch ewriler
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIONo. Manifee1 Ooc:umenl No. WASTE MANIFEST N c D o 7 o 0 0 2 1 1
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
Form A
2. Page 1 ol
Bureau ol Solid & Hazardous Waste Mgl
2600 Bull S>ee( Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5-424
roved. 0MB No. 2050-0039 E.x ires 9-30·88
Information in the shaded areas is not
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Unit /~~~'~%fi;
No. Type WVV'i. tHNh4l1ti:~A(f.t
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 72337
i&. GENERATOR'S CERTI_FICATION: I hereby declare that the contentsolthls conslgnmentare fully and accurately described above by proper shipping name and are clu.ained,
packed, marked, and labeled.and are in all respects in proper condition !or transpor1 by highway according to applicable International and national govemmentr~utatlona and
the la_ws ol ttie State ol South Carolina.
If I am a large Quantity gentirator, I certify that I have a program In place lo reduce the volume and toxicity ol waste generated to the degree I have determined to be economlealty
practicable and that I have selected the practicable method of treatment, storage, or dlspoaal currently available lo ma which minimizes the present and luture thr .. 1 to human
health and the environment OR, ii I am a small Quantity generator, I have made a good la Ith effort to minimize my waste generation and select the beat waste managemenl method
that is available to me and that I can afford .
.. Printed/Typed Name ROGER L. COATS.
17. Transporter l Au::nowledgement of Receipt of Materials
. Prinl /Typejl Name () t::' ,,/-/ • Iv t\..C{R-<)/., UI{ J{Jfu • "'.
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name
19. Discrepancy Indication Space
Signature
Signature
20. Facility Owner or Operator: Certification of receipt of hazardous materlals covered by this manttesl except as noted In Item 19.
Prinled/Typed Name Signature
I IL..J..JL..J..JU
b ._i J-1...J,_L..J
Month Year
O"
Month Day Year
O,'J//, 7
Month Day Year
jibs. C I jib!.
pt,,. d I 11bs.
Month 0.y Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
writer
Manifest UNIFORM HAZARDOUS .
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
NCDO 7 0 1 4 8°1rr·r.02
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
,. Generato~, Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
l 1. U.S. DOT Description (including Pfoper_ S~ipping _Name, Hazard Class, and ID. Number)
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72338
Emergency & Holidays: (803)73-4-5424
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1 lnlormation in the shaded areas is not
of required by Federal law, but Is by Stale law.
1 D T 2 0
· ,;f;F,o~ifofill!
Y ;;1E1Q1Q161g;
16. GENERATOR'S CERTIFICATION: I hereby declare thal lheconlent:i olthi:i con:ilgnmonlare lullyand accuretelydo1cribod above by proper shipping name and ere cla.aaifiod.
packod, mark&d, end laheled, and are In oll respect:i in proper condillon lor lran:ipor1 by highway according to appUcable lnlernaUona1 and national government regulation• and
tne lawa ol th8 State of South Carolina.
If I am a large quantity generator, I cer1ily that I have a program in place to reduce the volume and loxlcltyofwaalegenoratod totha degree I have determined to be economic.ally
practicable and thal I havo selected the practicable method ol lreatment, storage, or dlspoaal currently available to me which mlnlmltos tho present and luture thr-1 to human
health and the environment; OR, if I am a smo11 Quantity generator, I have made a good laith effort to minimize mywaslo generation and selecl the beat wute management method
that i1 available to me and that I can afford.
Printed/Typed Name ROGER L. COATS Signature
Signature
Signature
19. Discrepancy Indication Space
Year
Month Day Year
• ... I .L...L...L-L-'-'jlbs. c lL..L......._......,_,!lbs.
b I Jibs. d I Jibs.
T 20. Facility Owner or Operator, Certification of receipt of hazardous malerials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9186) Previous Editions are Obsolete (DHEC 1988 (Rev. 10186)]
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
SE PRINT or TYPE (Form desi ned for use on elite 12-itch writer
UNIFORM HAZARDOUS 1. Generalor"sU.S.EPAIDNo. Manifest Document No. WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator"sPhone 919 934-9711
5. Transporter 1 Company Name
·Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
0 0 2 1
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Einergency & Holidays.: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1 lnlormalion in the shaded areas is not
of required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Container, 13. Total Quantity 14. Unit \i/,W&.)i#iibei\t(
No. Type 'MN!l {£fii&i,i0ffofdf)§i
a
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72339
16. GENERATOR'S CERT\F\CA TION: I hereby declare Iha! Iha contents of this consignment are fully and accurately described above by proper ahlpplng name and are claaailled,
packed, marked, and labeled, and are in all respects in proper condition !or transport by highway according to applicable International and national government regulation• and
the laws of the State of South Carolina.
111 am a large Quantity generator, I certify that I have a program in place to reduce the volume and toxicity ol waste generated to the degree I have determined to be economically
practicable and that I have selected the practicable method ol treatment. storage, or disposal currently available to me which minimize• the present and future threat to human
health and the environment; OR, If I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the beat waste management method
that Is available to me and that I can afford.
Printed/Typed Name ROGER L. COATS Signature Month Day Year
0 c; r.,
eceipt of Materials
Month Year
6
Printed/Typed Name Month Day Year
19. Discrepancy Indication Space
a I ilbl. C I ilbl.
bl pbs. d I !lbs
20. Facility Own·er or Operator; Certification of receipt of hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter} OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Fedeial Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatment.,
storage, or disposal licililies to use the U.S. EPA Form 8700-22 Rev. 9166 fOHEC 1986 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Form
8700-22A Rev: 9/86 (DHEC 1988A) for both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States from
another country are respon~ible for cory,pteting the manifest Federal and State regulations also require generators and transporters of hazardous waste and
owners or operator~ of hazardous waste treatment, stor~ge, or disposal facilities lo complete the following inform·ation. · I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to th.is manifest by the generator beginning ":"ith 00001. II your company does not have a U.S. EPA Identification Number. please contact S.C .• -
OHEC at [phone] about obtaining an identification number.
2:. Page 1 of: Enter the total number of pages used to complete this manifest, i.e .. the first page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)] plus the
, number of continuation sheets EPA Form 8700-22 Rev. 9/B6A (DHEC 1988A) ii any.
A State Manifest Document Numbei-:-,.Leave blank.
s: Slate Generator Identification Number: .. Leave blank. " I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
4. Generator's Pholle Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the event ol an
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6.~ U.S. EPA 1D Number: Enter the U.S. EPA twelve digit identification number of the lirst transporter identified in item 5.
C. Slate Transporter's ID Number:, Leave blank: I
D. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the lirsttransporter can be reached in the event of
an emergency including nights, weekends, and holidays. I
T' Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. If more than 2 transporters will
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the waste.
8.. U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
E.. Slate Transporter's ID Number: Leave blank. I
F:. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent al the second transporter can be reached in the
even! of an emergency including nights, weekends, and holidays. .
9.. Designaled Facilily Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be the site address. which may differ from the mailing address.
10: U.S: EPA ID Number: Enter the U.S. EPA twelve digit identification number al the designated treatment, storage, or disposal facility identified in item 9.
G:. State Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event al an
I
emergency including nights, weekends, and holidays.. I
11: U.S: DOT Descripllbns: Enter proper shipping name, hazard class and ID Number (UN/ NA) !or each waste as identHied in 49 CFR 1 71-1 77. If additional space
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers tor each waste and the appropriate abbreviation from Table I (below) for the type of containers.
TABLE I
OM.= Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons. cases. roll offs
OW= Wooden drums. barrels, kegs TC= Tank cars CW=: Wooden boxes. cartons, cases I
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
Total Quantity: Enter total quantity al waste described on each line, relative to·the units used in item 14.
Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for"lhe unit of measure:
13 ..
14. I Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y-= Cubic Yards G-= Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 -79.261 Subparts C and D to I
identify the hazardous waste on each tine.
J: Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Authorization Request Form)
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted !or treatment storage or disposal in South Carolina. the
generator muSt obtain prior authorization from the treatment, storage or disposal facility. I
K. Handllng Codes tor Wastes Listed Above: Leave blank.
15 .. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or disposal
inlormalion or Bill of Lading Information. For international.shipments, generators must enter in this space the point ol departure (city and state) !or those
shipments destined for treatment, storage. Or disposal outside the jurisdiction of the United States. · I
16. Genera~or Certification: The generator must READ, SIGN (BY HANO I~ INK), and DATE the certificati?~ .. state,mert.11 a mode other than highway is used, the
word "highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below: If another mode in addition to the highway mode is
used, enter the appropriate a_dditional mode (e.g.,_and_ rail) in the space below.
mANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalf ol the first transporter.
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt.
., I That person must acknowledge
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behafl of the second transporter. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt: I
FACILITY SECTION .
19. Discrepancy Indication Space: The authorized repr~sentalive of the designated facility's owner or operator must note in this space any discrepancy between
the waste described on the ·maiiilest and the waste actUa!ly received at the facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit to the Department a letter with a copy of the manifest describing the discrepancy and attempts to I
reconcile iL The treatment storage. or disposal facility must enter the actual weight of waste in pounds in the spaces provided if the amount varies any from that
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Ownei-or Operator Certilicalion: Print or type the name ol the person accepting the waste on behalf ol the owner Or operator of the facility. That person
must acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INKfand entering the DATE ol receipt. I
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE. OR DISPOSAL FACILITY DESIGNATED TO
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. I
I South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
· P. 0. Box 1416, Smithfield, NC 27577
4. Generalo(sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sito Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
a.
t.
d.
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 72340
Form A
2. Page 1
of
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 E.x ires 9-30-88
Information in the shaded areas is not
required by Federal law, but is by·Stale law.
16. GENERATOR'S CERTIFICATION: I hereby declare lhat the contents of this consignment are lully and accuratelydascrlbod above by proper shipping name and are clasaified.
pack.ad, marked. and labeled.and are in all respects in proper condition for transport by highway according to applicable International and national government ra,gulatlon• aod
the laws ol lha State ol South Carolina.
111 am a large quantity generalor. I cortily !hat I he,vo a program In place to reduce lhavoluma and to:idclty ofwaslegenarated to Iha dagr-1 have datarmlnod to be economlcalty
practicable and that I have selecled the practicable method ol trealmont, storage, or dlspoaal currently available lo me which minimizes the present and lutura lhroat to human
health and the environment; OR, 1, 1 am a small quanlitygonorator. I have modo a good faith effort lo minimize my waste genorallon and aelecl the beal waate management method
that ia avai1abla to mo and that I can afford.
Printed/Typed Name ROGER L. COATS Signature Month Year
CJ C
T 17. Transporter 1 Atamowledgement of Receipt of Materials
Printed/Typed Name Signature
l
Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86))
a!....__......_.,_._
bl~~~
Month ay Year
0
Month Day Year
!lbs. e I jibs.
pbs. d I pbs.
Month Day Year
I
I T
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5-424
E PRINT or TYPE (Form desl ned foi use on elfte 12-ilch ewriler Form A· roved. 0MB No. 2050-0039 E.x ires 9-30-8.8
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D O 7
Manlfe11t Document No. 0 0 2 l 5
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generato~, Phone [phone]
5. Transporter l Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Haz~rd Class, and ID· Number}
t.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
2. Page 1
ol
1 D T
~~;~,~,~; ~~J !~:~i;::i.:11:~:;1 :~;i',':\t:\1r:;;1;i111t~111111:~ii1:1::;:i~1:1r,i:::1::':J1:ttiir:'.1i1
a.1LMJ-10,2,7,7,4l-11r1,o,21n·swn;:A1c-LLJ-I 1-1 , , , hr
b.LLJ:1 , , , , 1-1 , , , .J~ll11i!~~f!!ldw:L !.. 1-1 ·•
1S. Special Handling Instructions and Additional Information
GSX Work Order No.: 72341
Information in the shaded areas is not
required by Federal law, but is by State law.
l~'Yf ·~to~~,1 .. ,~911
2 O Y t.J1E1P10161g;
16. GENERATOR'S CERTIFICATION: I hereby declare the1 !he content, olthi, consignment are fully end accuro.tGlydescrlbed above by proper ahlpplno name and are cla.s.ailled,
packed. marked, and labeled, and are in all respects in proper condilion for Iran sport by highway according to applicable lnlernationel and natlonal governmanl r&gulatlona and
the laws ol the State of South Carolina.
111 am a large quantity generator, I certify that I have a program in placa to reduce the volume end toxicity of waste generated to the dog roe 1 have dalarmlnod to be economk:ally
practicable and that I have aalactad Iha praclicable mathod ol traatmanl. storage, or dlapoaal curranlly available lo me which minimizes tho preMnt and luture thrNt to human
health and the environment OR, 111 am a small quantilygenerator, I have made a good lalth effort to minimize mywesle generation and select the best wute management rn.thOd
that is available to me and that I can afford.
Printed/Typed Name ROGER L. COATS. Signature d h, Month Day y..,
17. Transporter 1 Ac:P':nowledgement of Receipl ol Materials
Printed/Typed Nam,L._ /, a-"' t1 Se :_,.; -' Signatuy -f:iyc)
18. Transp0rter 2 Acknowledgement of Receipt of Materials 1/ V
Printed/Typed Name Signature Monttl Day Year
19. Discrepancy Indication Space
a I !'bl CI jlbl
b I jibs. d I jibs.
20. Facility Owner or Operator, Certification of receipt ol hazardous materials covered by this manifest except as noted ln ttem 19.
Printed/Typed Name Signature Month Day Yea,
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
South Carolina Department of Health
and Environmental Control
SE PRINT or TYPE {Form desi ned for use on elite 12-itch writer Form A
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manliest 2. Page l
Document No. of WASTE MANIFEST N c o o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato(s Phone 9 I 9 9 34-9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
1 4 0 0 2 1 6
6. U.S. EPA ID Number
S C D O 7 3 7
8, U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Soee\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. OMS No. 2050-0039 E,:: ires 9-30-Ba
Information in the shaded areas is not
r&quired by Federal law. but is by State law.
1 ~1. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number) 1~
0
Conta~;~ 13. Total Quantity 1~~1 ·•,~:\~:f'.:.~~:t'
' Hazardous Waste, Solid, nos ORM-E !~~'ffo";l;'9Y5t
N l--~N::;A:!.,_9::..:_l'.:'._8.:_9 ______ _:_ __________________ .j....L.11:...j:D'.:..JT.:....l--1--1....:...L:2:XO+...:Y:__+t:!q.!:o E::::•~Q;!1~Q;!1;:6:!i.:l~~'. (! :".2,~.':-,<,, ,.·_-..:..,'i:..:~;;..,.,;,. ''t( :_,, I I I Le::,~ {fl !lt d1 1f\ "'~ • • ('I<
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 72342
16. CiENERATOR·s CERTIFICATION: I hereby declare that the contenis of this consignmonl are lullyand accurately described above by proper shipping name and are classified.
packed. marked, and 1a·beled, and are In all respects in proper condition for transport by highway according to applicable International and natlonal govemmont re,gulatlon• and
tr,e laws of the Slate ol Soulh Caronna.
I! I am a large quantity generator, I certify thal I have a program In place to roducothevotume and toxicity ofwastogeneralod to tho degr-1 have determined to be oeonomlcally
prac11cable and that I have selected the pracllcable method ol trealmenl storage, or disposal currently available to me which minimizes the present •nd luture thr-t to human
health and the environment: OR. if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the beat waate management method
that is available to me and that I can aNord.
Printed/Typed Name ~§§eR L. COATS
T 17. Transporter 1 At.:1mowledgemenl_of Aeceipl ol Materials
Prif!led/Typed Name
Printed/Typed Name
l 9. Discrepancy Indication Space
20. Facility Owner or Operator, Certificallon of receipt of hazardous malerials covered by this manifesl except as noled in Item 19.
Prinled/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
Month
Month Day Year
' l'-'-....... _._.-'!lbs. ' l'-'-,._._......, .... Pbs.
b I jibs. d I jibs.
Month Day Yw
I
.
. 6.-·{ ,4 '
·~
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7 6 o 1
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number .
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD07037
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72343
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 E.x ires 9-30-88
Information in the shaded a,-eas is no!
required by Federal law, but is by State law.
12. Containers 13. Total Quantify U. Unit
No. Type 'Mfld
1 D T
\1;F·tff,'i,'tf,11
\.;;; -jv;,
2 0 Y ~1F101D161~
16. GENERATOR'S CERTIFICATION: I hereby declare that the conlents ol this consignment ere fully and accurataly described above by proper thlpplng name and are clauifled,
packed, markod, and 1a·beled,and are in all respects in proper condition !or tronsport by highway according to applicable International and natlonal government r90ulatlon11 and
the taws ol the State ol South Carolina.
111 am a large quantity generator, I certify that I have a program In place to reduce the volume and toxlcftyol waste generated to the degree I have determined to be economically
practicable and Iha! I have selected the practicable melhod ol treatment, storage, or dispose! currently available to me which minimizes the present and future threat to human
health end the environment: OR, ii I am a small quantity generator, I have mado a good faith effort to minimize my waste generation and selacl the beat waata management methOd
thal Is available to me end that I can afford.
Printed/Typed Name ROGER L. COATS Signature Month
D
Year
T 17. Transporter 1 Ae;Knowledgemenl of Receipt of Materials
Printed/Typed NartJ.Lp. -> /Yl(';i 1-J. Signatur
0
18. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name Signature M9nth Day Year
19. Discrepancy Indication Space
I l~ .................. l'bs. C .... , ~ ...... _.jibs.
bl jibs d I jibs
20. Facility Owner or Operator; Certification of receipt of hazardous malerials covered by this manifest except as noted In ttem 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700·22 {Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
I
.
,f ~ .~ ,.
-~ ~.t'\~ :. 'l . -~
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
,. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
CD0737
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID fi!umber)
Form A
2. Page 1 of
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-00J9 Ex ires 9-30,88
Information in the shaded a<eas is noI
required by Federal law, but is by State law.
E a. Hazardous Waste, Solid, nos ORM-E i!f\'F;O~'T"f'§'\~f;
IN ~b-. _::N~A:._:9::1~8::9:__ ________________________ _J_...L..J:l:....j:D:'...lT'.:....j.-1.-1.-1.:2...l.'.:0+..:Y_l,;;;:!.i,:::!= .. ¼::Q:::,.-::;?:::.=:::,:::~~721f;::J,
''j ¼i :~;-~, .~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72344
16. GENERATOR'S CERTIFICATION: I hereby declarethal !ho contenta oflhia conalgnmenl are lully and accurately described above by proper ahlpplng n•m• and are cJaaailleG,
packed. mark~. and tabeled, and are In all respecta In proper condition fortranspor1 by highway according to applicable International and natlonal government re,gulatlons and
the laws of the State ol Soulh Carolina.
II I am a large quantity genera!or, I certify thal I have a program in place lo reducethavotume and toxicity ofwaategonerated to the dog roe I have determined lo be economteally
precticable and that I have selocled the practicable method ol treatment, storage, or dlspoaal currently available to me which minimizes the present and future throat lo ttumen
health and the environment; OR, 111 am a smol1 quantity generator, I have made a good laith effort to minimize mywastegeneratlon and select the ~st wa1ta management method
thal is available to me and that I can afford.
I Printed/Typed Name ROGER L. COATS.
T 17. Transporter 1 AcKnowledgement of Receipt of Materials I Pnnt~Typed Name ~•J:..-
P l:,},o,;J'f~ ..e,,;,-
~ 18. Transporter 2 Acknowledgement ol Receipt of Materials
Printed/Typed Name
19. Oiscrepan~y Indication Spac_e
Signature
Signature
20. Facility Owner or Operator; Cer1ificallon of receipl of hazardous materials covered by !his manifest except as noted In Item 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9186) Pre_vious Editions are Obsolote (DHEC 1988 (Rev. 10186))
aj ........ .L..J...._,_
bl~ ........ ~
Month
0
Monltl
/lbs. e I
/lbs. d I
Month
Day Year
jibs.
jibs.
Dey Year
I
I T
," ,,· ,~ ',. ~~\ < l •
·~-::·
South Carolina Department of Health
and Environmental Control ·-
E PRINT or TYPE (Form des! ned for use on elite 12-itch wrller
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
3. Generator's Name and Mailing Address
Channel Master
N C D O 7
P. O. Box 1416, Smithfield, NC 27577
Generator's Phone 9 1 9 9 3 4-9 7 11
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
1 4
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD07037
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number)
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72345
Form A
1 D T
Bureau of Solid & Ha.z.ardous Waste Mgt
2600 Boll Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-aa
Information in the shaded areas is nol
required by Federal law, but is by State law.
/,iF''(0;•1··19"1';;;-
2 0 Y l,E1Q1Q161I
• 16. GENERATOR'S CERTIFICATION: I hereby declare Iha! !he contents olthls consignment are fully and accuralelydescrlbed above by proper shipping name and ore cla»Wod,
packed. marked. and labeled.and are in all raspects in proper condilion for transport by highway according lo applicable International and national government r.;ulallons a/'\d
the taws ol the State ol South Carolina.
111 am a large quantity ·generator, I certify thal I have a program In place to reduce thevolumeand to:iclcltyofwaslegenerated lo the degr-I have determined to be economically
prac1icabte and that l have selected the practicable method ol lreatmant, slorage, or dlspoaal currenUy evallable to me which minimizes the present and lurura lhr-110 human
health and the environment OR, II I am a small quantity generalor. I have made a good la Ith effort to mini mite my waste generation and select the beat waate managemenl method
Iha! is available to me and that 1 can afford.
Printed/Typed Name ROGER L. COATS Signature ;k ~ Month Year
17. Transporter 1 Au:nowledgemenl of Receipt of Materials
Printed/Typed Name ___ ,,< Signature
r,,...., ;>--;n,. ~
18. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
a I libs. e I libs.
bl jibs. d I jibs
20. Facility Owner or Operator; Certification of receipt of hazardous malerlals covered by this manifest except as noted In Item 19,
Prinled/Typed Name Signature Month Doy Year
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)1
I South Carolina Department of Health.
and Environmental Control
Bureau or Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 E.x ires 9-30-88
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel·Master
P. 0, Box 1416, Smithfield, NC 27577
4. Generato(sPhone 919 934-9711
5. Transpor1er 1 Company Name
Willms Truckin Co Inc.
7. Transpcrter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc;
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7
10,. U.S. EPA ID Number
SCDO7O37
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
C.
d.
2. Page 1
of lnlormalion in the shaded areas is not
required by Federal law, but is by State law.
:~l:~~,:~~:~:::~I[:?~!;i~~~:~~~~~:;:i;t
l\\;t~;;;;?)i~i~((f ~~;;~~~i~t~ilt~iiitf ~!~J
12. Containers
No. Type
d\:t%'r/l%.>/~;,?\1/=:\t;=
13. Total Quantity 14. Unil ;L.WUIBNumli«((
wvva ;y\/?'( t:rnJNMf:?
:'-i..l;·: .. '-;.."~.:.,.:~~:c;.·1ti:.
,~J ~nt =f:,;~:~1)ii~fl;iillll~l;;~i:~l~rjlf:~1t~lllljll1~,!~!l~i1,l)!!J/il~:~~ij1t~~\~
b. W.:::1 . 1-1 1;i/,l!i:H!it't~:W::J ·······'··J .' }:I J ,11~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72346.
16. GENERATOR'S CERTIFICATION: I hereby declare thal the contents oflhls consignment are fully and accurately described above by proper shipping name and era cla.uilied ..
packed. marked, and 18beled.and are in all respects in proper condition tor transport byhlghwey eccording to applicable lnlernatlonal and nallonal governmen1 re,gulatlona and
u,e laws of the St.ale ol South Carolina.
If I am a large quantity generator, I certify thal I have a program In place lo reduce the volume and to,dclly ol waste generated to the d&Qroe I have determined lo be &eonomically
practicable and that I have selected tho practicable molhod of lrootmont, storage, or dlspoul currently available to me which minimizes the preunt and !ult.ire u,,_, to human
heellh and the environment; OR, ii I am a small quantity generator, l have mado a good laith ettort to minimize my waste generation and select tho beat waste management mothod
that is available to me and that I con allord.
Printed/Typed Name ROGER L. COAT Signature
Printed/Typed Name
19. Discrepancy Indication Space
20. Facility Owner or Operator: Certification ol receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
Month Day Year
a l~.._._.....,..,P.bs. ' 1..I .1....1.......,_..L.Jpbs.
b I pbs. d I pbs.
Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev.10/86)]
I South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generalor',U.S.EPAIDNo. Manifest
Document No. WASTE MANIFEST N c o o 7 6 o 1400221
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato(s Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D 0 7 0
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number)
L
Hazardous Waste, Solid, nos ORM-E
Form A
2. Page 1
of
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street, Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded Meas is not
required by Federal law, but is by State law.
N NA 9189 1 D T
/'Cir ;ch+: g"t~
2 o Y !1F1Q1D161I
C.
d.
~ti~,~~,~i:~t!~,~!r!i!~~!!·!:1!j!1:~\tlll!~i1i,li1!ttilfi,l!t~11 ll!~!lllf e~ll!,llli!~ 1£...illJ \012171714\ \l1l1012\%m/7ti ·LLJ \ I I J,,,,
b.LLJ-\ ,-, 1_1~l~~;f;!1ii:i!.~:W.=.L jc-j 1 ".J!i::!
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72347
,e. OENERATOR'S CERTIFICATION: I horobydoclare lhat the contents oflhls conslgnmonl aro lully and accuratolydoscribed above by proper ahlpplng name and are clau.iti.-d,
packed, marked, and laheled, and are In all respects in proper condition !or transport by highway according to appllc.ble International and natlonal government r-oulatlon• and
the laws of tho State ol South Carolina.
tr I am a large quanlity generator, 1 cer1ify that1 have a program In place lo reduce the volume and toidclty of waste generated to tho dog roe 1 have determined to be economically
. practicable and lhol I have selected the practicable method ol treatment storage, or dlapoaal currently available to me which minimizes tho present and luturo throat to human
health and the environment: OR, ii I am a smart quantity generator, I have made a good faith effort to minimize my waste generation and select the best wa11a management m,ethod
that is available to ma and that I can atford.
Printed/Typed Name ~©~ER L. COATS Month
0
Year
T 17. !ransporter 1 Ac.:Knowledgemenl of Receipt of Matwia1s
P nted/Typed Name C----l
U/'YI
gement of Receipt ol Materials
ed Name Signature Month Day Year
19. Discrepancy Indication Space
a I Jibs. C I Jibs.
bJ I Jibs. d I Jibs.
20. Facility Owner or Operator; Certification of receipt of hazardous malerials covered by !his manifest except as noted fn Item 19.
Printed/Typed Name Signature Month Dey Year
EPA Form 8700~22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
I
I
South Carolina Department of Health
and Environmental Control
Bureau of Solid·& Haz.ardous Waste Mgt
2600 Bull Street, Columbia. SC 29201
Phone: [phone]
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
4. Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood, SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Cfass, and ID Number)
a.
C.
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72348
Form A
2. Page 1
of
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded areas is not
required by Federal law, but is by State law.
12. Containers 13. Total Quantity 14. Unit
No. Type 'MNd
18. GENERATOR'S CERTIFICATION: I hereby declore lhat the contents olthls consignment ere fully and accurately described ebove by proper shipping name and are ctaaailled.
packed. marked, and lahelcd, and are in all respects in proper condilion for transport by highway 11ccording to applicable international and neuonel government regulaUon• arid
the laws ol the Slate ol South Carolina.
If I am a large Quantity generator, r certify lhal I have a program In placo to reduce the volume and toJ1dcJty ofwaslegeneraled to the degr-1 have determined to be economically
precticable and that I have selected the Practicable methOd ol treatment. storage, or disposal currently available to me which minimizes the pres.en! and luture threat to human
health and the environment: OR, If I am a small quantity generalor, I have made a good lailh effort to minimize my waste generation and select Iha bait wa1ta managamant method
that is avei1ab1a to me and that I can afford.
Printed/Typed Name
Printed/Typed Name Signature
19. Discrepancy Indication Space
Month
Month Cay Year
8 ~I ................. ~libs. c IL...L.J...J....L.J.-'pbs.
b I pbs. d I libs.
T 20. Facility Owner or Operator; Certification of receipt of hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Dey Y 08/
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull $tree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
N C D 0
P •. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone 9 1 9 9 3 4-9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site. Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
B. U.S. EPA ID Number
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class." and ID Number)
a
C.
d.
GSX Work Order No.: 72349
2. Page 1
of Information in the shaded Meas is not
required by Federal law, but Ls by State law.
1 e. GENERATOR'S CERTIFICATION: I horeby declare thallhe conlents ol thl1 consignment are fully and accurately d1111crlbetd above by Proper shipping nam• and ar• ctutined,
packed, marked, and ta'beted,and are In all respects In proper condition lor Iran sport by highway according to applicable lnlernallonal and national government r~ulatJor,a af\d
the laws ol the State of South Carolina.
If I am a large quantity generator, I certify that I have a program In place to reduce the volume and loxlcltyolwaategenerated to the degr-1 have determined to be economblly
practicable and that I have selected the practicable method of treatment. storage, or dlsposal currently available to me which minimizes the present and future threat Lo human
health and the environment: OR. Ill am a smelt quantity generator, I have made a good faith etlortto minimize mywastageneraUon and select the be1t wa1111 management method
that I• available to me and !hat I can afford.
Printed/Typed Name ROGER L. COATS Signature
7. T,ansporter 1 Acr<nowledgemenl of Receipt ol Materials
Printed/Typed Name Signature
1 9. Discrepancy Indication Space
11---------------T 20. Facility Owner or Operator; Certification of receipt ol hazardous malerlals covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
Month
0
Month Day Year
1 !....,,_,....,,_,....,,_,Pb!. c 1...I L...L..JL...L..JuPbl.
b I !lbs. d I jibs.
Month Day Year
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 E.x. ires 9-30-88
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manliest Document No, 2. Page 1
ol WASTE MANIFEST N c D o 7
3. Generator's Name 8nd Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato~, Phone 9 1 9 9 3 4-9 7 11
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood, SC 29125
0 0 2 2 4
6. U.S. EPA 10 Number
SCD0737
8. U.S. EPA ID.Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (inc/Uding Proper Shipping Name, Hazard Class, Bnd ID Number) 12. Containers
No. Type
a.
C.
d.
~~~~~~
15. Special Handling Instructions and Additional Information
·, GSX Work Order No. : 72350
Information in the shaded areas is not
required by Federal law, but is by State law.
13. Total Quantity 14. Unit il\Wala Numbei:/
· 'MNfJ ?tWnWth\ft%Jlffffe..'
16. GENERATOR'S CERTIFICATION: 1 hereby declare thal lhecontent:, olthl:, con:,lgnmentare fully and accuratelyde:,cribed above by proper shipping name and are clanifled,
packed, marked, and la°beled,and are In all respects in proper condiUon for transport by highway according to appllcable internatlonal and national government regulatlona and
the laws ol the Stale ol South Carolina. ·
It I am a large Quantity generator, I certify that I have a program in place to reduce the volume and toxicity of wa11e generaled to the dagree 1 have datarmlned lo be economically
practicable and that I have selected the practicable method cl treatment, atorage, or disposal currently available to me which minimizes the present and future threat to human
health and lhe environment; OR, 111 am a small quantity generator, I have made a good faith effort to minimize my waste generation and selecl the beat wa.te management methOd
that ia available to me and that I can afford.
Printed/Typed Name RO.GER L COAI~ Signature
nt of Receipt ol Materials
Signature
Printed/Typed Name Signature·
19. Discrepancy Indication Space
20. Facility Owner or Operator, Certification ol receipt ol hazardous materials covered by !his manifest except as noted In Item 19.
Printed/Typed Name Signature
Month
0
Year
Month Day Y~
#, 9. 't, i', J
Month Day Year
• !.......__.._._.._.___,Pbs. ' l ......... ...._......__.!lbs.
bl pbs.dl pt>s.
Month Day Yur
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
I South Carolina Department of Health
and Environmental Control
.EASE PRINT or TYPE ewriter
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No. Manifest
Document No.
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
4. Generator's Phone 91 9
Smithfield,
934-9711
S. Transporter 1 Company Name
Willms Truckin Co.
7. Transporter 2 Company Name
Inc.
C D O 9 7 6 0 4 7 1 4 0 0 2 2 6
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7 0 9 2 9
8. U.S. EPA ID Number
9. Designated Facility Name and Site Address 10. U.S. EPA ID NulTlber
GSX Services of SC, Inc.
Form A
2. Page 1
of l
Bureau of Solid & Hazardous Wa:ite Mgt
2600 Bull Stree~ COiumbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information In the sha·ded areas is no1
required by Federal law, but is by State law.
;~~::o!d B~~ ~~i 25 s C D O 7 0 3 7 5 9 8 5 mi,~·.;:~!='I~rl•fil19~~~t::1::fi11li5'iti\
11. U.S. DOT ,Description (including Proper Shipping Name, Hazard Class, and ID Number} 1~
0
~onta~;; 13. Total Quantity 1~:1 •:~~t&0tt,:~4~y
a.
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 72382
~::,r I
:()1 I
16. GENER.A. TO R'S CERTIFICATION: 1 horeby declare that the contents cl this consignment are lully and accurately described above bY pr0P4r shipping nam• end ar• clusiti9d.
packed. marked. and labeled. and are in all respects in proper condition lor trenspor1 by highway according to applicable lnlernalionel and national government r-oulations and
U'\e laws ol the State ol South Carolina.
If I am a large quan1ity generalor, I certily that I have a program In place to reduce the volume and toxicity of waste generated lo the degree I have determined to be economlcally
prachcable and that I have selecled tho practicable method ol treatmenl. storage, or disposal currently available to mo which minimizes the present and luture thr-t to human
health and the environmenl; OR, If I am a smatl quantity generator, I have made a good lallh effort to minimize mywasto generation and select the be•! we,te management ~thOd
that is available to me and that I can afford.
Printed/Typed Name Ro8£R L. COATS Signature
17. Transporter 1 Ae;Knowledgement of Receipt of Materials
Signature
18. Transporter 2 Acknowledgemenlol Receipt ol Materials
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator, Certification of receipt of hazardous materials covered by this manifesl excepl as noted in Item 19.
Printed/Typed Name Signature
EPA Form 8700·22 (Rev. 9/86) Previous Editions nre Obsolelo {OHEC 1988 (Rev. 10/86)]
• IL...L..L.J ........
bl~~~
Month Year
0
Month Year
(J /
Month Day Year
jibs. C I 111,s.
pbs. d I !lbs.
Month Day Year
)
'
I . Mi-"-, '4\
-~ .. '
South Carolina Department of Health
and Environmental Control
eu'reau or Solid & Hazardous Waste Mgt.
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holida)'1: [phone]
I PLEASE PRINT or TYPE (Form desi ned lor use on elite 12-ilch writer
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manlfeat
Document No.
Form A
2. Page 1
roved. 0MB No. 2050-0009 Ex ires 9-30-88
Information in the shaded areas is not
required by Federal law. but is by State law.
I
I
I
I
I
I
I
I
I
I
WASTE MANIFEST c D o 9 7 6 o 4 71400010
3. Generator's Name and Mailing Address i
Channel Master
P. o. Box 1416,
,. Generator's Phone 919
Smithfield,
934-9711
5. Transporter 1 Company Name
Willms Truckin Co.
7. Transporter 2 Company Name
Inc.
. 9. Designated Facility Name and Site Address
CSX Services of SC, Inc.
Route I, Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7 0 9 2 9
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
15. Special Handling Instructions and Additioriat Information
CSX Work Order No.: 71023
of 1
-~?~;a=-:e=.~+' .. :;1:~;t%f'.;\;~~;~~:1~;;;.
ti ;~;¾~~~!:11i~~;~~11'.fi>:~{,fi~t:r~~tHt~f&di
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents olthis consignment are fully and accurately da1cribed above by proper 1hipplng nama and ar•cla .... fled.
packed, marked, and 111·beted,and are in an respects in proper condition fortran,port by highway according to applleable lnlernatlonal and natlon1I governman1 raoulaUon, aNI
the laws ol lhe Stale ol South Carolina.
111 am a large quanlity generator, r cer1ity that I have a program In place to reducethevotume end toxicity of waste generated to the dog roe I have determined to b9 oconomicalty
practicable and that I have ,elected the practicable melhod ol treatment, storage, or dlspoaa.l currently availabla to me which minimlze11 the preaenl and future lhr .. 1 to hum,in
health and the environment; OR, ii I am a small quantity generator, I have made a good faith effort to minimize mywasteganeraUon and select the beat waata management method
that is available to me and thal I can ettord.
Signature
~ 1-1-'-7'-. ;_T..:r•;_n;::•P:.;O;_rt:.:•;_r ;_1 ;_A;:_«;:_n..:o ... w;_led..:.eg•;:_m;_e;_n;_t;_o;_I R;_•:..c..:•:.:iP;:_I ;:_ol;_M:..•::'•:.:r.::i•;_l•:_ __ -'-r--------------------------------~ I ~ Printed/Typed ~3S Signature L . . ~-Month Year
~ . 2.ocvYiQ r~ ~r
I
o 18. Transporter 2 Acknowledgement of Receipt ol Materials Ai.;;:_~===============---~----------------------------~ Signature Month Day Year ~ Printed/Typed Name
A
19. · Discrepancy Indication Space
I ~ L
a lw...,__,_.J,...J._,!lbs. c lu....,__,_.....,_,Jllil.
b I jibs. d I libs.
+ ~2-0-. -::F-,c-i-lity--,O_w_n-er_o_r_O,_p-e-ra-to_r._, C.,.e-rt"";r,'",c-a""lio_n_of receipt of hazardous materials covered by this manrfest except as noted In Item 19.
I V
Prinled/Typed Name Signature
.,..'---,.,.,.,,..,.,..,.,,..-,-,.,..,,..,,_,-,--=-,,.,...----=----,-1-,,,,...----------------~t.....1....L...I....L..1-.I EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)}
Month Day Year
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: n'PE ion a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulatioris require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, ii necessary, th& continuation sheet U.S. EPA Fo
8700-22A Rev:9/86 (DHEC 1988A) tor both inter-state and intra-state transportation. Transporters who lransport hazardous waste into the United States Ira
another country are responsible !or completing the manifest Federal and State regulations also require 9enerators and transporters or hazardous waste ana
owners or operator~ of hazardous waste treatment, storage, or disposal facilities to complete the following information. I
GENERATOR SECTION ,. Generator's U.S. EPA ID Number. Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unic;ue live digit
number assigned to this manifest by the generator beginning with 00001. If.your company does not have a U.S. EPA ldent\lication Number, please contact S.1 OHEC at [phone] about obtaining an ldenlllication number.
Page 1 of: Enter the total number of pages used to complete this manifest, I.e., the !list page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)] plus t
number of continuation sheets EPA Form 8700-22 Rev. 9I86A (DHEC 1988A) if any.
A. State Manilest Document Number:· .Leave blank: ·
B: State Generalor Identification Number: .. Leave blank .... • I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifes: lorms.
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in :he event of an
emergency including nights, weekends, and holidays. I 5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Numbe'r: Enter the U.S. EPA twelve digit identification nu·mber of the lirst transporter identified in item 5.
C. Slate Transporter's 10 Number: Leave blank.
O. Transporter's Phone Number: ·enter a te1eph0ne number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. · j
T. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. If more than 2 !ransporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was, .
8 .. U.S. EPA 10 Number:11 applicable, enter the U.S .. EPA twelve digit ID number of the second transporter identified in item 7.
E. State Transporter's ID Number: Leave blank. · I
F .. Tr.ansporter's Phone Number: Enter a telephone number including area code where an authorized agenl of the second transporter can be reached int ·
event of an emergency including nights, weekends, and holidays.
9.
10.
G:.
Designated Facilily Name and Site Address: Enter the company name and site address ol the treatment, storage, or disposal facility designated :o receive the
waste listed on this manifest The address must be the sile address, which may differ from the mailing address. I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage, or disposal facility identified in item 9.
Slate Facility's ID Number: Leave blank.
H;. Facility·, Phone Number: Enter a telephone number including area code where an aulhorized agent of the facility can be reached in me event ot an
emergency including nights, weekends, and holidays. · I
U.S; DOT Descriptions: Enter Rropershipping name, hazard class and ID Number (UN/NA) !or each waste as identified in 49 CFR 171.177.11 additional spa
is needed, use a U.S. EPA Form 8700-22A Rev. 9186 (DHEC 1988A) Continuation Sheet. ·
11:
12.. Cont8iners (no. and type): Enter number ol containers for each waste and the appropriate abbreviation from Table I (below) for the type o! containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons, cases. roll otts
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases I
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= B~rlap, cloth. paper or plastic bags
Total Quantity: Enter total quantity ol waste described on each line. relative to the units used in item 14.
T4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unil of measure:
13 .. I
Table II
P = Pounds L = liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid onli
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subparts C ar.d D
identify the hazardous waste on each line. •
J. Addltlonal Deseripllons for Materials Listed Above: In the spaces provided. enter the authorization number (lrom the S.C. DHEC Authorization Rec:iuest Form).
tor each waste stream listP.d in section 11 above. Nole: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. the,
generator must obtain prior authorization lrom lhe treatment. storage or disposal facility. I
K. Handling Codes for Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or dis po
information or Bill of Lading Information. For international shipments, generators must enter in this space the' point ol departure ·tcity and state) !or those
shipments destined !or treatment, storage. or disposal outside lhe jurisdiclion ol the United States. I
16. Generalor Certillcalion: The generator must READ, SIGN {BY HAND IN INK), and DATE the certification statement.11 a mode other than highway is used.:
word .. highway·· should be lined oUt 'and the apprO:priate mode (rail, water, or air) inserted in the space below. II another mode in addition 10 the highway mode
used, enter the appropriate additional mode (e.g.,.and rail) in lhe space below.
~NSPOITTERSE~ON . ,··
11; Transporter 1 Acknowledgemenl: Enter the name ol the person accepting the waste on behalf ol the first transporter. That person must acknowled
acceptance al the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf ol th.e second transporter. That person must
acknowledge accep1ance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt I
FACILITY SECTION ·
19. Discrepancy lndicalion Space: The authorized represen.tative ol the designated facility's owner or operator ITlust note in this space any discrepancy betwe\!
the waste described on the manifest and the waste actLially received at the racility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving !he waste must submit to the Department a letter with a copy of the manifest describing the discrepancy and atem::,ts I
reconcile iL The treatment. storage, or disposal facility musf enter lhe actual weight ol waste in pounds in the spaces provided if the amount varies any lrom th
specil1ed by the generator in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facility Own el' or Operator Certilicalion: Print or type the name of the person accepting the waste on be hall ol the owner or operator ol the facility. That person
must acknowledge acceptance ol lhe waste described on the manifest by SIGNING (BY HANO IN INK)and entering the DATE ol receipt. rl
IF AS'.:ISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT. STORAGE. OR DISPOSAL FACILITY DESIGtlATED
fiECE;• 'ETHE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I l. ;f
~~:;~
·~
. ---/
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5'24
Form A roved. 0MB No. 2050-0039 Ex ·res 9-30-88
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST c·o o 9 7 6 o 4
2. Page 1
ol l
Information in the shaded a,eas is not
required by Federal law, butls by Slate law.
l. Generator's Name and Mailing Address
Channel Master
• ·•'P. O. Box 1416,
4." Generato~, Phone 91 9
Smithfield,
934-9711
NC 27577
111=1~i;s~:r1<£tE
:1111a~t~IJtllJ~!ltlf.il
5. Transporter 1 Company Name
Willms Truckin
7. TransJ?Qrter 2 Company Name
Co. Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route 1, Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
SC DO 7 3 7 0 9 2"9 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SC DO 7 0 3 7 5 9 8 ·5
11. U.S. DOT Description (includif!g Proper Shipping Name, Hazard Class, and ID Number} 12. Containers
No. Type .. ,Hazardous Waste, Solid, NOS 0RM-E
NA 9189 l C M
d.
b. w-1 l01iic','.(}¥d~w-:-.1 ···'·--1,,,_• l~.I ... L I Jii;
15. Special Handling Instructions and Additional lnlormalion
'-_-GSX Work Order No.: 71096
,.,., .. ,,;.-· ,-·,m-vritW#MtW·A?-*-t¾T?Mtii¾) '::
"Pho<,e\)'} 803 :{767'"3333: --
~if1iifofif11
2 0 Y B, F, ~ 0, 6ii
16. GENERATOR'S CERTIFICATION: I hereby declare that tho contents of this consignment are fully and accurately described above by proper ahlpplng name and are cl..-ifled.
packed. marked, and la'beled, and are In all respects in proper condition tor transport by highway according to applicable lnttunatlonal and naUonal government reoutatlona and
tho laws ol tho State of South Carolina.
It I am a large quanury generator, I certify that I have a program In place to reduce the volume and toxicity or waste generated to the degrN I have datermln.cl to b9 economlc&lty
practicable and that I have selected the practicable method of treatment, sloraga, or dlapoaal currently available to ma which mlnlmizH the preMnt end future lhrMI to human
. health and lhe environment; OR, If I am a a mall quantity generator, I have mado a g"ood faith effort 10 minimize my waste generallon and aerect the beat waate managem.,,t meO'IOd
that Is available to me and that I can afford.
12
Signature
Sign"ature
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt of hazardous materials covered by this manifest except as noted in ttem 19.
Printed/Typed Name Signature
EPA F'.·,-q00~22 (Pev. 9/6~) Previou~ Editions are r · ·•OHEC 1988 1"· !0/861J
Month Day Year
,:7, &r / 1" 6'" 7
a ,._J ~~-'-'Jibs. c I !lbs.
b I !Jbs. d I !Jbs.
Monlh Day . YNI
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-p;tch (eWe) lypewdter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardcius waste treatment.
storage. or disposal licitities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1968 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Form
8700-22A Rev.-9/86 (OHEC 1988A) for both inter-state and intra-state transportation. Transporters who transport hazard.ous waste into the United States from
another country are responsible for completing the manilesl Federal and Slate regulations also require_ generators and transporters al hazardous waste and
owners or operator~ ol hazardo, us waste treatment. storage, or disposal facilities to complete the fol.lowing infor~ation. . ···I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manitest by the generator beginning with 00001.11 your company does no! have a U.S. EPA 1dentilication Number. please contact S.C.
OHEC at [phone] about obtaining an ldentilication·number. -· 1·
2: Page 1 of: _ Enter the total number cl pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86[0HEC 1988 (REV 10186)] plus th
number of continuation sheets EPA Form 8700-22 Rev. 9(86A (DHEC 1988A) ii any.
A:. St.ate Manifest Oc;,cument Number: .. Leave blank.
B: Slate Generalor Identification Number; Leave blank. · ' . 1·
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifes: forms. i
4. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the e11ent of a
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identilied in item 5.
C. Slate Transporter's ID Number: Lea11e blank.
0. Transporter's Phone Number: Enter a telephOne number including area code wh_ere an authorized agent ol the lirst transporter can be reached in the e11ent of
an emergency including nights, weekends, and holidays.
T.. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters will'
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheel and list the transporters in the order they will be transporting the waste
8.. U.S. EPA 10 Number.If applicable, enter the U.S. EPA twel11e digit ID number of the second transporter identified in item 7.
E. State Transporter's JO Number: Lea11e blank.
F:. Transporter's Phone Number: Enter a telephone number including area code.where an authorized agent of the second transporter can be reacned. in thl
event of an emergency including nights, weekends, and holidays. ·
9.. Oesignaled Facility Name and Site Address: Enter the company nnme and site address ol the treatment, storage, or disposal facility designated 10 rece1..-e the
waste listed on lh_is manifest The address must be the site address, which may differ from the mailing address.
10; U.S. EPA ID Number: Enter the U.S. EPA twel11e digit identification number of the designated treatment. storage. or disposal facility identified in item 9 .. I·
G:. State Facility's ID Number: Lea11e blank.
H;. Facilily's Phone Number: Enter a telephone number including area code where an authorized agent of the lacility can be reached in tr.e e11ent of an
emergency including nights. weekends, and holidays.
11: u.s: DOT Description,: Enter proper shipping name, hazard class and JO Number (UN/NA) !or en.ch waste as identified in 49 CFR 171 -177. II aCcitional spacl
is needed. use a U.S. EPA Form 8700-22A Ae11. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I
OM = Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM = MeIal boxes, canons. cases. roll offs I
OW= Wooden drums. barrels. kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 •. Total Quantity: Enter total quantity al waste described on each line, relative to the units used in item 14. I
14. Unit (weight/volume): Enter the appropriate abbre11iations lrom Table II (below) for the unit of measure:
Table II
P = Pounds L =. Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 -79.261 Subparts Car.~ D !-
identity the hazardous waste on each line. ',
J. Additional Descriptions for Materials Listed Above: ln the spaces pro11ided.enterthe authorization number (from the S.C. OHEC Authorization Request Form
for each waste stream listed in section 11 above. Note: Belo re any hazardous waste can be accepted lo"r treatmenl slorage or disposal in South Carclina. the
generator must obtain prior authorization lrom the treatment. storage or disposal facility.
K. Handling Codes lor Wastes Listed Above: Leave blank. I
15 .. Special Handling Instructions and Addillonal Information: Generators may use this space to indicate special transportation. treatment storage or disposal
information or Bill ol Lading lnlormation. For international shipments, generators must enter in this space the point of departure (city and s:a:e) lor those
shipments destined for treatment, storage, or disposal outside the jurisdiction of the United States.
16. ,Generator Certillcation: The generator must READ, SIGN (BY HAND IN INK), and DATE lhecertilicalion statement. II a mode other than hig_hwayis used, th •.
~ord "highway" should be lined out and the appropriate mode (rail, water, or air) inserted In the space below. II another mode in addition to the highway mode i
used, enter the appropriate a_dditional mode (e.g.,.and_ rail) in the space below. _ ·
TRANSPORTER SECTION _ \ , • ·
17: Tran_spo_rter. 1 Acknowledgement: E,nter the 'name ol the person accepting the waste on behalf ol the first lransporter. That person rTlust acknowledgl
· acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf ol the second transponer. That person must
acknowledge acceptance of the waste described oh the manifest by SIGNING (BY HANO IN INK) and entering the DATE of receipt.
FACILITY SECTION I
19. Discrepancy lndicalion Space: • The authorized representati..-e ol the designated facility's owner or operaIor must note in this space any discrepancy betwee
the was:~ described on the manifest and !he wasle actually received at lhe facility. Owners and operators ol facilities who cannot resolve significant
discrepanci..?s within 15 days receiving lhe waste mus I submit to the Department a letter wifh a copy of the manifest describing the discrepancy and at:emcrs :o
reco~~ite it The t~eatmenl storage, or disposal facility must enter the actual weight of was le in pounds in the spaces provided it the amount varies any lrom lhal
specrf1ed by the gent;rator In item 13 or ii the generator uses a unit ol measure other than pounds. -
20. Faclllty Owne'r or Operalcr Certification: Print or type the name of the person accepting the waste on behalf ol the owner Or operator of the facility. Thal person
must acknowledge acceptance of lhe waste described on lhe manifest by SIGNING (BY HANO IN INKf and entering the DATE al receipt ·
IF ASSISTANCE IS.NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGtlATED Tl
RECEIVE THE WASTE OR THE S.C. OHEC MANIFEST SECTION·AT (803) 734.5;~,• ••:;·r· ·· ... ,FROM 8:00 am TO 5:00 pm. .
. •-
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
•· Generator's Phone [phone]
5. Transporter l Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
NC 27577
Manlreat
Document No. 1400012
6. U.S. EPA ID Number
S C D 0 7 3 7
8. U.S. EPA ID Number
9. Designated Facility Name and Sile Address 10. U.S. EPA ID Number
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125 SC DO 7 0
11. U.S. DOT Description (including Proper Shipping Name. Hazard Class, and ID Number}
Form A
2. Page 1
of
Bureau of Solid & Hazardous Wa,te Mgt.
2600 Bull Stree~ Columbia. SC 29201
Phone: [phone]
Emergency & Holiday,: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded areas is not
required by Federal law, bul is by Stale law.
I G a. Hazardous Waste, Solid, nos ORM-E }(;ffo'Yf",9.'t~
E NA 9189 1 T 2 o Y TI F n n F. I
I A
i ~b-. ..!:.!!....~:;:'.:"...___:_ _________________________ -i-L..J.:..j'.:'....t:.+....l_l_L.:...1:'..-1--..'.....+\:!.:·'• !:' :;:•;::•::;:':::!:''!!Q-fi
6 J-----------------------------------l--1.-1-I-L-I-...L..J._jLL-1---4•ii;~:=····-;,1<=;·-=~=;=·•=" -,=•A=,~~i;;:!4!
)[_·I I I 1ft I R c. -1· ........ , ··"··,,. · ''""/;'oi;
,:~-:,
l----------,---------------------------l--1.....1_!~L.j......L..J._lLL+--i::.J;~'.. '·=· ::::':::::::::~.JI~'
I
I
I
I
I
'···,' , ~ ..... ' . .., ·s «\~.;
I I I I\'~ ,~f, d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71164
18. GENERATOR'S CERTIFICATION: I hereby declare that lhe contents ot this consignment are lully and accuratelydescrlbod above by proper •hipping n11m• and are cla ... ned.
packed. marked. and labeled.and ore in all respects in proper condition !or transport byhlghway according to appUcabla lntarnatlonal and natlonal government regulatlona and
the laws ol the State or South Carolina.
111 am a large Quantity gonerolor, I cortily that I have a program In placo lo reduce the volume and to,dclty ofwastaganeralod to !he d8Qr&e 1 have de1armlnod to be economically
practicable and that I have selected the practicable method ol treatment storage, or disposal currently available to mo which minimizes tha present and lutura threat to human
health and Iha environment: OR. ii I am a small quontityoenerator. t have made a good leith effort to mlnimtz.e my waste generation and select the boil wute management mothOcl
!hat is available 10 me and that I con afford. I Typed Name Signature
W-2.~~·er-:c_~Lb_, ....!:c.,,~·::.:CL:!a!ts.==-. _____ _j_ __ _::.,:::;a:~-...!:::::......!~~~----...ll£:i~~t.lg:j,.zl
Year
A p I
~ 17. orter 1 Aca<nowledgement o ·
N ~b,.~C!l.~~:_L.-=----.L,~(lti~~~:2.__1_2::=t,Y,,.'L.,J.'.__.L/.t....__L~tfZ..[l,~~L---~LLtl.u~!JLj
O 18. Transporter cknowledgemenl of Receipt ol Materials I i i.:_:::..:.Pn"·n::;ted:::::;/::;T:.:yp:..edc..:;N:;:a:;:m:.;ec:.::::!::::.:::::.:.::.~:::!::..:::~:::::.:::::..... __ ~S-i-gn-a.:.tu-,-e-...J:..... ____________________ M_o_n_tn __ D_a_y __ y_..,-1
19. Discrepancy Indication Space
F If 11---------------
a IL...I...L..L..W..J!Jbs e .. I .................. libs
bl IJbs.dj !Jbs
T 20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19. YJ--;:-:-:-7:::-=-'---'--,-----'-------,-::,------'-'--'---'-'--'-====--==-------------l
·~:':"':~P~r:in-:led:-::'::/T::'y-:p:-;:ed-:N;:a:m:e'::":'~~~'.""."'.-:e".~'."'."'.""."'"-::~":'"'.~~:,-Si;:gn-:a-::-1u::-re:-::~~~::'":"-----------------'-M•o,1,nth...l.Oa..l.y..l..Y.l.ear...l
EPA Form 8700-22 (Rev. 9/86) Previous Edilions are Obsolete (DHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE !on a 12-pitch (elite) typewriler] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!-
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, ir necessary, the continuation sheet U.S. EPA For
8700-22A Rev.-9186 (DHEC 1988A) foi both inter-State and intra-state transportation. Transporters who transport hazardous waste into the United States tro
another country are responsible for completing the manifest. Federal and State regulations also require generators and transporters al hazardous waste ar.d
owners or operators ol hazardous waste treatment. storage, or disposal facilities to complete the rolfowing information. I GENERATOR SECTION ,. Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
number assigned to this manifest by the generator beginning with 00001. llyour company does not have a U.S. EPAldentillcation Number. please con~act S.C.
OHEC al (803} 73-4~5200 about obtaining an identilication·nuiTiber. · · •·
Page 1 ol: Enter the total number of pages used to complete this manifest, i.e., the riist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (P,EV 10/86)] plus th
number ol continuation sheets EPA Form 8700-2?-Rev. 9/86A (DHEC 1988A) if any, ,
k State Manifest Document Number. .Leave blank. .
B: Slate Generator Identification Number: Leave blank. · I
3. Generator's NalTle and Mailing Address: Enter the na'ITle and mailing address of the generator who will manage the returned manifest !arms.
4. Generator's Phorle Number: Enter a lelephone number with area code where an authorized agent al the generator can be reached in the event al a
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identilication number of the firs! transporter identilied in item 5.
5. I C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent ol the lirst transporter can be reached in the event of
an emergency including nights, weekends, and holidays. I
7:. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 :ransi)orters w
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wast .
U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. 8 ..
E .. State Transporter's ID Number: Leave blank. I
F.. Transporter's Phone Number: Enter a telephone number including area code_ w~ere an authorized agent of the second transporter can be reached in I
event of an emergency including nights, weekends, and holidays.
9. Designated Facilily Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal facility designated :o receive the
,o.
G:.
waste listed on this manifest The address must be !he site address. which may diller !ram the mailing address. I
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment. storage. or disposal lacilif'/ identi!ieo in item 9.
Slate Facilily's ID Number: Leave blank.
H;. Facility's Phone Number~ Enter a telephone number including area code where an authorized agent ol the racility can be reached in the event al an
emergency including nights. weekends, and holidays. .
11'. U.s: DOT Descriptions: Enter proper shipping name. hazard class and ID Number(UN/NA) for each waste as identified in 49 CFR 171-l ii. 11 aCdi!ional spat
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers tor each waste and the appropriate abbreviation from Table I (below) for the type of c::intainers.
TABLE I
OM = Metal drums. barrels. kegs, TT= Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. roll offs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs DT = Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, clolh. paper or plastic bags
13 .. Total Quantity: Enter total quantity al waste described on each line. relative to the units used in item 14.
T4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II
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P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid onlt
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Manilgement Regulation R.61-79.261 Subparts C ar.d D
identify the hazardous waste on each line.
J. Addilional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Authorization Request Farm
for each waste stream listed in section 11 above. t«:>le: Before any hazardous waste can be accepted tor treatment. storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment. storage or disposal facility. I
K. Handling Codes lor Wasles Listed Above: Leave blank. ·
15 .. Special Handling Instruction~ and Addillonal Information: Generators may use this space lo indicate special transportation. treatment. storage or dispos
information or Bill al Lading lnlormation. For international shipments. generalors must enter in this space lhe point of departure (city and s:a:e) lor :hose
shipments destined for treatment. storage. or disposal outside the jurisdiction ol lhe United Slates. · I
16. Generalor Certilication: The generator musl READ, SIGN (BY HAND IN INK), and DATE the certilicalion statement. II a mode other than hiahway is used. t
word "highway" should be lined ouland the appropriate mode (rail, water.or air) inserted in the space below.11 another mode in addition to th; hi9hway mode
used, enter the approprJate additional mode (e.g.,.and. rail) i~-the space below. • ·
TRANSPORTER SECTION ·.,
17'. Tran,por:fer 1 Acknowledgement: Enter the name of the person accepting the waste On behall of the lirsl transporter.
acceptance al the waste desC:ribed on th'e manifest by signing {BY HAND IN INK) and entering the DATE of reCeipt.
18. Transporter 2 Acknowledgemenl: Enter. if applicable, the name of the person accepting lhe waste on behalf of the second transporter. That person must
acknowledge acceptance (?f the waste described on the manHest by SIGNING {BY HANO IN INK) and entering the DATE of receipt I
FACILITY SECTION
19. Discrepancy lndicalion Space: The authorized representative ol the designated facility's owner or oper3tor must note in this space any discrepancy betwe
the waste described on the manifest and the waste actUally received at the facility. Owners and operators of lacilities who cannot resoh·e signilicant
discrepancies within-15 days receiving !he waste musf submit lo the Department a letter with a copy al the manilest describing the discrepancy and ar:empts 1·
reconcile iL The treatment. storage, or disposal facility must enter the actual weight of waste in pounds in the spaces provided if the amount varies any !ram tr.
specified by the generator in item l 3 or ii the generator uses a unit ol measure other than pounds. .
20. Facility Ownei-or Operalor Certificalion: Print or type the name or the person accepting the waste on beharr of the owner or operator of the facility. That person
must aci<.nowledge acceptanc'e of the waste described on the m~nifest by SIGNING (BY HANO IN INK)°and entering the DATE ol receipt.
IF ASSISTANCE IS NEEDED. IN COMPLETION OF THIS MANIFF.c.1 roNTACT THE TREt,T,,lENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED Tl
PEC[' :ETHE WASTE OR THE S.C. OHEC MAIJIFEST SECTION Al IUJJ) 734-5200 WEEKO/,.v;; CROM 8:00 am TO 5:00 pm.
.
I .r,,1-, South Carolina Department of Health
-~ and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt.
2600 Bull S"ee\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-542( I PLEASE PRINT or TYPE (Form desi ned for use on· elile 12 writer
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo. Manlfoat Document No.
Form A
2. Page 1 ol
roved. 0MB No. 20S0-0039 Ex ires 9-30-88
Information in the shaded a<eas is not
reQuired by Federal law, but is by State law.
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WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
(. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
1400013
6. U.S. EPA ID Number
S C D 0 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Un~ /l\W&ite~Mi
No. Type 'MN~ {{{@}t/tN(\ft\i~.ff.
d.
]i~8j~~~!;~;~,!;!::!l!f!!f1::!1~!'!:ii'lt~!J1;l~1i;!:~1i~~!l~!!~!~:1!~!;1rj!11!!r~t~l!!l~ii~1~~
a. lE..il:Ll-lo 121717141-11 d1012l~J/i\\'1IJiicLJ.J-I J J J J 1-1 I J J I!¾\
b. LJ.J-1 1-1 111';;!i1'liii:1;td:LJ.J-I 1--,1,,, J Jii
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71165
16. GENERATOR'S CERTIFICATION: I hereby declare that the contenls ol this consignment are lully and accurately described above by proper ahlpping name and are cluaifittd,
packed, marked, and la"beled, and are in all respects in proper condition tor transport by highway according to applicable International and national govemment regulation• and
uie laws o! Iha Stale ol South Carolina.
111 am a large Quantity genere1or, I certify that I have a program In place to reduce the volume and toxlcltyofwastegeneraled to the degree I have determined to b<e oconomblly
practicable and thal I have selected the practicable method ol treatment, storage, or disposal currently available to ma which minimizes the present and lutura threat to human
health and the environment OR. If I am a small Quantitygeneralor, I have made a good faith aNort to minimize my waste generation and aalact Iha beat w111a management method
thal is available lo me and Iha! I can aHord.
--;/... ~ Month Day y..,
L. G,"-ts
17. Transporter 1 Ae;Knowtedgement ol Receipt of Materials
Printed/Typed Name
8
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name Month Day Year '.'.
19. Discrepancy Indication Space
• I l'bs. C I libs.
b I l'bs. d I l'bs.
20. Facility Owner or Operator; Certification of receipt of hazardous materials covered by this manifest except as noted in ttem 19.
Printed/Typed Name Signature Month O.y Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
r
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE {on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators ol hazardous waste treatmenl
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Rev: 9186 {OHEC ~ 988A) for both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ira
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters ot hazardous waste and
owners or operator~ of hazardous waste treatment. storage, or disposal facilities to complete the lollowirig information. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number~ Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
number assigned to this _manilest by the generator beginning with 00001. llyourcompany does not have a U.S. EPA Identification Number, please con~act S.C.
OHEC al [phone] about obtaining an identification rlumber. 1·
· 2: Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86ll plus th
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. _ _
A. State Manifest Document Number: .. Leave blank .•
B: State Generator Identification Number: Leave blank. J
3. Generator's Name and Mailing Address: Enter the name and m3iling address ol the generator who will manage the returned manifest forms. ·
4. Generator's Phorie Number: Enter a lelephone number with area code where an authorized agent ol the generator can be reached in the event ol a
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first tranSporter who will transport the waste. · I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identirication number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
O. Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent ol the first transporter can be reached in the event of
,, an emergency including nights, weekends, and holidays. ' I ".Ji: 1:: ··Ti-ansporter 2 Coriip3ii"y Name: II applicable, enler the company name ol the second transporter who will transport the waste. If more than 2 iransporters wi
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they wilt be transporting the was:
8 •. U.S. EPA ID Number:tl applicable, enter the U.S. EPA twelve digit 10 number ol the second transporter identified in item 7.
E. Slate Transporter's ID Number: Leave blank. ,.
F.. Transporter's Phone Number: Enter a telephone number including area code_ w~ere an authorized agent of the second transporter can be reached in th
event ol an emergency including nights, weekends, and holidays.
9. Designated Facility Name and Site Address: Enter the company name and site address ol the treatment, storage. or disposal lacility designated to receive the
waste listed on this manifest The address must be the site address, which may dilfer from the mailing address. I
10: U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment. storage, or disposal facility identified in item 9.
G: Stale Facility's ID Number: Leave blank.
H;. Facility's Phone Number; Enter a telephone number including area code where an authorized agent ol lhe lacility can be reached in the event ol an
emergency inctuding nights. weekends, and holidays. .
11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identified in 49 CFR, 71 • l ii. !I additional spacl
is needed, use a U.S. EPA Form·e700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers for each waste and the appropriate abbreviation lrom Table I (below) !or the type of containers.
TABLE I
DM = Metal drums. barrels. kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll offs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons, cases
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber o, plastic boxes. cartons. cases
I
TP = Tanks portable CY= Cylinders BA= Burlap. cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit ol measure: I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Melric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liQuid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Man3gement Regulation R.61 -79.26 l Subparts C ar:d D tJ
identify the hazardolls waste on each line.
J. Additional Descriptions lor Malerials Lis led Above: In the spaces provided. enter !he authorization number (from the S.C. DHEC Authorization ReQuest Form •
for each waste stream listed in section 11 above. Note: Belo re any hazardous waste can be accepted lor lreatment. storage or disposal in South Carclina. the
generalor must obtain prior authorization from the treatment. slorage or disposal facility. J
K. Handling Codes for Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Additional lnformalion: Generators may use this space to indicate special transportalion, treatment. storage or dispos
information or Bill of Lading Information. For international shipments, generators must enter in this space the poinl ol departure (city and s:a:e) for :nose
shipments destined lor treatment. storage. or disposal outside the jurisdiction ol the United States. • I
16. Generalor Certification: The gen_er.aior must READ, SIGN (BY HANO,IN INK), and DATE the certification statement. II a mode other than highway is used. th ·
word "'highway·· should be lined o\Jt and ihe appropriate mode (rail. water.or air) inserted in the space below. II another mod8 in addition to tt,e highway mode i
us·ed. enter the appropriate additional mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION ' ·
11: Transpor:er 1 Acknowledgement: Enter the name of the person accepting the waste On beh~lf of the first_ transporter. That person must acknowledgl
acceptance of the waste described on the marlilest by signing (BY HANO IN INK) and entering the DATE of receipt. '
18. Transporter 2 Acknowledgement:. Enter, ii applicable, the name ol ttie person accepting the waste on behalf ol the second transponer. That person mus:
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE al receipl I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative cil the designated facility's owner or operator must note in this space any discrepancy betwee
the waste described on the manifest and the waste acttially received at the lacility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit to the Department a letter with a copy of the manifest describing the discrepancy and a~empts •1
reconcile iL The treatment. storage. or disposal facility must enter the actual weight ol waste in pounds in the spaces provided ii the amount varies any trom rr.
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Ownei-or Operator Certificalion: Print or type the name or the person accepting the waste on behalf of the owner or operator or the facility. That person
must acknowledge acceptanc·e ol the waste described on the manifest by SIGNING (BY HAND IN INK)° and entering the DATE of receipt.
1; Ass•sTANCE Is NEED_~o-IN COMPLETION OF THIS MANIFEST, CONTACT THE rn_EATMUIT :"TORAGE, OR DISPOSAL FACILITY DESIGtJATED Tl
PEC[' .'c THE WAJJEOA THE S.C. DHEC MANIFEST SECTION AT [phone] WEE,!"" ·o am TO ~:00 pm. _
./ ----___________ J
I , South Carolina Department of Health
·.,. and Environmental Control
Bureau of Solid & Hazardous Wa,te Mgt
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
IPL.EASE PRINT or TYPE (Form desi ned for use on elite 12· itch writer
· UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
Form A roved. 0MB No. 2050-0039 Ex ·res 9-30-88
2. Page 1 ol lnlormation in the shaded a<eas is not
required by Federal law, bu! is by State law.
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WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box·l416, Smithfield, NC 27577
,. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Descriplion (including Proper Shipping Name, Hazard Class, and ID Number)
d.
12. Containers 13. Total Quantity 14. Uni! VW1s1B~l+
No. Type 'M/V~ df(/fr}jf:<.1\#}{{
:~~ :~1;.~~,~0Ei11;!:t!!~.f ~I:ll!:i1!'!~!~~l!f !!~!!l1!!'it~!!!i!~!l~:~!!!!
al.!:.lliJ-I012171714l-ll1l1012IJ/:liFXc.LLJ-I · 1-1 IT
b~ w~L 1-1 J~li!i::~i!~:li~:W:J. ·······! ....... 1 1-1 .. J~(r
15. Special Handling Instructions and Addilional lnlormation
GSX Work Order No.: 71166
16. GENERATOR'S CERTIFICATION; I hereby declare that the contents ol this consignment are fully and accurately described above by proper •hipping name and ar• cla.-.ifled.
packed, marke<I. and la°beled.and are in all r8spects in proper condition lortranspor1 by highway according to applicable International and national government r9Qutatlon• al'\d
the laws ol the State of South Carolina.
II 1 am a large quantity genoro,or, I cortily thnl I h11vo a program In placo lo reduce Iha volume and loldcltyolwastegenerated to th a degree I have delarmlned lo be oconomlcally
pr11c11cabte and tho! I tmvo sotuctcd tho prnchcoblo method ol trontmonl, slornge, or dlspoaal currently avollable to me which minlmlzu the present and luture threal to huenan
health and lh6 environment: On, ii I am o small quontitygonomlor, t hovo modo o good loith oNort lo minimize my waste genorallon and sulecl the be,t waeto managemenl rnothod
the! is available to mo and that I con ollord.
·~~~....:.1-:::.:.-...sG~~-,-,---_L---1..~~..iZ.....~~----1.S~~
T 17. Transport r 1 A<.amowledgement of Receipt of Materials I~ P5?/ p ~~~@~~~~____gL.Lf Y12.._;~.:....LL2~~~::f__12iJ:LLJ.Zl.j:1::'.:j
~ l-'1:.:8:.. . .:.T:.:ra:::n:::spo::::rt:::e:_r 2::..:.:A:::<k::.n:::o.::w.::l•:::d:S!.9e:::m:.:e:::n::.t.::ol:..:R.::•::<:::•:::i :.;:;..::;::;:::::::~--~----------------L----------""'-------~ I l:-i-t".":"-:P:,ri-nt_ed_/_T_y_ped-,-N-:a,-m_•--,-------------...I-S-ig_n_•t_u_r•-----------------------l'-1-.1....1...l.-l--l
19. Discrepancy Indication Space
M?nth Day Year
·~ a I 11"'-c I I lbs.
b I jibs. d I pbs.
•t---------------T 20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
I Yt----:-:-'---'-~~=~===:=.::::::..:.::--Prinled/Typed Name Signature Monlh Day YUi
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (eMe) typewdter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!'
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators or hazardous waste treatment.
storage. or disposal licnities to use the U.S. EPA Form 8700-22 Rev. 9/B6 [DHEC 19B8 (REV 10/86)] and, ii necessary, the continuation sheet U.S. EPA Form
8700-22A Rev:9/86 (OHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States from
another country are responsible ror completing the manifesl Federal and State regulations also require generators and transporters of hazardous waste and
owners or operator~ al hazardous waste treatm~nt, storage, or disposal facilities to complete the following information.
GENERATOR SECTION
Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live di9it
number assigned 10 this manifesl by the generator beginning wilh 00001.11 your company does not have a U.S. EPAldenlilication Number, please con:act S.C.
OHEC al [phone] about obtaining an ldenlification nurtlber.
1.
2; Page 1 of: EnterthetOtal number of pages used to complete this manifest, i.e .. the lifst page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (P,EV 10/86)1 plus the
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
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·A. Stale Manifest Document Number. .Leave blank.
State Generator ldenliflcallon Number: Leave blank. I a:
3. Generator's Nam~ and Mailing Address: Enter the name "and mailil'lg address of the generator who will manage ihe returned manifes! forms. , .
Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ot an
emergency including nights, weekends, and holidays.
4.
5. Transport 1 Company Name: Enter the company name of lhe first transporter who will transport the waste.
6. · U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number al the first transporter identified in item 5.
C. Slate Transporter's ID Number:. Leave blank:
D. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent or the first transporter can be reached in the event al
I
an emergency including nights, weekends, and holidays. I
1:. Transporter 2 Company Name: II applicable, enter the company name al the second transporter who will transport the waste. II more than 2 :rans;:,orters will
be used, use a U.S. EPA FOrm 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the waste.
U.S. EPA ID Number:1I applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. a ..
E ..
F ..
State Transporter's ID Number: Leave blank. I
Transporter's Phone Number: Enter a telephone number including area code. w~ere an authorized agent of the second transporter can be reaci",ed in the
event ol an emergency including nighls, weekends, and holidays.
9.. Oeslgnaled Facility Name and Sile Address: Enter the company nnme and site address of the treatment, storage, or disposal facility designated 10 receive the
waste listed on this manifest The address must be !he site address, which may differ from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment. storage. or disposal facility idenIi!ied in item 9.
State Facility's ID Number: Leave blank.
H;. Facility's Phone Number~ Enter a telephone number including area code where an authorized agent of the facilifY can be reached in the event ot an
I
,,._ emergency including nighls, weekends, and holidays. · .
U.S: DOT Oescriplions: Enter proper shipping name, hazard class and ID Number (UN/NA) !or each waste as identilied in 49 CFR 171-177.11 additional space I
is needed. use a U.S. EPA Form·S700·22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation !ram Table I (below) for the type of containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (lank trucks) CM= Metal boxes. cartons, cases. roll otfs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases I
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap. cloth. paper or plastic Oags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to the units used In item 14.
14. Unit (weight/volume): Enter lhe appropriate abbreviations from Table II (below) for the unit of measure:
. Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specilied in South Carolina Hazardous Waste Management Regulation R.61 -79.261 Subparts C and Oto I
identity the hazardous waste on each line. ·.
J. Additional Descriptions tor Materials Listed Above: In the spaces provided. enter the authorization number (from the S.C. OHEC Authorization Request Form)
for each waste stream listf!d in section 11 above. Note: Before any hazardous waste can be accepted !or treatment. storage or disposal in South Carc!ina, the
generator must obtain prior authorization lrom the treatment. storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
TS. Special Handling lnslruclfons and Addillonal Information: Generators may use this space lo indicate special transportation. treatment. storage or disposal
information or Bill cl Lading Information. For international shipments, generators must enter in this space the point ol departure (City and s:a:e) for :nose.
shipments destined for treatment. storage. or disposal outside the jurisdiction ol the United States. . . ·. :· ·: ·· · •
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than hiahway is used: the
word "highway" should be lined out and the appropriate mode (rail, water.or aii) inserted in the space below. II another mode in addition to th~ hig·hway mode is
used, enter the appropriate additional mode {e.g.,_and rail) in the space below. · ' ' , ·
TRANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter the name of the person accepling the waste On behalf of the first transporter. That person must acknowledge I
acceptance of the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE al receipt. · ·
18 .. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf o( the second transporter. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt I
FACILITY SECTION
i9. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy between
!tie wasle described on the manilcst and the waste ach..ially"received al the facilily. Owner$ and operalors of facilities who cannot resolve significant
discrepancies within 15 days receiving the was le must submit to the Department a letter with a copy of the nianilest describing !he discrepancy and artemots :o
reco~~ile it. The 1rootment, at~rogo, or dl~poon_ l ln<:ilily m1.iot 12nlor tho nctual wolghl 01 wnslo in pounds in tho spaces provided if !he amount var.es any from tt':at I
spect11ed by the generator 1n item 13 or 1I the generator uses a unit ol measure other than pounds.
20. Facility Ownef or Operator Cerlificalion: Print_ or type the name ol the person accepting the waste on behall ol the owner or operator of !he facility. That person
must acknowledge acceptanc·e of the waste described on the manifest by SIGNING (BY HAND IN INKf and enlering the DATE of receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT TH.E TREATMENT s1 nr.,'-GE, OR DISPOSAL FACILITY OESIGrlATED TO I
PE Cf "!E fHE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAY:; ' . .en TO 5:00 pm. · .
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone] I PLEASE PRINT or TYPE (Form desi ned for use ori elite 12· itch ewriter
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAtONo.
Form A roved. 0MB No. 2050-0039 Expires 9-30-88
2. Page 1
ol Information in the shaded a<eas is not
required by Federal law, but ls by State law.
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WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone( 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA 10 Number
9. Designated Facility Name and Site Address 10. U.S. EPA ID Number
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125 SC DO 7 0
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Class, snd ID Number}
d.
15. Special Handling lnslruclions and Additional Information
GSX Work Order No.: 71167
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents olthb consignment are fu11yand accurately described above by proper 1hipping name and are claaaififtd,
packed. mark&d, and 1a·beled,and are in all respects in proper condition lor transport by highway according to applicable lnlernalional and nallonal government reoulatlon• and
the tawa ol the St.ale or South Garollna.
111 am a targo quanlily gtinarator, I certify !hat I have a program In placo lo reduce the volume and toxleltyofwaatagenerated totha degree I have datarmlnftd to tM economically
practicable and that l have :selected the practicable method ol lroatment. :storage, or dlapoaal currently available to ma which minimize:, tho pre:,ont and luturo threat to human
health and Iha environment: OR, 111 am a small quanlitygonerator, I hflvo made a good lailh ettortto minimize mywaate generaUon and select the beat waata management method
thal is availat,le 10 mo and !hat 1 can attord.
~ ~ Montn Day Year
17. Tr I of Malerials
Pri -#q7 ~
18. Transporter 2 Acknowledgement or Receipt of Materials
Printed/Typed Name Signature ',1ontll Day Year
19. Discrepancy Indication Space
Ir a L.I J..J....L.J.-"--'/lba. c / ....... J..J....L..1.-'/lbs.
b I /Iba. d I /lbs.
,i.,.,,..,,-=-=-----,:----::--c:-,:---~. 20. Facility Owner or Operator; Certification of receipt of hazardous malerlals covered by this manifest except as noted In Item 19.
Montll Day Year I Printed/Typed Name Signature
~~~---::-:,,,----,,,.-,--~---------"'..............J .......... EPA Form 8700-22 (Rev. 9/B6) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pilch (elite) typewriler] OR use FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste trea1mel
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, if necessary, thl:l continuation sheet U.S. EPA Fa
8700-22A Rev.-9/86 (OHEC 1988A) loi b·o1h inter-state and intra-state transportation. Transporters who transport hazardous waste into the United Slates tr
another country are responsi6Ie for completing the manifesl Federal and State regulations also require generators and transporters of hazardous. waste ar.d
owners or operator~ al haza.rdous waste treatment, storage, or disposal facilities to complete the following information.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number• Manilest Document Number: Enter the generalor's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number, please contact S.C.
DHEC at [phone] about obtaining an Identification nUmber. · I
2: Page 1 of: Enlerthetotal number of pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REI/ 10/86)! plus:
number of continuation sheets EPA Form 8700-22 Rev:9/86A {DHEC 1988A) if any ..
A. State Manifest Document Number: .Leave blank.
B: State Generator ldentlllcallon Number: Leave blank. . I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manilest forms. · ·
4. Generator's Pholle Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA lwelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank. ·
D. Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. · · I
7: Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 trans~orters ·
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheel and list the transporters In the order they will be transpo~ing the was .
a.. U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7.
E .. State Transporter's ID Number: Leave blank. · I
F;. Transporte~•s Phone Number: Enter a telephone number including area code. w~ere an authorized agent of the second. transporter can be reached in I
event ol an emergency including nights, weekends, and holidays. •
9. Designated Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal facility designated to receive rne
waste listed on this manifest The address must be the site address, which may diller lrom the mailing address. 1.
10: U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number ol the designated treatment. storage, or disposal facility identified in item 9.
G:. Slate Facility's 10 Number: Leave blank.
H;. Facility's Phone Number~ Enter a telephone number including area code where an authorized agent ol the facility can be reached in the event of an
emergency including nights, weekends, and holidays. .
1,: ~-S: DOT Descriplions: Enter proper shipping name, hazard class and ro.Num_ber(UN/.NA) for each waste as identified in 49 CFR 171-177 II additional spal
,s needed, use a U.S. EPA Form·8700-22A Rev. 9/86 (DHEC 1988A) Conllnuat1on Sheet.
12.. Containers (no. and type): Enter number or conlainers lor•each waste and the appropriate abbreviation from Table I (below) for the type of containers.
TABLE I
OM = Metal drums, barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons. cases. roll offs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons, cases I OF'= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity al waste described on each line, relative to the units used in item 14.
14. Unit (weighl/volume): Enter the appropriate abbreviations lrom Table II (below) for the unit of measure: I Table II
F' ir F'ounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid only)
I.. Wasle Number: Enter hazardous waste numbersasspecilied in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subparts C and]
identity the hazardous waste on each line.
J. Addilional Descriplions for Materials Listed Above: In the spaces provided, enter the authorization number (rrom the S.C. OHEC Authorization Request For
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatmenl storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes tor Wastes Listed Above: Leave blank. ·
15. Special Handling Instructions and Addlllonal Information: Generalors may use this space lo Indicate special transportatlon.1reatmen1. storage or dispo
information or Bill ol Lading Information. For international shipments. generators must enter in this space the point or departure (city and s:ate) for :nose
shipments destined tor lrealment. storage. or disposal outside lhe jurisdiction ol the United States. 1·
16. General_or Certilicalion: The generator ~us! READ, SIGN (BY HAND IN INK), and DATE lhecertilicalion statement. tr a mode other than hignway is used.
word ··highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. II another mode in addition 10 the highway mod
us·ed, enter the appropriate additional mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowl~dgement: Enter the name ol \he person accepting the waste On behalf of the first transpone,r. That person must acknowledl
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt. .
18. Transporter 2 Acknowledgement: Enter, if applicable, the name ol the person accepting the waste on behall of the second transponer. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt J
FACILITY SECTION ·
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in this space any discrepancy betw
the wasle described on the manifest and the waste actUally received al lhe facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 1 S days receiving the waste must submit to lhe Department a letter with a copy of the manifest describing the discrepancy and a~emp!I
reconcile it. The 1reatmenl storage. or disposal facility must enler the actual weight ol waste in pounds in the spaces provided ii the amoun! varies any from 1
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Owne"r or Operator Certificalion: Print or type the name of the person accepting the waste on behalr ol lhe owner or operator of the facility. Thal person
must acknowledge acceptanc'e or the waste described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE of receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGI/ATED I
PEC[ .'ETHE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Harardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holiday~ [phone] I PlfASE PRINT or TYPE (Form desi ned !or use o~ elite 12· ewriter
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
Form A roved. 0MB No. 2050-003'l Ex ires 9-30-Ba
2. Page 1
ol Information in the shaded a<eas is not
required by Federal law, but is by State law.
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WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter l Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
SCD073
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard crass, and ID Number)
d.
~,~E~ r;~~;f~:~l;j'.!'!J:,',:(1,!;~j)J::i:;;l~l!1ll~!ll!;,1;~l\;;)E~!;!tr.1!~!f fr~,lll1l1:!~r :;~i,:~tl
a.lLMJ-!o,2,1,1,4!-!1,1,0,21&1>:i}!;}::cu..J-I , , , , 1-1 , , , li)i
b. w:::1 1-1 ,~1:i!i1J~~~~w:::J., , , , -'=J ,_ , .,,,111
15. Special Handling Instructions and Additional tnlormation
GSX Work Order No.: 71168
,e. CEMERATOR'S CERTIFICATION: I hereby declare that the conlenls ol this consignment era lully and accuratelydescrlbod above by proper shipping nama and ar• cJa-N.ci,
packed. marked, and 1aheled, and are In all respects In proper cofldltion tor Iran sport by highway according to appllcab1e lntornallonal and natlonal government r~ulatioMs af'\d
tile laws ol lhe State ol South Carolina.
111 am a large Quantity genc,otor, I corlily that 1 havo a program In place lo roducethevolume and toxlcltyol waste generated to the d&gr-1 have dalermln8d to be economically
pr11c11cable and that I have selected the practicable method of treatment. slorege, or dlsposal currently avnilable lo me which minimizes the present and luture thrMI to human
health and the environment OR, ifl am a small quantity generator, I have mode a good lailh eHor1 to minimize my waste generaUon and select the bell wa11e management method
tr'lat is available to me and Iha! I can afford.
Printed~ Name L, Signature --/_ c~ Month Day
Cc.ti:fs
17. Transponer 1 Ac.:1mowledgement of Receipt ol Materials
Printed/Typed Nam"'ao fe/1 -567' B ,,/2/::5 Signature Month Day Year
Q
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name Signatu Month Day Year ,.
19. Discrepancy Indication Space
If
a IL..L..1..1...L.J....Jpbs. c !,_.__.....,__._.,_,Pbs.
b I jibs. d I jibs. ,,_ ______________ _
~,_20_.~F~a~c_il_i~;,::o_w_n_e~r~or_O-'-pe_r_a_ID~r;~C_e_rt_il_ic_a_ti_on_o_lr~•~c~•i~p-lo~r_h_az_ar_d_o~u~•~m~a~l•~n~·a~l•~c~o~v~er~edc:..:b~y~th~i=•~m~a~n~it~e•=t~e~•=c•~p~t=•=•~n=o~ledc:..:in;;.;;ll=emc:..:1=9~·---------------~
1 ':=-::":-:-,P-r-int'::"ed=:/:":T:":yp=:ed~N-am_•~:-::--::--,-::-.:-,--,,,-~-,~,::S,::ig-,na.,.Ju"'re,-,----,----------------.LM-0.Lnlll..L-D.la-y.l..Y.Joari-J
EPA Form 8700-22 (Rev. 9/86) Previous Editions ore Obsoloto [DHEC 1988 (Rev. 10/86)]
IMPORTANT:
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST . I
TYPE (on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE.
GENERAL INFORMATION: Federal Reg. ulations require generators and transporters ol hazardous waste and owners or operators of ha_zardous waste treatment
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 and, ii necessary, the continuatton sheet,U.S. EPA For
8700-22A Aev:9/86 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States fro
another country are responsi6Ie !or completing the manifest Federal and State regulations also require generators and transporters al hazardous was:e and
owners or operators of hazardous waste treatment, storage, or disposal lac1lllles to complete the fol!owmg 1nlormat1on.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's U.S. EPA twelve d1g1t 1dent1l1callon number and the unique five d1g1~
number aSsigned to this manifest by !he generator beginning with 00001. II your company does not have a U.S. EPAldentification Number, ;:;lease con:act S.C.
OHEC at [phone] about obtaining an identification number ... · · I
2; Page 1 of: Enter the total number al pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10186)} plus !h
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEG 198t3A) ii any.
A:. Stale Manilest Document Number: .Leave _blank. ,~·:~.· · .
e: State Generator Identification Number: Leave blank. ·:" I
3. Generator•S Name and Maillng Address: Enter lhe name and mailing address of the gene~alor who will manage the returned manifest forms.
4. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in :he event cl a ·
emergency including nights. weekends, and holidays.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number ol the first transporter identified in item 5.
5. Transport 1 Company Name: Enter the company name al the first transporter who will transport the waste. 1.
.? C. Slate Transporter's ID Number:. Leave blank: . -~
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event ol ,<
an emergency including nights, weekends. and holidays. · ''
1:. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. JI more than 2 :rans porters w·1·-·
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they wilt be transpon.ing the wast ··
8 .. U.S. EPA ID Number:I1 applicable, enter the U.S. EPA twelve digit 1D number of the second transporter identified in item 7.
E.. State Transporter's ID Number: Leave blank. '
F •. Transporter's Phone Number~ Enter a telephone number including area code_w_here an authorized agent of the second transporter can be reacr,ed in th.
event of an emergency including nights. weekends, and holidays.
9. Designated Facilily Name and ?ite Address: Enter the company nnme and site address of the treatment, storage, or disposal facility designated to receive !he
waste listed on this manifest The address must be the site address, which may differ rrom the mailing address.
10; U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment. storage, or disposal facility iden11!ied in item 9. I
G:. Stale Facility's ID Number: Leave blank.
H;. Facility's Phone Number~ Enter a telephone number including area code where an authorized agenl of the facility can be reached in the event of an
emergency including nights, weekends. and holidays.
11'. U.S: DOT Descriptions: Enter proper shipping name. hazard class and ID Number (UN/NA) !or each waste as identilied in 49 CFR 171-177.11 additional spacl
is needed, use a U.S. EPA Form·B7Q0-22A Rev. 9/86 (OHEC 1986A).Continuation Sheet.
12.. Containers (no. and _type): .Enter number of conlainers for each waste and tt1e appropriate abbreviation from Table I (below) !or the type of containers.
TABLE I
OM= Metal drums. barrels. kegs .TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons, cases. roll otls I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or p!astic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity ol waste described on each line, relative to the units used in.item 14. I
T4. Unit (weight/volume): Enter the appropriate abbreviations lrom Table II (below) for the unit of measure:
Table II
P = Pounds L =Liters. K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons ~iquid only)
1.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subpar:s C ar.d DJ
identity the hazardous waste on each line.
J. Additional Oescriplions tor Malerials Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authoriza1ion Request For
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatmenl storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment. storage or disposal facility, I
K. Handling Codes for Wastes Listed Above: Leave blank.
TS. Special Handling Instructions and Additional lnformalion: Generalors may use this space to indicate special transportation. treatment. storage or.dispos
information or Bill of Lading Information. For international shipments. generators must enter in this space the point of departure (city and s:ate) for :hose
shipments destined for treatment. storage. or disposal outside the jurisdiction ol lhe United States:
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE theceriification statement.Ha mode other than highway is used. th.-
word "highway .. should be lined Out and the.appropriate mod7(rail, watei'.or air) inserted in the space below. If anoiher mode in addition to tl',e highway mode i
used. enter the appropriate additional mode (e.g.,,and_ rail) in the space below.
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: E~t~r-the name of the person accepting the waste On_ behalf ol the first transporter. That person must acknowledgl
acceptance ol the waste described oii the manifest by signing (BY HANO IN INK) and enterin·g the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name or lhe person accepting the waste on behalf of the second transporter. That person mus_t
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE of receipt
FACILITY SECTION . I
19. Discrepancy lndicalion Space:· The authorized representative of the designated facility's owner or operator must note in this space any discrepancy betwee
the waste described on lhe manifest and the waste actUally received al the facility. Owners and operators of racilities who cannot resolve significant
discrepancies within 1 5 days receiving the waste must submit to the Department a letter with a copy of the manifest describing the discrepancy and ar.emp1s 10
reconcile it The trealmenl storage. or disposal facility musfcnterthe actual weight of waste in pounds in the spaces provided if the amount varies any from tr.I
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds. .
20. Facility Ownei-or Operalor Certilicalion: Print or type the name of the person accepting the waste on behalf ol the owner or operator ot the lacility. That person
must acknowledge acceptance or the waste described.on !he manifest by SIGNING (BY HANO IN INK)° and entering the DATE of receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT. STORAGE. OR DISPOSAL FACILITY DESIGIJATED Tl
PECf':E THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. .
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South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous W.ute Mgt
2600 Bull Street, Columbia. SC 29201
Phone: [phone]
LEASE PRIITT or TYPE
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
ewriter
1. Generator's U.S. EPA ID No.
C D O 9 7 6 0 4 7 1 4
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Expires 9-30-sa
Manueat 2. Page 1 Information in the shaded areas is not ?J0 c(.)m(t 1°·7 of 1-required by Federal law, but is by State law.
4. G:n:,a~,:. p~~n: 1~ i ~' Sm~~::~;i~' NC
27 5 77 lU!l!~~f ,y:~'!fi°&::lr;,,m:i(i;;!:1:::;\;'{l:i:;'
~5~.~T~,a~n~s~po~n~e~r~1~Co;m~p~a~ny;N~a~m~.;"-~-"-'=-:.:...:=------,s~.LU~.s;.EE~PAA~IO)NN~um~be;,r~-=----~~~~,~~ii/ifi~~[tj:-.::t<!·=J.'St'sc:::::j>1>~>ti'i2,J1)·~,)Q:}2\~i;j· ·~
Willms Truckin Co. Inc. S C D O 7 3 7 803 /767"'3333:
7. Transporter 2 Company Name 8. U.S. EPA ID Number
. 10. U.S. EPA ID Number .,. 9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route 1, Box 255
Pinewood SC 29125 S C D O 7 0 3 7 5 9 8 5
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Uni :•l'Wa111Nl.rN;(E
No. Type 'MN~ f/6%ifJ;'.(:tt:hi}M{
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71224
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents olthia consignment are tul1y and accurately described abova by proper 1hipplng name and ara cl•-fled.
pack ad, marked. and labeled, and are In all raspacts in proper condition for transport by highway according to appllcebla lntarnalional and national government ra,;;iulatlon• and
the laws ol the Stale of South Csro11na.
II I am a large quan1ity generator, I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic.ally
praclicable and that I have selected the practicable method ol treatment, storage, or dlspos.al curranlly available to me which minimizes the praaont and future thr-t lO huma.n
health and the environment: OR, II I am a small quantity generator, I have made a good lalth effort to minimize mywasto generaUon and select tho boal waste managament method
that 11 available to me and that I can afford. ·
,~
p ~ 1-'c:8::.. _;T.:;ra::n.::sc::po.:::.:rt•::•..:2:..A:.::::::n.::o:.:w::l•::;d:,9c:•:::m::•::.n::.t ::ol..:R.:;•::<::e'.:!ip:;t.:o::.I ::M::a::t•::.•i::a::l'"'---~--------------------"'--------------.L~ I ~i--+--P-•i-nt_ed_,r_y_p_ed_N_am_• ______________ -1_s_ig_n_at_u_r•----------------------...IM._on1.th...1-D1.ay...1,_Y.1ear1--1
19. Discrepancy Indication Space ·~ 11---------------
a ._I J...L..L.J.--'-'/lbs. c i...,_J...L..L.J.-'/lbs.
b I pbs. d I pt>s.
T 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted In Item 19.
l y~~==-=====:::;::::=.:====="'--------,,---~ Printed/Typed Name Signature Month Day Year
EPA Form 8700·22 (Rev. 9/86) Previous Editions .:are Obsolete [DHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
TYPE [on a 12-pitch.(elite) typew,ite,J OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLI' IMPORTANT:
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous was:e trea1mel
storage. or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 and, ii necessary,'tha continuation sheet U.S. EPA For
8700-22A Rev:9186 (DHEC 1988A) !or b·oth inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States fro
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters of hazardous waste ar,d
owners or operators ol hazardous waste treatment, storage, or disposal fac11it1es to complete the following 1nlormatron.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit 1dent1!1cat1on number and the unique live d1,
number assigned to this manifest by the generator beginning with_00001. lf your company does not have a U.S. EPA Identification Number. please con tac: S.C.
OHEC at {803) 734;5200 about obtaining an identification number.· ... • · I
2: Page 1 of: Enter the total number of pages used lo complete this manifest, i.e .. the first page EPA Form 8700-22 Rev. 9/86 !DHEC 1988 {REV 10/86)1 plus:
number of continuation sheets EPA Form 8700-22 Rev. _9/86A (OHEC·1988A) ii any. . .. .
A. State Manifest Document Number. .. Leave blank.
e: State Generalor Identification Number: Leave blank. · . I
3. Generator's Nafne and Mailing Address: Enter the name and mailing addreSs of the generator who will manage the returned maniles! forms. ·.
4. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the event of •
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5, I C. Slate Transporter's 10 Number: Leave blank.
0. Transporter's Phone Number:
0
Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays.
7: Transporter 2 Company Name: II applicable, enter the company name olthe second transporter who will transport the waste. II more than 2 :ransporters ...
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they wit1 be transporting the was■
a .. U.S. EPA ID Numbed! applicable, enter the U.S. EPA twelve digit 10 number ol the second transporter identified in item 7.
E. Slate Transporter's ID Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code where an 'authorized agent of the second transpor!er can be reacned in ti
event al an emergency including nights. weekends, and holidnys. · .
9.. Oesignaled Facility Name and Sile Address: Enter the company name and site address or the treatment, storage. or disposal facility designated to receive the
waste listed on this manilesl The address must be the site address. which may diller from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment. storage. or disposal facility identifieo in item 9. I
Slale Facilily's ID Number: Leave blank.
10.
G:.
H;. Facilily's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in t~,e event of an
emergency including nights, weekends, and holidays.
U.S'. DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) !or each waste as identified in 49 CFR 171-117. If additional spa.
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): En!er number ol containers for each was!e and !he appropriate abbreviation from Table I (below) lor the type or containers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons, cases. roll oHs I
OW= Wooden drums. barrels. kegs TC= Tank cars CW= Wooden boxes. car1ons. cases
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders 'BA= Burlap, cloth, paper or plastic bags
13 .. Total Ouanlity1 Enter total-quantity ol waste described on each line. relative to the units used in item 14. I
14. Unit (weighl/volume): Enter the appropriate abbrevintions from Table II (below) for the unit ol measure:
Table II
P = Pounds L = Liters K:; Kilograms T = Tons M :; Metric Tons N:; Cubic Meters Y:; Cubic Yards G = Gallons (liquid only)
Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and □,
identify the hazardous waste on each line.
J. Addilional Descriptions tor Malerials Listed Above: In the spaces provided, enter the authorization number(lrom the S.C. OHEC Authorization Request For
for each waste stream listr.d in section 11 above. Note-: Before any hazardous waste can be accepted lor treatment. storage or disposal in South Carclina. the
generator must obtain prior authorization lrom lhe treatment, storage or disposal facility. I
K. Handling Codes for Wastes Listed Above: Leave blank.
15 .. Special Handling Instructions and Addillonal lnlormalion: Generators may use !his space to indicate special transportation. treatment. storage or dis po
information or Bill of Lading Information. For international shipments, generators must enter in this space the point al departure (city and s:a:e) for :nose
shipments destined lor treatment, storage, or disposal outside lhe jurisdiction of the United States. · I
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE lhecertification statement. II a mode other than highway is used. t •
word "hiQhway" should be lined out anO the appropriate mode (rad, water.or air) inserted in the space below. II anothCr mode in addition to the highway mod
used, enter the appropriate additional mode {e.g .. _and_ rail) in ttie space below.
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: Enter ;he name of the person_ accepting the waste on behalf of the rirst transporter. That person must acknowteCI
acceptance ol the waste described on the manifest by signing (BY1HANO IN INK) and entering the DATE of re~eipl. _ ,
18. Transporter 2 Acknowledgement: Enter, if applicable, the name,ol the person accepting the waste on behall ol the second transporter. That person must
acknowledge acceptance ol the waste described on the manifest/by SIGNING (BY HAND IN INK) and entering the DATE ol receipt.
FACILITY SECTION . I I
19. Discrepancy Indication Space: The authorized representative cl.the designated rac1hty's owner or operator must note 1n this space any discrepancy betwe
the waste described on the manifest and the waste actUally received at the facility. Owners and operators or facilities who cannot resotve signiricar,t
discrepancies within 15 days receiving lhe waste must submit to the Department a le lier with a copy of the manilest describing !he discrepancy and ar.emptsl
reconcile iL The treatment storage. or disposal facility must enter th. e actual weight al waste in poUnds in the spaces provided ii the amount varies any from t
specified by the generator in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facility Owner or Operator Certlllcallon: Print or type the name al the person accepting the waste on behall of the owner or operator al the facility. That person
must acknowledge acceptance of the waste described on the ma1nilest by SIGNING (BY HAND IN INK)° and entering the DATE of recelpL
tF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE. OR DISPOSAL FACILITY DESIG~JATED 1
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull So .. \ Columb;a. SC 29201
Phone: [phone]
Emergency & HoHdays: [phone]
LEASE PRINT or TYPE (Form desi ewriter Form A roved, 0MB No. 2050-0039 Ex ires 9·30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA 10 No.
N C D O 7 0
Manifeat Document No. 1400018
P. 0. Box 1416, Srni th field, NC 27577
.t, Generator's Phone [phone]
S. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
2. Page 1
ol Information in the shaded areaS is nol
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Unit
No. Type 'MNrJ
a
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 l D T
J./t~~0 ~m~:~,~~tJ;11;!~!l1}1:)Ji:':;~~;:(~i::l;~\r1tr5!~~J!:'!;)!1!!i!!!i'!1~'!';~11'll~~r;:'.:
a lE..Jl:lj-lO I 2I7I7,41-1 l ,1 IO I 2 I;,,,--, 'V c.LLJ-I 1-1 ho
((,\''/i'1 Jg:
b.l.J,..J-::1 I I I I 1-1 I I I !:1;~s-;h,¥idJ7u-:,I I !,, I I-! I ,,Ji\{
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71258
2 0 Y
;~~~;F::.,-=·cn=1-=·t:lftl
;t,i1E1Q10161~'3
'{r·;:·
~f:}_ I
16. GENERATOR'S CERTIFICATION: I hereby declare that the conlenls ot this consignment are fully and accurately described above by proper shipping name end era crasadled,
packed. marked, and ta°beled, end are in all rospacts in proper condition for transport by highway according to appllcable International and natlonal government re-gulatlon-1 al'\d
the taws of the State ol South Carolina.
If I am a large c:iuantity generator, l cer1ity that I have a program In place to reduce the volume and toxicity ol waste generated to the d8',;Jr-1 have determined to be oconomie.Uy
practicable and thal I have setected the practtcabte method ol treetment, slorage, or dlspoaal currently available to me which minimizes the pre.son! and future thr-1 to human
heanh and Iha environment: OR, 111 am a small quantity generator, I have made a good faith eHor1 to minimize my weste generation and ulect the beat waate management ~thod
that is availao!a to ma and that I can aHord.
Printed !J::IJ'ed Name
'I<-• ..er L.
17. Transporter 1 Ae;,mowledgement of Receipt of Materials
18. Transporter 2 Acknowledgement ol Receipt of Materials
Printed/Typed Name
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Prinled/Typed Name Signature
EPA Form 6700-22 (Rev. 9/86) Previous Editions are Obsolete {DHEC 1988 (Rev. 10/86)]
-ryttf
'I
bl
Month Cay Year
Month• Day Year
8'"',,?
Month Day Year
JI"'-' I P"'-
I'"'-d I jibs.
Month Day Year
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE Fl.RM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, ii necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev.-9/86 (DHEC 1988A) tor both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
another country are responsible for completing the manifesl Federal and State regulations also require generators and transporters of hazardous waste ana
owners or operators ol haza'rdous waste treatment. storage, or disposal facilities to complel~ the following informati.on. . I
. GENERATOR SECTION
1. Generator's U.S. EPA ID Number .. Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the un1que five dig1
number assigned to this manifest by the geneiator beginning with 00001.11 your company does not have a U.S. EPA Identification Number, please contact S.C.
OHEC at [phone] about obtaining an Identification number: ·• · I
2; · Page 1 of: Enter the total numbe< of pages used to complete this manifest, i.e., the lifst page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 plus t
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any. ·
k Stale Manifest Document Number. .. Leave blank.
B: State Generator Identification Number: Leave blank. · I
Generator's Name and Mailing Address: Enter the name·and mailing address of the generator who will manage the returned manifest !arms.
Generator's Phoiie NumbE!r: Enter a telephone number with area code where an authorized agent al the generator can be reached iii the event al .
3.
4.
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the lirst transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent of the lirsl transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. 1·
T.. Transporter 2 Company Name: II applicable; enter the company name ol the second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700-2:i!A Rev. 9/86 (DHEC t988A) continuation sheel and list the transporters In the order they will be transponing !he wa
U.S. EPA 10 Number:11 applicable. enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7.
Slate Transporter's ID Number: Leave blank. ·
8 ..
"E ..
F •.
9.
10.
G:.
"H;.
Transporter's Phone Number: Enter a telephone number including area code _where on authorized ugenl or the second transporter can be reached in ti
even! al an emergency including nights, weekends, and holidays.
Designated Facility Name and Site Address: · Enter the company nnmeand site address ol the treatment, storage, or disposal facility designated to receive the
waste listed· on this manifest The address must be the site address. which may dill er fron:i the mailing address. · •· ~···
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment. storage, or disposal racility identified in item 9 .•
Slate Facility's ID Number: Leave blank. ·
Facilily's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event al an
emergency including nights, weekends, and holidays.
1 r. U.S. DOT Oescriplions: Enter proper shipping name. hazard class and ID Number (UN/NA) for each waste as identilied in 49 CFR 171 • 177.11 additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation rrom Table I {below) for the type of containers.
TABLE I
OM = Metal drums. barrels. kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. roll oHs I
OW = Wooden drums, barrels, kegs TC = Tank cars CW= Wooden boxes. cartons, cases
OF= Fiberboard or plastic drums, barrels, kegs DT = Dump truck CF= Fiber or plastic boxes. cartons. cases
'!' TP = Tanks por1abte CY= Cylinders BA= Burlap, cloth. paper or plastic,bags ·
t .. , 13 .. Total Quanlily: Enter tolal quantity ol waste described on each line, relative to the unils used in item 14. • 1
t4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) !or the unit al measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number; Enter hazardous waste numbers as specHied in South Carolina Hazardous Waste Management ~egulation R.61 • 79.261 Subpar1s C ar,d l
identify the hazardous waste on each line.
J. Addilional Descriptions !or Materials Llsled Above: In the spaces provided. enter the authorization number (from the S.C. OHEC Authorization Request For
, lor each waste stream HslP.d in section 11 above. Nole: Be lore any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal facility.
K. Handling Codes for Wastes Listed Above: . Leave blank. I
15 •. Special Handling Instructions and Additional lnformalion: Generators may use this space lo indicate special transportation. treatment. storage or dispo
information or Bill of Lading lnlormation. For international shipments, generators must enter in this space the point of departure (city and state) !or those
shipments destined for treatment, storage, or disposal outside the jurisdiction of the United Slates.
16. Generalor Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used .•
word "highway" should be lined out and the appropriate mode (rail. water.or air) inserted in the space below. JI another mode in addition to the highway mod
used. enter the appropriate a_dditionat mode (e.g.,.and. rail) in the Space below.
TRANSPORTER SECTION , ·
.11: Trans.porter 1 Acknowledgement: Enter the name ol the person accepiing lhe waste on behalf of the first transporter. That person must acknowledl
. acceptance of the waste described on lhe manifest by signing (BY HANO IN INK) and entering the DATE al receipt.
18. Transpor1er 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf ol the second transporter. That person must
acknowledge acceptance al the wasle described on the manifest by SIGNING (BY HAND IN INK) nnd entering the DATE or receipt
FACILITY SECTION . I
19. Discrepancy Indication Spac_e: The authorized representative or the designated facility's owner or operator ~us! note in this space any discrepancy_ betw ,
the waste described on the manifest and the waste actUally received at the facility. Owners and operators of lacililies who cannot resolve significant
discrepancies within 15 days receiving lhe waste must submit to lhe Department a letter with a copy of the manifest describing the discrepancy and at!emots :o
reconcile it. The treatment, storage.or disposal facility must cnler the actual weight of waste in pounds in the spaces provided ii the amount varie. s·any tram 11
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Owner or Operator Cerlllication: Print or type the name of the person accepting the waste on behatl of the owner or operator al the lac1l1ty. That person
must acknowledge acceptance of !ho ".'aste described on the manifest by SIGNING (BY HAND IN INK) and entering lhe DATE al receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734-.5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
LEASE PRl"'1 or TYPE (Form desi ned for use on ellte 12· itch Form A roved. 0MB No. 2050-0039 Ex ires 9-30-68
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc;
Route, I Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
S C D O 7 0
2. Page 1
of lrllormalion in the shaded a<eas is no!
required by Federal law, but is by State law.
11. U.S. OCT Oescriplion (including Proper Shipping Name. Hazard Class, and ID Number} 12. Containers 13, Total Quantity 1•. Unit ··l'Wa:ite Nwabert+
No. Type WtNrJ :t?ffi?:J:(V:j/gt
a.
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
1:}tt~~~~~:~,i:~,':!;';r;..,;!!lf !11:Illil!!l!l!i(l!1
1ilil1
il:!l"il~ll!~!/1!!!!/1!:::\;!,1t!l!1:1li~il1f il!f I'
a. l£..ili.J-Io , 2 , 1 , 7 , 4 1-I 1 ,i , o , 2 I ~l#il!;J\i/ c. LLJ-I I-I I ltt
b. Lid .. :-, 1-1 10l!!i!!rii1i:!l~w:L ........... J:J , , Ji'i~
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71259
2 0 Y
111. GENERATOR'S CERTIFICATION: I hereby declare that the contents oflhlacon•lgnmentarefully and accuratelydaaerlbod above by proper ahlpplng name and are clu.aifled,
packed, marked, and 1a·beled.11nd are ln atl respects in proper condition !or transport byhlghway according to applicable lntarnaUonal and national govemmont re-Qulatlona and
the laws ol the State ol South Carolina.
111 am a lar"ge cwan1ity generator, I certify Iha! I h&ve a program In ptace lo reduce lhavolumeand toxlcltyolwaslaganeraled to the deg,_ I have determined to be economically
practicable and that I have selected lhe practicable method ol lreatmenl. storage, or disposal currently available to ma which minimizes Iha present and luture ttHMI to human
health and lha environment: OR, II I am a sma11 quantity generator, I have made a good faith effort to minimize mywastegeneraUon and select Iha be11 wl!llla management method
t!"lal is available to me and thal I can attord. ·
Print~yped Name
1<-" . .e,y-L.
17. Transporter 1 At;,cnowledgemenl ol Receipt of Materials
18. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name
19. Discrepancy Indication Space
Signature
Signature
Signature
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature
,!?o
• I
b I
Month Day Year
/lbs. CI /lbs.
/lbs. d I jibs.
Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions n_ro Obsololo [DHEC 1988 (Rev. 10/86)1
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE Fl.RM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Fedeial Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and, if necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev: 9/86.(0HEC ~ 988A) lei both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
another country are responsiDle for completing the manifest Federal and State regulations also require generators and transporters of hazardous waste and
owners or operators of hazardous waste treatment. storage. or disposal facilities to complete the following information.
GENERATOR SECTION I
1.
2:
Generator's U.S. EPA 10 Number. Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
number assigned to this manilest by the generator beginning with 00001. llyour company does not have o U.S. EPA ldentilication Number, Dlease contact S.C.
OHEC at [phone] about obtaining an Identification number. · · I
Page 1 of: Enter the total numbe<of pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 918? (OHEC 1988 (REV 10186)] Dlus: ,
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ir any. ·
k State Manliest Document Number: .. Leave blank. · ·
e: State Generator ldenlification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned mani!es: !arms.
4, Generator's Phorie Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the event al
emergency including nights." weekends. and holidays. ·
5. Trans.port 1 Company Name: Enter the company name al the rirst transporter who will transport the waste.
6. U.S. EPA 10· Number: Enter the U.S. EPA twelve digit identification number al the lirst transporter identified in item 5. I C. Stale Transporter's ID Number: Leave blank.
D. Transporter's Phone Number: "enter a telephOne number including area code where an authorized agent al the lirst transporter can be reached in the event or
an emergency including nights, weekends, and holidays. .
T.. Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the_waste.I1 more than 2 transporters~
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transDorters in lhe order they will be transDorting the wa
8.. U.S. EPA ID Number:11 apDlicable, enter the U.S. EPA twelve digit ID number al the second transporter identified in item 7.
·· E.. Slate Transporter's ID Number: Leave blank. . ·
F •. Transporter's Phone Number: Enter a telephone number including area code _where ,m authorized agent al the second transporter can be reached in ti
event ol an emergency including nights, weekends. and holidays.
9.. Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
. waste listed on this manifest The address must be the site address, which may differ rrom the mailing address.
10. ~U.S. EPA ID Number: Enter the U.S. EPA twelve digit iden!Hication number of the designated treatment. storage, or disposal facility idenli!ied in item 9 .•
G:. Slate Facility's ID Number: Leave blank. · · · ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in the event of an
emergency including nights, weekends, and holidays. ·
11·. U.S. DOT Descriptions: Enter Rropershipping name, hazard cla_ssand ID Number (UN/NA) lorcach waste as idenlilied in 49 CFR 171-177.11 additional spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/66 (DHEC 1968A) Continuation Sheet. .: •
12.. Containers (no. and type): Enter number ol containers !or each waste and the approDriale abbreviation from Table I (below) for the tyDe of containers.
TABLE I . ;,
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases. roll oHs
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF = Fiberboard or plastic drums. barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13.: Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
t4. Unit (weighl/volume): Enter the appropriate abbreviations !ram Table II (below) tor the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only}
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Managemen't Regulation A.61 -79.261 Subparts C and ]
identify the hazardous waste on each line.
J. Additional Descriptions for Malerials Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request Fo
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatmenl storage or disposal In South Ca retina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handllng Codes lor Wastes Listed Above: Leave blank.
15 .. Special Handling lnstrucllons and Additional Information: Generators may use this space to indicate special transportation, treatment storage or dlspo
information or Bill ol Lading Information. For international shipments, generators must enter in this space the point of departure (cir-; and s:are) for those
shipments destined lor treatment. storage. or diSDOSal outside the jurisdiction al the United Slates. I
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. If a mode other than highway is used. ·
word "highway" should be lined out and the appropriate mode(rail, water.or air) inserted in the space below. II another mode in addition.to the highway mod
used, enter the appropriate additional mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION · ,
17: Transporter 1 Acknowledgement: Enter the name ol the person acceDting the waste on behalf of the first transporter. T~at~person mus! acknowlel
, acceDtance al the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE cl receipt. ·.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalf al the second transporter. That Detson mus!
acknowledge acceptance of the waste described on the manilest by SIGNING (BY HAND IN INK) and entering the DATE al receipt
FACILITY SECTION I
19. Discrepancy lndicalion Space: The authorized representative al the designated facility's owner or operator ~ust note in this space any discrepancy betw
the waste described on the manifest and the waste actliatly received at the facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submil to the Department a lefler with a copy of the manifest describing the discrepancy and at'!em::,tw
reconcile it The trealmenl storage, or disposal lacility must enter the actual weight of waste in pounds in !he spaces provided if the amount varies any from!
specified by the generator in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facility Ownei or Operator Certilicalion: Print or type the name ol the person accepting the waste on behall or the owner or operator ol the facility. That person ·
must acknowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HAND IN INK)' and entering the DATE al receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734·5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
I
I
South Carolina Department of Health
· and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Str .. \ Columb;a, SC 29201
Phone: [phone] ·
Emergency & Hondays: [phone]
Form A roved. 0MB No. 2050-0039 E.x ires 9-30-88
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo. Manifeat Document No. WASTE MANIFEST N c D o 7 6 o 140002
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, I Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
C D O 7
10. U.S. EPA ID Number
S C D O 7 0 3 7
2. Page 1 lnlormalion in the shaded a,eas is not
of required by Federal law, but is by State law,
11. U.S. DOT Description (including Proper Ship{Jing Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity U. Unit
No, Type 'MNd
a.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 I D T
~~=0~~~~~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71260
2 0 Y
t~1YF· :(6~!'1'!-9~1~~
.t'.hE101016,q:
"ifi""
:/? I
16. GENERATOR'S CERTIFICATION: I hereby declare that Iha contantsolthis conalgnmentara fully and accurately described above by proper ehlpplng name and are clasaifl~.
packed, marked, and raheled, and are in all respects in proper condition for lranspor1 by highway according to appllca.blo lnlarnatlonal and national government regulation• arid
U'le 1aws ol tha Stale ol South Carolina.
111 am a large quantity generalor, I certiry that I have a pr~ram In place to reduce the volume and toxicity ofwastagonaraled to the d~ree I have da!Ormlnod lo be oconomiully
practicable and that I have aorected the practicable method ol lraatmant. storage, or dlspoaal currently available 10 mo which minimizes the present and future threat ta human
heelth end the environment; OR, 111 am a small quantity generator, I have made a good lalth effort to minimize my waste generation and select the boil waste management method
that is available to me and that I can afford.
Monlh Day Year
1 9. Discrepancy Indication Space
• I jibs CI jibs
bl jibs d I jibs
20. Facility Owner or Operator, Certirication of receipt of hazardous materials covered by this manifest except as noted ln Item 19.
Printed/Typed Name Signature Month Day Year
EF'A Form 8700·22 (Rev. 9/86) Provlous ~dltlons ore Obsotole {DHEC 1988 (Rev. 10/86))
I
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FI_RM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel ·
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev: 9/86 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
~ another country are responsible !or completing the manifesl Federal and State regulations also require generators and transporters of hazardous waste and
owners or operator~ of haza.rdous waste treatment. storage, or disposal lacilities to complete the ro!lowing information.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
number assigned to this manifest by the geneiator beginning with 00001. If your company does not have a U.S. EPA Identification Number. please contact S.C.
OHEC at [phone] about obtaining an Identification number·. • I
2; Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 {OHEC 1988 (~EV 10/86)1 plus t
number al continualiol"! sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any. •
A:. State Manifest Document Numbei-: .. Leave blank. .
B: Slate Generator Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned mani!est forms.
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent ol lhe generator can be reached an the event of
emergency including nights.' weekends, and holidays. ·
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number:
0
Enter a teleph0ne number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and hotidayS. I
T.. Transporter 2 Company Name: II applicable, enter the company name al the second transporter who will transport the waste. ti more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters In the order they will be transporting the wa
8 .. U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit 10 number ol the second transporter identified in item 7.
E Stale Transpor1er's ID Number: Leave blank. · I
F .. Transporter's Phone Number: Enter a telephone number including area code _where an autt1orized agent of the second transpor!er can be reached mt
event of an emergency including nights. weekends. and holidays.
9.. Designated Facility Name and Site Address: Enter the company name and site address al the treatment, storage. or disposal facility designatea to receive the
1 waste listed on this manHesl The address must be the site address. which may dilfer from the mailing address. I 10:··u.s. EPA ID Number: Enter the U.S. EPA twelve digit identification number al the designated treatment. storage. or disposal facility identi!ied in item 9.
G:. Slate Facllity's 10 Number: Leave blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in the event al an
1L
12..
emergency including nights. weekends, and holidays. , ·
U.S. DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) !or each waste as identified in 49 CFR 171•177. If additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
Containers (no. and type): Enter number ol containers for each waste and the appropriate abbreviation lrom Table I (below) for the type ol containers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes.' cartons, cases. roll oHs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases I OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13.: Total Quantity: Enter total quantity ol waste described on each line. relative to the units used in item 14. I 14. Uni! (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit al measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Ga!lons {liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Subparts C and ]
identify the hazard.ous waste on each line. · ·
J. Additional Descriptions lor Materials Listed Above: In the spaces provided. enter the authorization number(from the S.C. OHEC Authorization Request For
tor each waste stream tistr.d in section 11 above. Neile: Be!Ore any hazardous waste can be accepted for treatment. storage or disposal in ~outh Carc:-lina. the
generator must obtain prior authorization lrom the treatment. storage or disposal facility. . I
K. Handling Codes for Wasles Listed Above: Leave blank. •
15 •. Special Handling Instructions and Additional Information: Generators may use this space lo indicate special transportation, treatment. storage or dispo
inlormation or Bill of Lading Information. For international shipments, generators must enter in this space the point of departure (city and s:ate) !or those
shipments destined !or treatment. storage. or disposal outside !he jurisdiction of the United States. I
16. Generator Certificalion: The generator must READ, SIGN,(BY HAND IN INK), and DATE the certilication statement. II a_mode other than highway is used.
word "highway'" should be lined out and the appropriate mode (rail, waler.or air) inserted in the space below. If another mode in addition :a the highway mod
used, enter the appropriate a_dditional mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION . · ,
11: Transporter 1 Acknowledgement: Enter the name of the person accepiing the waste on behalf or the first transporter. That person must acknowle,11
acceptance of the waste described on the·manifest by signing (BY HAND IN INK) and entering the DATE al receipt. • • 'W
18. Transporter 2 Acknowledgement: Enter. if applicable, the name al the person accepting the waste on behalf al the second transporter. That person must
acknowledge acceptance of the waste described on the manilest by SIGNING (BY HANO IN INK) and entering the DATE al receipL
FACILITY SECTION J
19. Discrepancy Indication Space: The authorized representative ol the designated facility"s owner or operator must note rn !his space any discrepancy betw
the waste described on the manifest and the waste acll.ially received at the facility. Owners and operators ol facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit 10 the Oepartmenta letter with a copy ol lhe manilestdescribing the discrepancy and artemotl
reconcile il The treatment, storage. or disposal facility mus! enter the actual weight ol waste in pounds in the spaces provided if the amount varies any tram t
specilied by the generator in item 13 or ii the generator uses a unit al measure other than pounds.
20. Facility Ownei-or Operator Certilicalion: Print or type the name of the person accepting the waste on behalf al the owner Or operator or the facility. That person ·
must acknowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HAND IN INK)° and entering the DATE of receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
Rf::CEIVE THE WASTE on THE s.c. m-tf;C MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Streel Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (B03)734-5424
LEASE PRINT or TYPE (Form desi ned for use on elite 12· itch writer Form A roved. 0MB No. 2050-0039 Exc,ires 9-30-88
UNIFORM HAZARDOUS 1.Generator'sU.S.EPAIDNo. Manlteat Document No. WASTE MANIFEST N c D o 7 6 o 1400021
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato(sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D 0 7 0
2. Page 1
of lnlormalion in the shaded areas is not
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13, Total Quantity 1•. Unit ·,:l'!Wate·~·,;4c
'MN~ 7/Hf/h\1:t~t:½~ffltf
a.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71261
No. Type
1 D T 2 0 Y
\{ LI -L....JL....L...Jj ·i~:
:1:t,. . _114:
1 e. C!NERATOR'S CERTIFICATION: I hereby declare that the contents ol this consignment are lully and accurately described above by proper shipping nam• and are ctuajn.:i.
packed. marked. and le°beled.and are in all respects in propercondilion for transport by highway according to applicable International and national govarnmont r~ulaUons al'\d
tho laws cl tho State ol South Carolina.
If I am a largo Quantrty genere1or, I certiry that I have a praoram In place to reduce tho volume and toxlcltyolwastegenerated to tho d&Qree I have delormlned to~ economically
practicable and lhat I have •elected Iha practicable molhod ol lreotmenl, storage, or dlspoaal currently ave.Hable to me which mlnlmi:r.o• the present and lutura threat to human
heallh and !he environmont;OR.111 am a smo!I Quanlity generalor, I hove mode a good faith effort lo minimize my waste generallon and a elect the ~•t wa1\a management method
that is available to me end that I con otford.
Signature Day Year
Signature
Signature Month Day Year
19. Discrepancy Indication Space
'I pbs. C I pbs.
b I pbs. d I libs.
20. Facilily Owner or Operator; Certification ol receipt ol hazardous materials covered by this manifest e:a:cepl as noted In Item 19.
PrinledtTyped Name Signature Month Day Year
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ·I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
storage. or disposal licililies to use the U.S. EPA Form 8700-22 Rev. 9/86 {OHEC 1988 (REV 10/86)) and. ii necessary, the continuation sheet U.S. EPA Fa
8700-22A Rev.-9/86 (DHEC 1988A) foi b·oth inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
·· another country are responsiOle for completing the manifest Federal and State reQurations· also require generators and transporters of hazardous waste and
owners or operator~ ol hazardous was_te treatmenl, storage. or disposal facilities to complete the following infor~ati.on. . I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number~ Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and lhe unique five digit
number assigned to !his manifest by the geneiatorbeginning with 00001. llyour company does not have a U.S. EPA ldenlilication Number. please contact S.C.
OHEC al [phone] about obtaining an identification number. • • I
2; · Page 1 ol: Enter the total numbe-rol pages used to complete.this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (~EV 10186)1 plus t
number of continuatio~ sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any.
k State Manifest Document Number: .. Leave blank.
B: State Generator Identification Number: Leave blank. . I
Generator's Nafne and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
Generalor's Phol1e Number: Enter a telephone number with area code where an authorized agent of the generatotCan· be reached in the event of
emergency including nights,' weekends, and holidays. ·
3.
4.
5. Trans.port 1 Company Name: Enter the company name of the first transporter who will transport the waste. I 6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification nl!mber of the lirst transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: 0Enter a teleph~ne number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. · I
T.. Transporter 2 Company Name: II applicable, enter the company name ol lhe second transporter who will transport the waste. If more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
8.. U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
'E.. St.ale Transporter's ID Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code :,vtiere an authorized agent ol the second transporter can be reached in ti
event of an emergency including nights, weekends, and holidays.
9.
10.
G:.
'H;.
1L
Designaled Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive !he
waste listed on this maniresl The address must be the site address. which may dirfer from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number or the designated treatmenl, storage, or disposal facility identified in item 9 .•
State Facility's 10 Number: Leave blank. ·
Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the racifity can be reached in the event ol an
emergency including nights, weekends, and holidays.
U.S. DOT Oescriplions: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identified in 49 CFR 171-177.11 additional spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation lrom Table I (below) tor the type of containers.
TABLE I
OM = Metal drums, barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. cartons, cases. r011 otts I
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. caSeS ·
OF= Fiberboard or plastic drums. barrels, kegs DT = Dump truck CF= Fiber or plastic boXes. car1ons. cases
TP = Tanks por1able CY= Cylinders BA= Burlap. cloth, paper or plastic bags
13.: Total Quantily: Enter total quantity al waste described on each line. relative to the units used in item 14. ' I
14. Unit (weight/volume): Enter the appropriate nbbreviations from Table II (below) !or the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subpar1s C ar.d]
identity the hazardous waste on each line.
J. Additional Oescriplions for Materials Lisled Above: In the spaces provided, enter the authorization number(from the S.C. DHEC Authorization Request For
for each waste stream listP.d in section 11 above. Nole: Before any hazardous waste can be accepted !or treatment. storage or disposal in South Carolina. the
· generator must obtain prior authorization from the treatment. storage or disposal racility. I
K. Handling Codes !or Wastes listed Above: Leave blank.
15 •. Special Handling Instructions and Additional Information: Generators may use this space to indicate special lransportation. treatment. storage or dispo
Information or Bill or Lading Information. For international shipments, generators must enter'in !his space the point of departure (city and slate) for those
shipments destined for treatment. storage. or disposal outside the jurisdiction of the United Slates. I
16. Generalor Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used,
word "highway" should be lined out and the appropriate mode(rail, water.or air) inserted in the space below. II another mode in additiOr. to !t',e highway mod
used, enter the appropriate additional mode (e.g.,_and_ rail) in the space· below.
TRANSPORTER SECTION . · •
11: Transport~, .1 Acknowl~dgement: Ente_r the nam~ of the person accepiing the waste o.i behalf of the first transporter. That_ person mus! acknowlet
. acceptance of the waste described on the manHest by signing (BY HAND IN INK) and entering the DATE ol receipt. ·
18. Transporter 2 Acknowledgement: Enter, if applicable, the name ol the person accepting the waste on behalf ol the second transponer. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN lNK) and entering the DATE al receipt.
FACILITY SECTION I
19. Discrepancy Indication Spac_e: The authorized representative ol the designated facility's owner or operator must note rn !his space any discrepancy betw
the waste described on the manifest and the waste actlially received at lhe facility, Owners and operators of facilities who cannot resolve significant
discrepancies wilhin 15 days receiving the waste mus I submit to the Department a letter with a copy ol lhe manilest describing lhe discrepancy and ar.emotl
reconcile it. The treatmen~ storage, or disposnl racility must onlor tho octual wcioht of waste in pounds in the spaces provided ii the amoun! varies any lrom t
specified by lhe generator in Hom 13 or ii lhe generator uses a unit or measure other than pounds.
20. Facility Owne"r or Operalor Certllicatlon: Print or type the name ol the person accepting the waste on behalf or the owner or operator al the lacili!y. That person
must acknowledge acceptance of lhe waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE ol receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT. STORAGE. OR DISPOSAL FACILITY DESIGNATED I
OeCEIVE THE WASTE OR THE s.c. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. .
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manifest
Document No. WASTE MANIFEST N c D o 7 6 o 1400022
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
a.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71262
2. Page 1
of
I T
Information in the shaded a<eas is no!
required by Federal law, but is by State law.
2 0 y
1~';p to'fT1'iJ"i'~
Qj•E1Q1Q161I
1 6. GENERATOR'S CERTIFICATION; I hereby declare that the contents of this consignment are fully and accurab!lly described above by proper ahlpplng name and are clasailled,
packed. marked, and ta.bclcd,and are in all respects in proper condition !or transport by highway according to applicable International and natlonal govemment regulations and
tl'le laws of the State or South Carolina.
111 am a large quantity generator, I certify that! havo a program In place to reduce lhovolumeand toxicltyol waste generated to the degree I have delarmlned to be economlcally
pracl!cable and that I have selected the practicable method cl treatment. storage, or disposal currently available to me which minimizes the present and luture throat to human
health and the environment: OR. if I am a small quantity generator, I have made a good lailh effort to minimize my waste generation and select the best waste management method
that is available to me and that I can attord.
Signature Month Day Year
~~Zo
ledgement of Receipt of Materials
Month Day Year
19. Discrepancy Indication Space
'I [lbs. 'I jibs.
b I jibs. d I jibs.
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86)1
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pilch (elite) typewrilerj OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Fedeial Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmenl
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Rev:9/86 (OHEC 1988A) for both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States lro
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters of hazardous waste and
owners or operators ol haza.rdous waste treatment. storage, or disposal facilities to complete the following information. I ·
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manifest bythegeneralor beginning with 00001. If your company does not have a U.S. EPA Identification Number, please contact S.C
OHEC at [phone] about obtaining an idenliliCation number. · I
2. Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] plus th
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any.
A'. State Manifest Document Number. .Leave blank.
s: Slate Generator ldentilicatlon Number: Leave blank · I
3. Generator's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage the returned manilest forms
4. Generator's Phoiie Number: Enter a telephone number with area code where an authonzed agent ol the generator can be reached In the event of an
emergency including nights, weekends, and holidays.
5.
6.
Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identilied in item 5.
C. Slate Transporler's ID Number: Leave blank. I
O. Transporler's Phone Number:
0
Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event ~f
an emergency including nights, weekends. and holidays. · 1
7:. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. If more than 2 transporters wi
bo used, use ;i U.S. EPA Form 8700-22A Rev. 9/BG (OHEC 1988A) continuntion sheet and lir.l tho lr:mspmtcrs in tile order they will be tr;msporting tho w:1sll
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit 10 number al the second transporter identified in item 7. 8 ..
E: .. Slate Transporler's ID Number: leave blank. I
F .. Transporler's Phone Number: Enter a telephone number including area code _where an authorized agent of the second transporter can be reached in th
event of an emergency including nights, weekends, and holidays.
9. Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manifc:st. The address must be the site address, which may differ from the mailing address.
U.S: EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment. storage, or disposal facility identified in item 9.
Slate Facility's 10 Number: Leave blank. I
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends, and holidays.
11: u.s: DOT Descriplions: Enter proper shipping name. hazard class and ID Number (UN/NA) tor each waste as identified in 49 CFA 171 •l 77. If additional spacl
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. .
12.. Containers (no. and type): Enter number ol containers for each waste and the appropriate abbreviation from Table I (below) for the type of containers.
TABLEI .
OM= Metal drums, barrels, kegs TT= Cargo tanks (lank trucks) CM= Metal boxes. cartons, cases. roll offs
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. car1ons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13. Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
14. Uni! (weight/volume): Enter the appropriate abbreviations from Table II {below) for the unit of measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subparts C and O t,
identity the hazardous waste on each line.
J. Addilional Descriptions for Materials Listed Above: In the spaces provided. enter the authorization number (rrom the S.C. OHEC Authorization Request Form
for each waste stream listed in section 11 above. ~le: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carolina, the
generator must obtain prior authorization from the treatment. storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
15 .. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or dispos
information or Sill al Lading 1nlormation. For international shipments, generators must enter in this space the point of departure (city and state) lo, those
shipments destined for treatment, storage. or disposal outside the jurisdiction al the United States. I
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE thecertilication statement. II a mode other than highway is used. th
word "highway" should be lined out and the appropriate mode (~atl, water. or air) inserted In the space below. If another mode In add1t1on to the highway mode 1
used, enter the appropriate a_dditional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter the name or the person accepting the waste on behall al the lirst transporter. That person must ack~o. wledgl
acceptance ol the waste described on.the IT!anifesl.by.signing (BY HAND IN INK) and entering the DATE of.receipt.
18. Transporter 2 Acknowledgement: Ente~, ii applicable, the name of the person accepting the wasle on behalf of the second transporter. That person must
acknowledge acceptance of the waste described on the manilest by SIGNING (BY HANO IN 1NK) and entering the DATE of receipt.
FACILITY SECTION I
19. Discrepancy Indication Space:·· The authorized representative of the designated facility's owner or operator must note in this space any discrepancy betwee
the waste described on the ·manirest and the waste actl.ially received at the facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit 10 the Department a fetter with a copy ol the manifest describing the discrepancy and attemots 1 reconcile il The treatment. storage, or disposal facility must enter the actual weight of waste in pounds in the spaces provided if the amount varies any trom th
specified by the generator in item 13 or if the generator uses a unit of measure other than pounds.
20. Facility Ownei-or Operator Certification: Print or type the name of the person accepting the waste on behalf of the owner Or operator of the facility. That person
must acknowledge acceptanc"e of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE ol receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED Tl
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. .
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia. SC 29201
Phone: {80.3)734-5200
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7 6 o 1 4
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
4. Generator's Phone 919
Smithfield,
934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
a.
C.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions an~ Additional lnlormation
GSX Work Order No.: 71263
Form A
2. Page 1
ol
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 E.x ires 9-30-88
lnlormation in the shaded areas is nol
required by Federal law, but is by State law.
12. Containers 13. T otat Quantity 14. Uni!
No. Type WtNrJ
1 D T
~~t1:F :,=-cft'f·t-9~;1;~:
2 0 Y ;:~1f1Q10.161\f
~fi"'
:st, ..
16. GENERATOR'S CERTI_FICATION: thereby declare lhol lhe contents ol lhis consignment ere fully end accuratelydascrlbed abova by proper shipping name and are clasa,tied.
pack ad. markod. and labeled.and ore in nll respects in proper condition lor transport by highway according to applicable lnlarnalional and na!lonal government regulatlon, ar,d
the laws ol lhCI State ol South Carolina.
II I am a large quantity genera1or, I certify that I have a program in piece lo reduce tho volume and todcltyof wastogenoraled to the degree I have determined to b4 economic.a.tty
practicable and Iha! I have selected tho practicable method ol lreolment. storage, or dlsposal eurronUy avoilablo to mo which minlmiu11 tho pros.an! and luturB threal to humen
health and Iha environment: OR. 111 am a small quantitygonorator, I hove mode o good lelth effort lo minimize my waste generation and se1ocl tho beat wa,1a management ~!hod
that is available to me end \hat I con ollord.
Printed~ Name
17. Transponer 1 Ac;Knowledgement ol Receipt of Materials
Printed IT yped Name
Printed/Typed Name Monttl Day Year
19. Discrepancy Indication Space
Printed/Typed Na.me Signature Month Day Year
EPA Form 8700·22 (Rev. 9/66) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)1
\ . . -. ·ir':'t :·' ·•i\J+,1~:-·,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FI_RM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatm. •1
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, if necessary, lhEI continuation sheet U.S. EPA Fo
8700-22A Aev.-9186 (DHEC 1988A) foi both inter-state and intra-stale transportation. Transporters who transport hazardous waste into the United States Ir
'"another country are respon~ifile !or completing the manifesl Federal and State regulations also require generators and transporterS ol hazardous waste and
owners or operators ol hazardous waste treatment, storage. or disposal fac1lll1es to complete the lollow1ng 1nlormatIon. ·
GENERATOR SECTION • ' I
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve d1g1t idenhhcallon number and the unique five dIg1
number assigned to this manifest by lhegeneiator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please co'ntact S.C.
OHEC at [phone] about obtaining an idenlili_cation number. • . ,, i· I
2; Page 1 of: Enter the total numbefol pages used to complete this manilesf, i.e., the first page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (~:~V 10186)1 plus t
number of coptinuation sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) if any. · ·, , . f
A. State Manifest Document Number: .. Leave blank.
e: State Generator Identification Number: Leave blank. · ' 1·
3. Generator's Name and Mailing Address: Enter the name and mailfng address of the generator who will manage the returned manifest forms.
4. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent ol th'e generator can be reached in !he event al
emergency including nights," weekends, and holidays. ·
5. Tranq:,ort 1 Company Name: Enter the company name al the first transporter who will transport therwaste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number al the first transporter identified in item 5. ,
9. Slate Transporter's ID Number: Leave blank. ,... •' •
0. Transporter's Phone Number: 'enter a teleph~ne number including area code where an authorized agent of the first transporter can be reached i~ the evE!nt of
an emergency including nights, weekends. and holidays. ; 1
T.. Transporter 2 Company Name: If applicable, enter the company name of the second tra~sporter who will transport the Waste. II more than 2 transporters JI
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in thE! ord~ithey will be transporting !he was■ '"· "' 8 .. U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. '·
E.. State Transporter's ID Number: Leave blank. · · ' . '.
F .. Transporter's Phone Number: Enter a telephone number including area code :,"here an autllorized agen.l of the second transporter can be reached in ti:
event of an emergency including nights. weekends, and holidays. ' .• ,
9.. Designated Facility Name and Site Address: Enter the company name and site address or the treatment, stO~age, or disposal facility designated to receive the 1
waste listed on this manifest The address must be the,site address. which may differ from the mailing address. .i, '. 11
. 10;· U.S. EPA ID Number: Enter the U.S. EPA twelve digil•identification number ol the designated treatment. storage, or disposal facility ide_ntilied in item 9. ·. I :
G: .. Slate Facility's ID Number: Leave blank. ·
'H;. Facility's Phone.Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of . .in
emergency including nights, weekends. and holidays. · • ... ~--J
t t'. u.s: DOT Oescriplions: Enter proper shipping name, hazard class and 10 Number (l!tti'NA) for each waste as idenltlied i~/9 CFA 171-t ?7.11 additional spa.
is needed, use a U.S. EPA Form 870~-22A Rev. 9/86 (OHEC 1988A) Continuation She~t. , .. •./· ,.
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation from Table I (below) for the type al containers. I TABLE I __ ,. . .•. ..,.. •
OM :: Metal drums. barrels, kegs TT:: Cargo tanks (tank trucks) CM = Metal boxes, cartons. cases. roll offs
OW:: Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels. kegs OT= bump truck CF= Fiber or plastic boxes'. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap. cloth, paper or plastic bags r
i3.'.Total Ouantily: Enter total quantity al waste described on each line. relative to the units used in item 14. •
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table 11
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and DI
identity the hazardous waste on each line.
J. Additional Oescriplions for Malerials Li sled Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request For .
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal lacjlity. I
K. Handling Codes lor Wastes Listed Above: Leave blank. ·
15. Special Handling Instruction~ and Additional Information: Generators may use this space to indicate special transportation. treatment. storage or dispo
information or Bill al Lading Information. For international shipments, generators must enter' in this space the point ol departure {city and slate) tor those
shipments destined for treatment, storage. or disposal outside the jurisdiction ol the United States. · ·
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. If a mode other than highway is used .•
word "highway" should be lined out and the appropriate mode{rf"il, water.or air) inserted in the space below. II another mode in addition to tr,e highway mod
used, enter the appropriate a_ddilional mode (e.g.,_and, rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter the name al the person accepting the waste on behalf of the first transporter. That person must acknowledl
acceptance al the waste described on the manifest by signing (BY HAND IN.INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behall al the second transporter. That person must
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipl
FACILITY SECTION I
19. Discrepancy Indication Spac_e: The authorized representative al the designated facility's owner or operator ,;,us! note in this space any discrepancy bet we
the waste described on the manilest and the waste actually received at the racility. Owners· and operators of facilities who cannot resolve significant
discrepancies within 15 days rec·eiving the waste must submit to the Department a letter with a copy of the manifest describing the discrepancy and ar!emots to
• reconcile il The treatment storage, or disposal lacilily mus! enler the actual weight of waste in pounds in the spaces provided if the amount varies any from ti
specified by the generator in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facility Own el' or Operator Certification: Print or type the name ol the person accepting the waste on behall of the owner or operator of the facility. That person ·
mus! acknowledge acceptanc·e of fhe waste described on the manliest by SIGNING (BY HAND IN INK)°and entering the DATE al receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT. STORAGE. OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE S.C. OHEC MANIFEST SECilO~l t,T {803) 734-5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
PL.EASE PRINT or TYPE (Form desi ned for use on elite 12-itch writer
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIONo. Manlreat Document No. WASTE MANIFEST N c D o 7 6 o 1400024
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transpor1er 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 71264
Form A
2. Page 1
of
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 2920\
Phone: [phone]
Emergency & Holidays: [phone]
roved, 0MB No. 2050-0009 E,pires 9-30-Ba
Information in the shaded areas is not
required by Federal law, but is by State law.
16. CENERATOR"S CERTIFICATION: I hereby declare Iha! the contanl.s Ollhl:, con:,ignment are tullyand accuralely de:,cribod obovo by proper ahlpplng nome and are clas••fie,d.
packed. markod. and laheled. and are in a1l respects in proper condilion !or transport by highway according to applicable International and naUonal govornmon1 r..,;iulatJona arid
U'\e laws ol the Stale ol Soulh Carolina.
111 am a large quantity generator, I certily !hall have a program In placo to reduce tho volume and toxicity of waste generated lo the do,orete I heve determined to be economically
practicable and that I have selocled the practicable method of treatment, slorage, or dlspoul currently evaitablo to mo which minimizes tho prasenl and lutura thr-t to human
health and the environment: OR. II I am a small quantitygeneralor, t hove made III good loith eNort to mlnlmir.e my weste gonerotlon end salect tho beat wa11e management method
tt,af is available to me and Iha! I can aNord.
11--i--P-ri-nt_ed~C,l:::;yip.:'led.!:4'-iNa:m_•.:,L:;;,._.:;G,;;;· ~~:::· :/;s.=: ______ _j_s_ig-na-tu_r•_t,;,€~~~~---...J.:::;~_.::~~~::!;:.t,. _____ L.:;i!~~
T 17. Transpor1er1 AtKnowledgemenlofReceiplolMalerials "' 1
Day Year
lj~7t-d~r7·~~ed~,T~yp-ed~;~a-me_..a,... __ _,c _____ ,::-:-:-,----j/--,._..,-~-0~r---,--f---------:-,~-::-
o ,;a~ Transporter 2· AcfnOwledgement ol Receipt ol Material / Al--''--...:...:.:.:...;.;c..c-"C--''-=-'-'-"-'..:.......:.:.:.:c..c. _ _;__c_ __ 4_,_ _______________ ,,__ _____________ _ 1 .. i-+--P-ri-nt_ed_l_T_y_p_ed_N_,m_• ______________ _._S_ig_n_at_u_r• ______________________ _...,_._..__.__
19. Discrepancy Indication Space
Montn Day Year
Month Day Year
F a J If b~,~~~~
I 1---------------~ 20. Facility Owner or Operator, Certification of receipl of hazardous materials covered by this manifesl except as noted In Item 19.
Jibs CI jibs
jibs. dJ jibs
I Printed/Typed Name Signature
EPA Form 6700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)1
Montn Day Year
;'
IMPORTANT:
STATE o~ souTH CAROLINA 1Ns:j~:T1Jis ,F,OR·t~~:iSRM HAZARDOUS WASTE MANIFEST I
TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL .
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators al hazardous waste treatmel
storage. or disposal licillties to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fo
!700-22A Rev.-9/86 (DHEC 1988A) tor both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States tr
• another country are responsible lor completing the manifest Federal and State regulations also require generators and transporters of hazardous waste ano
owners or operators ol hazardous waste treatment, storage, or disposal racilities lo complete the rollowirlg information. I
GENERATOR SECTION · .
l. Generator's U.S. EPA ID Number. Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five dig1
number assigned to this manilest by the generator beginning with 00001. llyour company does not have a U.S. EPA Identification Number. please contact S.C.
DHEC at {803) 734-5200 about obtaining an Identification number. I
2; Page 1 of: Enter the.total numberol pages used to com.plete this manilest, i.e., the lifst page EPA Form 8700-22 Rev. 9/86[DHEC 1988 (REV 10/86)] plus I
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any. ·
A. State Manifest Do~ument Number: .Leave blank.
B: State Generator Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manilest forms.
4. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in !he event of
emergency including nights." weekends, and holidays. ·
5. Trans.port 1 Company Nam_e: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the rirst transporter identified in item 5. I C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: 0Enter a teleph0ne number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. •
T.. Transporter 2 Company Name: If applicable, enter the company name ol the second transporter who will transport the waste. ti more than 2 transporters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC rn88A) continuation sheet and list the transporters in the order they will be transponing the was
8.. U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
~ E.. Stale Transporter's ID Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code .where an authorized agent ol the second transpor1er can be reached in 'I
event of an emergency including nights, weekends. and holidays.
9.. Designated Facility Name and Site Address: Enter the company name and site address of the treatment. storage, or disposal facilily designated to receive the
, waste listed on this manifest The address must be the site address, which may differ rrom the mailing address.
10.-U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment, storage, or disposal facility identified in item 9 .•
G:. · Slate Facility's ID Number: Leave blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights. "'.{eekends, and holidays. .
11'. U.s: DOT Descriptions: Enter proper shipping name, hazard class and lO Number (UN/NA) for each waste as identified in 49 CFR 171 -177.11 aCdi!ional soal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers for.each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I
OM = Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes. cartons, cases. roll otts I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
•> OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
;,-TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
~--13.:Tolal Ouantily: Enter total quantity of waste described on each line, relative to the units used in item 14. · •
14. Unit (weight/volume): Enter lhe appropriate abbreviations from Table II (below) !or the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only}
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 -79.261 Subparts C ar.d 01
identify the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatment storage or disposal in South Carclina. the
generator must obtain prior authorization rrom the treatment, storage or disposal facility. I
K. Handling Codes lor Wasles Listed Above: Leave blank.
15 •. Special Handling lnstrucllons and Additional lnformalion: Generators may use this space to indicate special transportation, treatment. storage or dispo
information or Bill ol Lading lnlormation. For international shipments, generators must enter' in this space the point ol departure (city and s1a1e) for those
shipments destined !or treatment, storage. or disposal outside the jurisdiction ol the United States.
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used .•
word "'highway" sh·ould be lined out and the appropriate mode (rail, water.or air) inserted in the space below.II another mode in addition to the highway mod
used. enter the appropriate a_dditional mode (e.g.,_and_ rail) in the spac'e below.
TRANSPORTER SECTION
17'. Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behaU of the first transporter. That person must acknowlet
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the·DATE ol receipt. · ·
18. Transpor1er 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting !he waste On behalf al the second transporter. That person must
· acknowledge acceptance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in !his space any discrepancy betwe
the waste described on the· manifest and the waste acttia!ly received at the lacifity. Owners and operators ol facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit to the Oepartmenl a letter wilh a copy of the manifest describing the discrepancy and ar.emc1s :o
reconcile it The treatment storage. or disposal facility must enter the actual weight of waste in pounds in the spaces provided ii the amount varies any from ti
specified by lhe generalor in ilem 13 or if !he generator uses a unit ol measure other than pounds.
20. Facility Ownei-or Operatof Certilication: Print or type the name ol lhe person accepting the waste on behalf of the owner or operalor of !he lacili1y. That person
must acknowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE ol receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED 1
RF.CE:'.'F. THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I So.uth Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull S~ee\ Columb;a. SC 29201
Phone: [phone]
Emergency & HoHdays: [phone]
LEASE PRINT or TYPE (Form desi ned for use on elite ewriler Form A roved. 0MB No. 2050-0009 Ex ire, 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No. Manifest Document No. 2. Page,
ol
3. Generator's Name and Mailing Address
Channel Master
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
1400025
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers
No. Type
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
·csx Work Order No.: 71265
l D T
Information in the shaded a<eas is not
required by Federal law, but is by State law.
2 0 Y
=.,:,; ,~~_.__.___., ~l,tl
d, 1lr .... ,,,,.,,:,,
, 6. GENERATOR'S CERTIFICATION: I hereby declare that the contents ol thlsconalgnmentaralullyand accurately described above by proper shipping nam• and are cJHailled,
packed, marked, and laheled,and are in all respects in proper condition tor transport by highway according to applicable International and national government re,gulations af'\d
the laws ol the State of South Carolina.
111 am a large quantity genaralor, I certify Iha! I have a program In piece lo reduce the volume and toxicltyol waste generated to the do-groe I have determined 10 be economically
prac11eable and that I have selected the practicable method ol treatment, storage, or dlspoaal currenlly a¥ailable to me which minimize, the present and futur• thrNl to hu1n11n
health and the environment; OR, 111 am a smoll Quantity generator, I have made a good laith oNortto minimize my waste generation and u1act tha beat waata managam•nt method
that is availaDle to mo and that I can aNord.
Signature
Pl¥\ ·~A
Printed/Typed Name Monttl Day Year
19. Discrepancy Indication Space
a I l'bs. C I jibs.
bl l'bs. d I l'bs.
20. Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manifest excepl as noted In Item 19.
Printed/1:yped Name Signature Month Oay Yur
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete {DHEC 1988 (Rev. 10/86)]
J
j \I; :./, •'. ., .. it
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ,. IMPORTANT: TYPE [on a 12-pilch (elile) typewriter] OR USE Fl.RM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators al hazardous waste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, if necessary, Iha continuation sheet U.S. EPA Fo
8700-22A Rev:9186 (DHEC 1988A) toi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States fr
· another country are responsiDle !or completing the manilesl Federal and State regulations also require generators and transporterS ol hazardous waste and
· o~ners or operators of haza.rdous waste treatment, storage. or disposal facilities to complete the following information. I
GENERATOR SECTION
1. Generator's U.S. EPA 10 Number• Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number ana the unique live dig1
number assigned to this manifest by thegeneiator beginning with 00001.11 your company does not have a U.S. EPA 1dentilication Number, please contact S.C.
DHEC at [phone] about obtaining an Identification number. ' I
2; · Page 1 of: Enterthelolal number of pages used to complete this manifest, i.e .• the lifst page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)] plus t
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. ·
A. Stale Manifest Document Number: .Leave blank.
e; State Generator Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest !arms.
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the even! of
emergency including nights: weekends. and holidays. ·
5. Transport 1 Company Name: Enter the company name of the rirst transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent ol the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. · . 1:_ Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
8 •. U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in ilem 7,
E .. State Transporter's ID Number: leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code _where an authorized agent ol the second transporler can be reached in t.l
event of an emergency including nights, weekends, and holidays.
9. Oesignaled Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal lacility designated :a receive the
waste listed on this manifest The address must be the site address, which may differ rrom· the mailing address.
10; ·u.s. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment. storage, or disposal racility identified in item 9 .•
G:. Slate Facility's ID Number. Leave blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event al an
emergency including nights, weekends, and holidays.
11'. U.S. DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) lorcach waste as identified in 49 CFR 171-177.11 additional soal
is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation lrom Table I (below) !or the type of conlainers.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons, cases, roll oHs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons, cases
OF'= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13.~ Total Ouantily: Enter total quantity ol waste described on each line, relative lo the units used in item 14.
t4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit ol measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subparts C ar.d 01
identify the hazardous waste on each line.
J. Additional Descriptions for Materials Li sled Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted !or treatment storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. .
K. Handling Codes lor Wastes Listed Above: Leave blank. I
15. Special Handling Instructions and Additional lnlormallon: Generators may use this space lo indicate special transportation, treatment. storage or dispo
information or Bill ol Lading Information. For international shipments, generators must enter'in this space the point ol departure (ciry'and state) !or those
shipments destined for treatment, storage. or disposal outside the jurisdiction ol the United States.
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used .•
word .. highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. II another mode in addition to the highway mod
used, enter the appropriate a.ddilional mode (e.g.,.and, rail) in the space below.
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: Enter the name ol the person accepling the waste on behalf al the first transporter. That person must acknowlet
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalf of the second transporter. That person must
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE of receipt.
FACILITY SECTION i
19. Discrepancy Indication Spac_e:• The authorized representative of the designated facility's owner or operator ~us! note in this space any discrepancy betw
lhe was!e described on the manifest and the waste actUa!ly received at the racility. Owners and operators of facilities who cannot resolve significan
discrepancies within 15 days receiving the waste must submit to the Department alerter with a copy of the manifest describing the discrepancy and artemcts :o
reconcile iL The treatment.storage. or disposal lacilily must enter the actual weight of waste in pounds in the spaces provided ii the amount var.ies any from ti
specified by the generator in item 13 or ii the generator uses a unit al measure other than pounds.
20. Facility Owner or Operator Certification: Print or type lhe name ol the person accepting the waste on behalf of the owner or operator ol the lac1lity. That person
mus! acirnowledge acceptance of !he waste described on the manifest by SIGNING (BY HANO IN INK}' and entering lhe DATE of receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control '
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull S"ee\ Columbia, SC 29201
Phone: (BOO) 734-5200
Emergency & Holidays: [phone]
LEASE PRINT or TYPE (Form desi ned for use on elite 12· itch Form A roved. 0MB No. 2050-0039 Exoires 9-30-88
3 .. Generator's Name and MilHing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone ( 919 9 34-9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transpor1er 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
B. U.S. EPA ID Number
10. U.S. EPA 10 Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
~,~~~~r~~~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71266
2 0 Y
::J,t ;o·;I19"i~~
·:;:1 IF IO IO I 6 l\f
.... · ...•.. ~.-.. .. ~.-... ~ ...
tr,L.• · ..... _ .... ..1......,, ;il
{~ I l'j
16. GENERATOR'S CERTI_FICATION: I hereby declare that the contents of lhisconsignmanl ara lully and accurately described above by proper •hipplno riam• arid ere ,:l•••ilied.
P•C~od. marked, and labeled.and ore In all respect• in proper condition for transport by highway according to appUcabla International and natlonal govornmenl r--.iulatlon• and
tne laws 011110 State ol Soult! C.::arollna.
111 am a large quantity gencro1or, I cortily that I have a program in ploco to raduce the volume and toxicltyol waste genoralod to the d&gr-I have determined to be economically
precticac,le and that I have selocled the practicable method ol trootment. slorago, or dlsposal currenlly available to me which minimizes Iha pres.en! end lul\Jre throat to human
health and the environment; OR, If I am a small quantilygoneralor. I hove made a good laith aNort lo minimize my waste generation and select the beat waste management method
that is available to me and that I con aNord.
Print~yped Name
'/Cc,, L,
l 7. Transponer l At;Knowledgement ol Receipt of Materials
Pr" led/Typed Name -r,
Printed/Typed Name
19. Discrepancy Indication Space
Signature
20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by !his manifest except as noted in Item 19.
Printed/Typed Name Signature
'I
b I
Month Oay Year
Month Oay Year
libs. C I libs.
jibs. d I !lbs.
Month Oay Year
EPA Form 6700-22 (Rev: 9/86) Previous Editions are Obsolete jDHEC 1988 (Rev. 10/B6)!
'
p 1
IMPORTANT:
STATE OF SOUTH ~ARO\INA INST~t~Tl~N~ ~OR
0
~Ji~F&RM HAZARDOUS WASTE MANIFEST I
TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBL •
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators ol hazardolls waste treatmel
storage. or disposal licifities to use the U.S. EPA Form 8700-22 Rev. 9/86 {OHEC 1988 (REV 10/86)) and, ii necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev.-9/86 {OHEC 1988A) loi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States fr
... another country are responsible for completing the manifest Federal and State regulations also require generators and transporters of hazardous waste and
owners or opeiator~ al hazardous waste treatment, storage. or disposal racilities to complete the, rollowirig informati.on. . . . ·, I
. GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's U.S. EPA twelve digit Identification number and the uniQue five digit
·number assigned to this manifest by the generator beginning with 00001. llyour company does not have a U.S. EPA Identification Number. please contaci S.C.
OHEC al [phone] about obtaining an identification number. I
2: Page 1 ol: Enter the total numbe<of pages used to complete this mani!est, i.e., the liist page EPA Form 8700-22 Rev. 9/86(DHEC 1988 (~EV 1 Ol86ll plus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any.
A:. Stale Manifest Document Number: .Leave blank.
e: State Generator Identification Number: Leave blank. I
~-· 3. Generator's Name and Mailing Address: · Enter the name and mailing address of the generator who will manage the returned mani!est forms.
r '
4. Generator's Ph'orie Number_: Enter a telephone number with area code where an authorized agent of the generator can be reached in the eve~t of
1
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I ,
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol lhe first transporter identified in item 5. !
C. Slate Transporter's ID Number: Leave blank. I
0. Transporter's Phone Number: °Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event of 1
an emergency including nighls, weekends, and holidays. I
T.. Transpor1er 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheel and list the transporters in the order they will be transponing the was
8.. U.S. EPA ID Number:!! applicable, enter the U.S. EPA twelve digit 10 number of the second transporter Identified in item 7.
E.-Slate Transporter's ID Number: Leave blank. ·
F .. Transporter's Phone Number: Enter a telephone number including area code _where nn authorized ngent ol the second transponer can be reached in ti
event ol an emergency including nights, weekends, and holidays.
9. Oesignaled Facility Name and Sile Address: Enter the company name and site address of the treatment. storage, or disposal facility designatea to r~ceive the
waste listed on this manifest The address must be the site address. which may differ from the mailing address.
10~·'u.s. EPA JO Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment. storage, or disposal facility identified in item 9 .•
G:. State Facility's ID Number: Leave blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends, and holidays. · .
11·. U.S: DOT Oescrlplio'ns: Enter proper shipping name, hazard class and ID Number (UN/NA) lorcach waste as identified in 49 CFR 171-177.11 additional spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ·
12.. Containers (no. and type): Enter number al containers !or each waste and the appropriate abbreviation from Table I (below) lor the type of containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Me!al boxes, cartons. cases. roll oHs
OW= Wooden drums, barrels. kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13.: Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
t4. Unit {weighl/votume): Enter the appropriate abbreviations from Table II (below) tor the unit of measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management ~egulation R.61 • 79.261 Subpans C ar.d l
identity the hazardous waste on each line.
J. Additional Oescriplions for Malerials Lisled Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listed in section 11 above. Note: Be lore any hazardous waste can be accepted for treatmenl storage or disposal in South Carc:,lina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
: TS •. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or dispo
information or Bill of Lading Information. For international shipments, generators must enter' in this space the point of departure (city and state) for those
shipments destined for treatment, storage. or disposal outside the jurisdiction ol the United States.
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used .•
word "highway" should be lined oul and the appropriate mode(rail. water.or air) inserted in the space below. II another mode in addition to tl"',e highway mod
used, enter the appropriate a_dditional mode· (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION . · ,
11: Transporler 1 Acknowledg'ement: Enter the name of the person accepting the waste on behalf of the first transporter. That person mus! acknowlet
. acceptance of the waste described,on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt..
18. Transporter 2 Acknowledgement: Enter. if applicable, the name ol the person accepting the waste on behalf of the second transponer. That person must
acknowledge acceptance ot !he waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
FACILITY SECTION . . . · ■
19. Discrepancy lndicalion Spac_e: The authorized representative al the designated lacility's owner or operator must note in this space any discrepancy betwel
the waste described on the manifest and the waste actually received at the racility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 d.:iys receiving the wasle must submit to the Department a letter with a copy of the manifest describing the discrepancy and attempts to
reconcile it The treatmenl storage. or disposal lacility must en tor the actual woighl ol wasle in pounds in the spaces provided ii !he amount varies any lrom 11
si,eclfied by !he generator In Item 13 or II !he generalor uses a unit ol measure other than pounds.
20. Facility Ownef or Operator Cerlilicalion: Print or type the name of the person accepting the waste on behaH ol lhe owner or operator ol the facility. Thal person
must acimowledge acceptance or the waste described on the manHest by SIGNING (BY HANO IN INK)and entering the DATE of receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE s.c. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
I
I
F
A
C I
L
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bult Street Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS 1. Generator"sU.S.EPAtONo. Manlloat 2. Page 1 Oocumant No. of WASTE MANIFEST N c D o 7 6 o 1 4 0 0 0 2 7
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator"sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
Information in the shaded a<eas is not
required by Federal law, but is by Sta.le law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 1". Unit
No. Type 'MN~
a.·
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T 2 0 Y
., .....
;) ~, ~_,._.,_~ ,:--i
':.1/ .. !. I
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71267
,e. GENERATOR'S CERTIFICATION: I herebyde·clarethat the conten1, olthls consignment are fully and accurataly described above by proper 11hlpplng name and are clasaifled.
packed. marked, and la.bated, and are In all respects in propercondilion for transport by highway according to appHcable International and national government r~ulatlona and
tne laws ol the State of South Carolina.
111 am a large quantity generator, I certify that I have a program in place lo reclucathavotumeand IO)(lclry ofwa,taganaralecl totha degr-I have determined to be economic.all)'
prac1icable and that I have satected the practicable method ol treatment. storage, or dlapoul currently available lo ma which mlnlmlz.aa the present and future tnrNI to human
heallh and the environmont:OR, ii I am a small ciuanlitygenerator, I have made a good lallh effort to minimize my waste ganara!Jon and select the boat we ate management ""'8thod
that is avaitab!a to ma and Iha! I can attord.
C ts
18. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name
19. Discrepancy Indication Space
Signature C
Signature Month Day Year
a lu...r...L..L..L..Jpbl c L-1 .r...L..L..L..J-lpbl
bj !Jbl dj !Jbl
I 1---------------~ 20. Facility Owner or Operator; Certification or receipt ol hazardous materials covered by !his manifest except as noted In Item 19.
Printed/Typed Name Signature Month Day Yaar
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
' . , :(,{.\ f. :i• ·:.;:,J
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT; TYPE [on a 12•pilch (elite) typewriter] OR USE F\RM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
.' storage. or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, ii necessary, thEl continuation sheet U.S. EPA Fo
1-:-8700-22A Rev.-9/86 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
io-another country are responsible !or completing the manifesl Federal and State regulations also require generators and transporters al hazardous waste and
owners or operators ol hazardous waste treatment. storage. or disposal lac11ihes to complete the lollow1ng 1nformat1on. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manllesl Document Number: Enter the generator's U.S. EPA twelve d1gIt 1denhlicatton number and the unique five d1g1
number assigned to this manitest by the genefator beginning with 00001. H your company does not have a U.S. EPA Identification Number. please contaCI S.C.
OHEC at [phone] about obtaining an ldenlification number. · I
2; . Page 1 of: Enter the total numbe<of pages used to complete this manifest, i.e., the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P.EV l0/86)] plus t
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any. ·
A:. State Manilest Document Number: .. Leave blank. ·
e: State Generator Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned mani!es: !arms.
4. · Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event al
emergency including nights," weekends. and holidays. · s. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste: I
6. U.S. EPA ID Number; Enter the U.S. EPA twelve dtgil identification number ol the first transporter identified in item 5.
C. Slate Transporter's ID Number:. Leave blank:
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. I
T.. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa
8 .. U.S. EPA ID Number:1I applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E.. State Transporter's ID Number: Leave blank. .
F .. Transporter's Phone Number: Enter a telephone number including ~rea code _where an authorized agent or the second transporter can be reache·d in ti
event of an emergency including nights, weekends. and holidays.
9. Designated Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal lacility designated to receive the
, waste listed on this manifest The address must be the site address, which may dilfer from the mailing address. .
10;· U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment. storage, or disposal facility identified in item 9 .•
G:. Stale Facility's ID Number: Leave blank. ·
· H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends. and holidays. ·
11·. U.S: DOT Descriptions: Enter Rropershipping name, hazard class and 10 Number (~NINA) !or each waste as identified in 49 CFR, 71-177. If additional spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Conlalners (no. and_ type): Enter number <;>I containers !or each waste and the appropriale abbreviation lrom Table I (below) !or the type at containers.
TABLE I
OM~ Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons, cases. roll otts
DW = Wooden drums, barrels, kegs TC= Tank cars CW= Wooderl boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13.: Total Quantity: Enter total quantity of waste described on each line. relative to the units used in item 14.
T4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C ar.d l
identity the hazardous waste on each line.
J. Addilional Descriptions !or Maleria1s Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request For
lor each waste stream listed in section 11 above. t«:ite: Before any hazardous waste can be accepted tor treatment storage or disposal in South Carc-lina. the
generator must obtain prior authorization from the treatment. storage or disposal facility. · · · I
K. Handling Codes for Wasles Listed Above: Leave blank.
15 .. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation. treatment. storage or dlspo
information or Bill or Lading Information. For international shipments, generators must enter'in !his space lhe point ol departure (city and state) !or those
shipments destined tor treatment, storage. or disposal outside the jurisdiction of lhe United Slates.
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. If a mode other than highway is used .•
word "highway" should be tined out and the appropriate mode(rail, water.or air) inserted in the space below. If another mode in addition to the highway mod
used. enter the appropriate a_dditional mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION .
11: Transporter 1 Acknowledgement: Enter the name ol the person accepiing the waste on behalf of the first transporter. That person must acknowledl
. acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter. ii applicable, the name of the person accepting the wasle on behalf ol the second transporter. That person mus!
acknowledge acceptance ol the waste described on the manifest by SIGNING {BY HAND IN INK} and entering the DATE of receipt
FACILITY SECTION . I
19. Discrepancy Indication Spac_e: The authorized representative of the designated lacility·s owner or operator must note in this space any discrepancy betwe
the waste described on the manifest and the waste ac!Ually received at lhe facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving lhe waste mus! submit to the Oepa_rtmenl a leller with a copy of lhe manilesl describing the discrepancy and a:1empts to
reconcile it The treatment slorage,ordisposal facility must enter the aclual weight of waste in pounds in lhe spaces provided ii the amount varies any from II
specified by the generator in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facility Ownei-or Operator Certification: Print or type !he name ol lhe person accepting the waste on behall of the owner or oPerator at the facility. Thal person
must acknowledge acceptanc·e of the waste described on the manHest by SIGNING (BY HAND IN INK}"and entering the DATE al receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau or Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
I. PLEASE PRINT or TYPE (Form desi ned for use on elite 12-itch ewriler
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manifest Document No.
Form A
2. Page 1
of
roved. 0MB No. 2050-0039 Expires 9-30-88
lnlormation in the shaded a<eas is not
required by Federal law, but is by State law.
I
I
I
I
I
I
WASTE MANIFEST N c D O 7 o 1400028
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
Gsx·services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
~ ~t-~~i~:~2i,t :~~:~ili,~1iliii/1! l1iill!f i1lllliii:!1il'1ill1ililiJ;ii1iI!;:i/l!!i~ll~i1ii;i1~~~ii!i
: ~=:o :2 :7 :7:4:;:1:1:o:2~~t!J~J!llf :;~,;,: ,L,} __ ,_ :~:,,... :,
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71268
16. GENERATOR'S CERTI_FICATION: I hereby declare that lhe contents olthls consignment are fully and accurately described above by proper ahipplng nam• and are ctasaili.c:1,
packed. marked. and labeled, and are in ell respects in proper condition for transport by highway according to applicable international and national government ,.,_ulations and
tne laws ol the Slate ol South Caroline.
II I am a largo Quantity generator, I certify that\ have a program In placo to reduce thavo1ume and loxlcltyolwaslageneraled 1othe dog,_ I have del9rmlned lo be economically
practicable and that I have selected the practicable method ol lrealmont. storage, or dlapoaal currently availabla to me which minimize• the present and luture thrNI 10 human
health and the environmenl:OR, 111 am a amall quantity gonorator, I have modo a good feith effort lo minimize my waste generation and aelect Iha be1l wHte management m9thod
thal ls available to me and Iha! I can afford.
T ~1!._7:.,. ~T r~a:'.ns~p=o;rt.:.er'.._1'.._A~<~•'.'.n~o~w~led~ge:'.m~e:'.n~I ~of~R~e=c.:.ei~p'.cl o~l~M~•~le:'.r~i•~l•~---r.-::f:::=::::""'-ss::-----------a;-----------:-:-::--::--::-~ ·~ ~ 1-'-8-:. ::-',-•_n...;soo=rt_er_2_,A.,.c,..k_n_o_w_c_d"-ge_m_e_n_1_o_e_c_e1.:.p_10_1_M_a_1,_r_ia_s ___ -r,::-\,----="'----------------------:-:-::--::--::--t
l1-i-+--P-,i-nt_ed_/_T_y_ped_N_•_m_e ______________ _;. _________________________ -1.,...1....i...J...L-l'"'"4
19. Discrepancy Indication Space
Month Day Year
F a I Ir b,~~~~ jibs. C I jibs.
jibs. d I jibs.
If---------------~ 20. Facility Owner or Operator: Certification of receipt ol hazardous materials covered by this manifest except as noled In Item 19.
PtlnlOdlTVPOd Namo Signature Monlll Dey YW
EPA Form 8700·22 (Rev. 9/86) Previous Editions nro Obsolele (DHEC 1988 (Rev. 10/86)]
,
l
I
; . . i 1-..
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE Fl.RM POINT PEN• PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators of hazardous waste treatmel
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, ii nec~ssary, the continuation sheet u.5:. EPA Fo
8700~22A Rev: 9/86 (DHEC 1988A) foi both inter-state and intra-state lransportatlon. Transporters who transport hazardous waste into the United States Ira
·-another country are responsiD!e !or completing the manifest Federal and State regulations also require generators and transporters of hazardous waste and
owners or operators ol haza.rdous waste treatment, storage, or disposal fac1llt1es to complete the following 1nlormat1on.
GENERATOR SECTION I
1. Generator's U.S. EPA 10 Number. Manifest Document Number: Enter the generator's US. EPA twelve d1g1t idenhhcation number and the unique five d1g1
number assigned to this manifest by the geneiator beginning with 00001. If your company does not have a U.S. EPA Identification Number, please contact S.C.
OHEC at (803) 734·5200 about obtaining an Identification-number. I
2; Page 1 of: Enter the total number of pages used to complete this manifest, i.e .• the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (~,EV 10/86)] plus t
number ol continuation sheets EPA Form 8700·22 Rev. 9/86A (DHEC 1988A) ii any.
A:. Slate Manifest Document Number. .. Leave blank.
e: Slate Generator Identification Number: Leave blank. I
3. Generalor's Name and Mailing Address: Enter the name and mailing address al the generator who will manage the returned manifest !arms.
4. Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol ,
emergency including nights: weekends, and holidays. ·
5. Trans.port 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the rirst transporter identified in item 5.
C. Slate Transporter's 10 Number: Leave blank.
O. Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. · · ·• 1:. Transporter 2 Company Name: If applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
8.. U.S. EPA ID Number:1I applicable. enter the U.S. EPA twelve digit ID number of the s~cond transporter identified in item 7.
E,. Slate Transpor1er's ID Number: Leave blank. ·
F .. Transporter's Phone Number: Enter a telephone number including area code ~here an authorized agent of.the second transporter can be reached in ti
event or an emergency including nights, weekends. and holidays. • .
9. Oesignaled Facility Name and Site Address: Enter the company name and site address ol the treatment, storage. or disposal facility designatea to receive the
, waste listed on this manifest The address must be the site address. which may differ from the mailing address.
io. ·u.s. EPA ID Number: Enter the U.S. EPA twelve digit identilication number ol the designated treatment, storage, or disposal facility identified in item 9 .•
G:. State Facility's ID Number. Leave blank. ·
• H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in the event of an
emergency including nights, weekends, and holidays. ·
11' U.S: COT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) !or each waste as identified in 49 CFR 171-177.11 additional spa.
· is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number of conlainers for each waste and the appropriate abbreviation from Table I (below) !or the type of containers.
TABLE I .
OM,= Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons. cases. roll ot!s
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
oF· = Fiberboard or plaStic drums, barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. cart~ns. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13.:Total Ouanlily: Enter total quantity al waste described on each line. relative to the units used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpa~s C ar.d l
identily the hazardous waste on each tine.
J. Additional Descriptions for Malerials Lisled Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Authorization Request For
· for each waste stream listP.d in section 1, above. Nole: Belo re any hazardous waste can be accepted lor treatment. storage or disposal in South Carc-lina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K.. Handling Codes tor Wastes Listed Above: Leave blank. .
15 •. Special Handling Instructions and Addilional Information: Generalors may use this space to indicate special transporta!ion. treatment. storage or dispo
information or Bill ol Lading Information. For inlernational shipments, generators must enter· in this space the point ol departure (city and state) !or those
shipments destined !or treatment, storage, or disposal outside !he jurisdiction of the United States. I
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and CATE the certification statement. II a mode other than highway is used.
word "highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. If another mode in addition to the highway mod
used. enter the appropriate a_ddilional mode {e.g .. ,and. rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalf of the first transporter. That person must acknowlet
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the CATE ol receipt. "
18. Transporter 2 Acknowledgement: Enter, ii applicable. the name al the person accepling the waste on behalf of the second transporter. Thal person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE of receipt
MCl~SECTION . ·1
19. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy betw
the wasle described on the manifest and the waste actUally received at the facility. Owners and operators of facilities who cannot resolve significant
discrepancies wilhin 15 days receiving the wasle mus I submit lo the Department a lefter with a copy of the mani/esl describing the discrepancy and artemotsl
reconcile it The treatment. storage, or disposal facility must enler the actual weight of waste in pounds in the spaces provided if the amount varies any from t
specilied by the generator in item 13 or if the generator uses a unit ol measure other than pounds.
20. Facility Owner or Operalor Certification: Print or type the name ol the person accepting the waste on behalf al the owner or operator of the facility. Thar person ·
must acknowledge acceptance of fhe waste described on the manifest by SIGNING (BY HAND IN. INKf and entering the DATE of receipt
IF ASSISTANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECUIE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
· and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
LfASE PRINT or TYPE (Form desi wriler Form A roved. 0MB No. 2050-0039 Expires 9-30-sa
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
4. Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 2757.7
Manlfeet
Document No, 140002
6. U.S. EPA ID Number
C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard ~lass, and ID Number) .
a
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
2. Page 1
of
l D T
;c;;:;;;;;~~~,;-111¥~
b LL.I-I I I I I 1-1 I I I l:fo}\'iil!!Md:b-i-J-1 . 1J-:-.L 11!,ji
15. Special Handling Instructions and Additional lnlormat~on
GSX Work Order No.: 71269
lnlormation in the shaded areas is not
required by Federal law, but is by State Jaw.
2 0 Y
t,,, .. ·,;.,;. .. '/•'•i<¼'<;·•, ..... •.:.,; /{~i··~~ ..... ~~1 ·••'• ,1~:
..-.; ·.;_' :.~·-'fi';,~~-
_o·;· ,;~r
16, GENERATOR'S CERTIFICATION: r hereby declare thalthe conlents ol this consignment e.relully and 11ccuratelydescrlbod above by proper shipping name and ora claWlied,
packed, marked, and 1aheled, and are in all respects in proper condition !or transport by highway according to applicable International and natlonal government regulations and
ttie laws ol lhe Stale ol South Carolina.
111 am a large quanlity genera1or, I certify that I heve a program In place to reduce the volume and toxlcltyol wastogeneralod to the degr-I have determined to be economically
practicable and that I have selected the practicable method ol treatment. storage, or dispose I currently avalleble to me which minimizes the presant and lutura throat to human
health and the environment: OR. if I am a small quanlitygonoralor, I hnve made a good lallh eNort to minimize my waste generation end select the best waste management method
thal is available lo me and that I can afford.
Printed/Typed Name Signature Month Day Year
17. Transporter 1 Ae;,cnowledgement ol Receipt of Materials
Printed/Typed Name
:L ~,v , :;;r?
Printed/Typed Name Signature Monttl Day Year
19. Discrepancy Indication Space
• I /lbs. eJ jibs.
b I I'"'-dj pt,s,
20. Facility Owner or Operator; Certification of receipl ol hazardous materials covered by this manifest except as noted in /!em 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)1
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a'12-pilch (elite) typewriter] OR USE Fl,RM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste trea1mel
storage, or disposal ficilities to use the U.S. EPA Form 8700·22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if necessary, the corltinuation sheet U.S. EPA Fe
8700•22A Rev.-9/86 (OHEC 1988A) foi both iriter-state and intra-state transportation. Transporters who transport hazardous waste into the United States fr
· another country are responsible !or completing the maniresl Federal and State fegu1ations also require generators and transporters ol hazardous waste ano
owners or operator~ ol hazardous waste treatment. storage, or disposal lacitities to complete the lollowing information. I ,-GENERATOR SECTION
Generator'• U.S. EPA 10 Number -Manllesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manifest by the generator beginning with 00001. llyour company does not hove a U.S. EPA Identification Number. please contact S.C.
OHEC at [phone] about obtaining an Identification number. · I
Page 1 of: Enter the total numbe.rof pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10186)] plus t
,.
2;
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. ·
k State Manifest Document Number: .. Leave blank.
B: Stale Generalor Identification Number: Leave blank. I
3. Generator's Naffle and Mailing Address: Enter the name and mailing address al the generator who will manage the returned manifest forms.
4. Generator's Pholle Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of
emergency including nights." weekends, and holidays. ·
5. Trans.port 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5. I C. Slate Transporter's ID Number:. Leave blank: .
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. • I
7:. Transporter 2 Company Name: If applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa
8 •. U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. St.ale Transporter's ID Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code ~here an authorized agent of the second transporter can be reached in ti
event al an emergency including nights, weekends, and holidays.
9. Designated Facilily Name and Site Address: Enter the company nnme and site address of the treatment. storage, or disposal lacility designated to receive the
waste listed on this manilesl The address must be the site address. which may differ from the mailing address. -
10: 'U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment, storage. or disposal facility identified in iterrl 9 .•
G:. Stale Facility's ID Number: Leave blank. _ · ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached .in the event of an
emergency including nights. weekends, and holidays. · ·
11: U.S. OCT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as idenlilied in 49 C~A 171-t 77. !I additional spal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I
OM:;;: Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases. roll oHs , I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
[ TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13.: Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14. I
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) tor the unit al measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M:;;: Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specilied in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subparts C ar.d]
identify the hazardous waste on each line. · ·
J. Additional Descriptions for Malerials Listed Above: In the spaces provided, enter the authorization number (from thE? S.C. OHEC Authorization Request Fo
for each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carcliiia. lhe
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes !or Wastes Listed Above: Leave blank.
15 •. Special Handhng Instructions and Add11ional Information: Generators may use this space to 1nd1cate special transportat10n, treatment. storage or dtspo
information or Bill or Lading Information. For international shipments, generators must enter' in this space the point ol departure (city and state) !or those
shipments destined tor treatment, storage, or disposal outside the jurisdiction or the United States.
16. Generator Certilicalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode o!herthan highway is used .•
word "highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below.If another mode in addition to the highway mod
used, enter the appropriate a_dditional mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION , ,
17'. Transporter 1 Acknowledge_ment: Enter the name ol the person accepiing the waste on behalf of the first transporter. That person must acknowlet
. acceptance al the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE ol receipt. •
18. Transporter 2 Acknowledgerl'lent: Enter, ii applicable, the name ol lhe person accepting the waste on behalf al the second transporter. That person must
acknowledge acceptance ol lhe waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE ol receipt
NCl~SECTION I
19. Discrepancy lndicalion Space: The authorized representative of the designated facility's owner or operator must note in this space any discrepancy betw
the waste described on the ·manifest and the waste actUa!ly received at the racility. Owners and operators or facilities who cannot resolve significant
discrepancies within.15 days receiving !he waste must submit to !he Department a letter with a copy of the manifest describing the discrepancy and aitemotl
reconcile it. The treatment storage, or disposal facility must enter the actual weight of waste in pounds in the spaces provided if the amount varies any from I
specified by the generator in item 13 or ii lhe genernlor uses n unit ol measure other th.,n pounds.
20. Facility Ownei-or Operator Certilicalion: Prinl or type the name of the person accepting the waste on behalf ol the owner or operator ol the facility. That person
must acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN. INK) and entering the DATE ol receipt.
IF ASSISTANCE IS NGEOEO IN COMP~ETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
AECE!VF. THE WASTE OR THE S,C, OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm,
I _South Carolina Department of Health
· and Environmental Control . :i.
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
Emergency & Holi~ays: [phone]
Form A roved. 0MB No. 2050-0009 Expires 9-30-88
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manifest O0cument No. WASTE MANIFEST N c D o 7 6 o 14000 0
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator'sPnone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facm,ty Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
2. Page 1
of Information in the shaded a<eas is not
~equired by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Uni!
No. Type 'MNr/.
b.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71270
1 D T 2 0 Y
16. GENERATOR'S CERTIFICATION: I hereby declo.rethat the contents olthis consignment are fully and accurately described above by proper shipping riama arid are claHoli9d,
packed, marked, and lahelcd, and are in all rospecls in proper condition for transport by highway according to applicable lnlernalional and national govarnment re,gulation• and
the laws or the State ol South Carolina.
111 am a large ciuantity generator, I certify thal I have a program In place lo reduce thevolumeand loxlcltyolwasteganerated totha degree I have determined lo be aconomlcalty
practicable and thal I have selected the practicable method ol lreatment. storage, or disposal currently available to me which minimizes the pre&ent and lutura thr-1 to human
health and the environment; OR, ifl am a small quantity generator, I have made a good laith effort to minimize mywasl&generatlon and select !tie beat waate manage man! method
that is available to me and that I can afford.
Printed/Typed Name Signature
17. Transporter 1 Aucnowledgement of Receipt ol Materials
Signature
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name Signature Monttl Day Year
19. Discrepancy Indication Space
• I lib< C I jib<
b I lib< d I lib<
20. Facility Owner or Operator; Cer1ilicalion ol receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions .ire Obsolete (DHEC 1988 (Rev. 10/86)]
;,v.t, 1• , ;;.,'I; V' ' /
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT; TYPE [on a 12-pitch (elite) typewriter] OR USE Fl.RM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION:· Federal Reg. ulations require generators and transporters ol hazardous waste and owners or operators of ha_zardous w. aste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev: 9/86 (OHEC 1988A) for both inter-stale and intra-state transportation, Transporters who transport hazardous waste i~lo the Untied States fr
"another country are responsible for completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
o'Nners or operators of hazai-dous waste treatment, storage. or.disposal fac11il1es to complete the following 1nformat1on .
. . GENERATOR SECTION I
·,:· ·Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's US. EPA twelve d1g1t 1dent1l1cat1on number and the unique live drg1
number assigned to this manifest by the geneiator beginning with 00001. lfyourcompany does not have a U.S. EPA Identification Number. please contact S.C_.
OHEC at [phone] about obtaining an Identification number. I
2: Page 1 of: Enter the total numbe-r of pages used to complete this manifest, i.e., the !list page EPA Form 8700·22 Rev. 9/86 (OHEC 1988 (~EV 10186)] plus t
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A:. Slate Mariilest Document Numbei-: .. Leave blank.
B: State Generalor Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the~returned manifest lorms.
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol
emergency including nights: weekends, and holidays. ·
5. Tran~ort 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified·in item 5. I C. Slate Transporter's 10 Number: Leave blank.
O. Transporter's Phone Number: 0Enter a teleph~ne number including area code where an authorized age~t of the fil°st transporter can be reached in the event of
an emergency including nights, weekends, and holidays. · · · I
T.. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
8.. U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
·· E .. State Transporter's ID Number: Leave blank.
F .. Transporter's Phone Number: Enter a te_lephone number including area code :where an authorized agent al the second transporter can be reached in ti
event of an emergency including nights, weekends, and holidays.
9.. Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal racility designated ~o receive the
, waste listed on this manifest The address must be the site address. which may differ from the mailing address. ·
10. · U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment. storage, or disposal racility identified in item 9 .•
G:. Slate Facility's ID Number: Leave blank.
· • H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event ol an
emergency including nights, weekends, and holidays. ·
1 r. U.S. DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) roreach waste as identilied in 49 CFR 171 -177.11 additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12... Containers (no. and type): Enter number ol containers for each waste and the appropriate abbreviation from Table I (below) for the type of containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons, cases. roll offs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
. OF = Fiberboard or plastic drums, barrels, kegs OT = Dump truck CF = Fiber or plastic boxes, cartons. cases I
f_. TP = Tanks portable CY= Cylinders BA= Burlap. cloth, paper or plastic bags
13: Total Quantity: Enter Iota! quantity ol waste described on each line, relative to the units Used in item·14_
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subparts C ar.d]
identity the hazardous waste on each line. ·
J. · Additional Descriptions lor Malerials Listed Above: In the spaces provided. enter the authorization number (lrom the S.C. DHEC Authorization Request Fo
for each waste stream listE'!d in section 11 above. Nole: Bel ore any hazardous waste can be accepted !or treatment. storage or disposal in South Carclina: the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes for Wastes Listed Above: Leave blank. ! /' 15 •. Special Handling Instructions and Additional Information: Generators may use this space lo indicate special transportation, treatment. storage or dispo
information or Bill of Lading Information. For international shipments, generators must enter"in this space the point of departure (city and state) !or those
shipments destined !or lreatnient. storage, or disposal outside the jurisdiction of the United States.
,~. Generator Certificalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. If a mode other than highway is used .•
word .. highway" should be lined out and the appropri2te mode(rail, water.or air) inserted in the space below.JI another mode in addition to tt-,e t}ighway mod
used, enter the appropriate a_dditional mode (e.g.,_a.nd_ rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter the name ol the person accepting the waste on behalf of the first transporter. That person must acknowlet
acceptance ol the waste described ori the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalf ol the second transporter. That person must
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy betwell
the waste described on the manifest and the waste actually received at the facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 d.:iys receiving the waste must submit to the Oeparlmenl a le tier wilh a copy of the manifest describing the discrepancy and art:emots to
reconcile il The lreatmenL storage. or disposal facility must enter the actual weight of was.le in pounds in the spaces provided ii the amount var.ies any from ti
specified by !he generator in item 13 or ii the genera for uses a unit ol measure other than pounds.
20. Facility Ownef or Operator Certification: Print or type the name of the person accepting the waste on behalf of the owner or operator ot the facility. That person ·
must acknowledge acceptanc·e of the waste described on. the man\fest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKOAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control ...
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia. SC 29201
· Phone: (803) 734•5200
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ;res 9-30-88
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIONo.
WASTE MANIFEST N c D o 7 6 o
Monlfeat Document No. 14000 1
2. Page 1
of Information in the shaded .weas is no1
required by Federal law, bul is by State law.
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
4. Generator's Phone 919
Smithfield,
934-9711
NC 27577
~~~~;z;~;l~.=~=:;:~;;::_~(:~~i:~a{~:ts~r
;l~i;t~~t~0 )~;Jf:l~t;!:!:;:,:;t;_\iM:l14{f~jt;,:\f!fI:
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA 10 Number
SCD0737
8. U.S. EPA 10 Number
10. U.S. EPA 10 Number
S C D 0 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Unit = L'.Watl! Numbe,·:,,\<
No. Type 'MNd. '·:+i\:'(/fAI:i<://(}:if
a.
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
:::~~~'~;i~i~!i7~~~;!1~!:!1::i:;:;!i:11:~!~'::;!l~\_;~~'\(:~~11!~!rt!1!;~:r1:1!l\!:;;':l:!:!::]!;I;~
bw---1 1-1 ,J~ll!Jiil,!~\!.~:W:.1 .... ,,.1---1 ... ! ... 111~
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71271
2 0 y
"••.,-)::i
. .. ,,._)¥:
16. GENERATOR'S CERTIFICATION: I hereby declare thal !he conlents ol this consignment are fully and accurately described above by proper a hipping name and are classified,
packed, mark&d. and laheled.and are in all respects in proper condition lor lranspor1 byhlghwayaccording lo applicable lnlernalional and national government re,gulations al"d
trie laws of the State ol South Carolina.
111 am a large quantity genera1or, I cer1ify that I have a program In place to reduce the volume and lo:dcltyol wastaganeraled to the degree I have determined lo be economically
practicable and that I have selected tho practicable method ol treatmonl. :storage, or dlspoaal currently available to mo which minimize:, the present and future tnrNt to l'lu~n
l''ll!t.!llth and the environment.: OR. If I am a smnl1 Quontitygenerator. I have mado a good lalth eNor1to minimize my waste generation and solac1 ttio be•I wa•la management ,r,etr'IOd
!hat is available lo mo and thi,I t can nNord.
Printed/Typed Name ~
,
Prin ed Typed Name
1/2. r 'tJ n/
1 a. Transparter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name
19. Discrepancy Indication Space
Signature
Signature
20. Facility Owner or Operator; Certification ol receipl ol hazardous malerials covered by this manifest e·xcept as noted In Item 19.
Prlnle-d/Typed Name Signature
PA Form 6700-22 {Rev. 9/86) Previous Editions arc Obsoloto (DHEC 1988 (Rev. 10/86)]
Montt, Day Year
• l......_ ...... .._._,Pbo. c ,._I ....._.._.,.....,!lbs.
b I pbs. d I pbs.
Month Day Year
\• : !~-I L ~ •
• ' • .i_'~ .; •. • l·
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE Fl.RM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage. or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA F"o
8700-22A Rev.-9/86 (DHEC 1988A) for both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
• another country are responsiDle for completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operator~ ol haza,rdous waste treatment. storage, or disposal facilities to complete the following information. I GENERATOR SECTION ,.
2;
Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
number assigned to this mani!est by the generator beginning with 00001. lfyour company does not have a U.S. EPA ldentilication Number, please contact S.C.
OHEC at [phone] about obtaining an identification number. I
Page 1 ol: Enterthet6tal numbe<ol pages used to complete this manilest. i.e .. the riist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (~EV 10186)] plus:
,number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A_ State Manifest Document Number: .. Leave blank.
B:
3.
4,
Slate Generalor Identification Number: Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifes: forms.
Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol
emergency including nights." weekends, and holidays. ·
5. Transport 1 Company Name: Enter the company name al the lirst transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5. I C. Slate Transporter's ID Number:. Leave blank:
D. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. I
T.. Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. If more than 2 transporters
8 ..
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number Ot the second transporter identified in item 7.
E .. State Transporter's ID Number: Leave blank. .
F .. Transporter's Phone Number: Enter a telephone number including area code :,'{here an authorized agent of the second transp~rter can be reached in ti
event of an emergency including nights, weekends, and holidays.
9.
10:
G:.
Designated Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage, _or di_sposal facility designated :o receive the
waste listed on this manifest The address must be the site address. which may differ from the mailing address. :
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage, or disposal facility identified in _item 9 .•
State Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in the event ol an
11".
emergency including nights, w·eekends, and holidays. ·
U.S. DOT Oescriplions: Enter proper shipping name, hazard class and ID Number (l!N/NA) !or each waste as identified in 49 CFR 171-177.11 additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) lor the type of containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons, cases. roll otts
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases I
r TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags ! 13:. Total Quantity: Enter total quantity of waste described on each line. relative to the units used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as sp~cilied in South Carolina Hazardous Waste Management ~egulation R.61-79.261 Subparts C ar.d]
identity the hazardous waste on each line.
J. Additional Descriptions for Malerials Us led Above: In the spaces provided. enter the authorization number (lrnm the S.C. DHEC Authorization Request Fo
for each waste stream listr.d in section 11 above. Note: Belore any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. the
generator must obtain prior authorization from the trealment. storage or disposal facility. · I
K. Handling Codes lor Wastes Listed Above: Leave blank. ·
15 .. Special Handling Instructions and Additional lnformalion: Generators may use this space lo indicate special transportation, treatment. storage or dis po
information or Bill ol Lading Information. For international shipments, generators must enter' in this space the point ol departure (ciry and state) lor those
shipments destined for treatment, storage. or disposal outside the jurisdiction ol the United States. I
16. Gener<!_lorCertilicalion: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used,
word "highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. If another mode in addition 10 the highway mod
used, enter the appropriate a,dditional mode (e.g.,_and. rail) in the space below. ::
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: Enter the name of the person accepting lhe waste on behalf of the first transporter. That person must acknowlet
acceptance of the waste described on the manilest by signing (BY HANO IN INK) and entering the DATE al receipt.
18. Transporter 2 Acknowledgement: Enter. if applicable, the name ol the person accepting the waste on behalf of the second transporter. Thal person must
ack~owledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE o! receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in !his space any discrepancy betw
the waste described on the 'manifest and the waste actUally received al the facility, Owners and operators ol facilities who cannot resolve significant
discrepancies within 15 days receiving lhe waste must submit to lhe Department a letter with a copy ol the manifest describing the discrepancy and a~emots,,
reconcile it. The treatment. storage. or disposal lacilify mus! enter lhe actual weight ol waste in pounds in the spaces provided if the amount varies any lrom f
specified by the generator in item 13 or ii the generntor uses a unit of measure olher than pounds.
20. Facility Owner or Opcralor Certification: Print or type the name ol the person accepting the was le on behall of the owner or operator of the facility. That person
must acknowledge acceptanc'e of lhe wasle described on lhe manifest by SIGNING (BY HANO IN INK)and entering the DATE ol receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
AECF."iVE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bult Streel Columbia, SC 29201
Phone: (B-03) 734-5200
Emergency & Holidays: [phone]
LEASE PRINT or TYPE (Form desi ned lor use on elite 12-itch ewriler Form A roved. 0MB No. 2050-0039 Expires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
l. Generator's U.S. EPA ID No.
N C D 0 7 6 0
Manliest
Document No. 1400032
P. O. Box 1416, Smithfield, NC 27577
4. Generalor's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
B. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D 0 7 0 3 7
2. Page 1
of Information in the shaded a<eas is not
reQuired by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Unit
No. Type 'M/VrJ
a
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
is. Special Handling Instructions and Additional Information
GSX Work Order No.: 71272
l D T 2 0 Y
;if tF t6~=-1·ygyJ~
',!1f1D1D161it
',,,.,v>.,·.,~.~-:~::.
::::~ "1 -'-''--'--'1 ff
::;:? ( ... !:tt:
•: ·,·: .. -.'·:::U-:·•:
:/'Li -'-''--'--'j·:,:v
~l, ,~f
1 5. CEHERATOR'S CERTIFICATION: I hereby declare that Iha contents ot thisconslgnmenl are lully and accurately described above by proper shipping name and are ctasailied.
packed, marked, and labeled, and are in all respects in proper condition tor transport by highway according to appllcabte International and national government r~ulations and
the laws ol the State of South Carolina.
II I am a large quantity generator, I certify that I have a program In place lo reduce Iha volume and toxlcltyol waste generated lo the d&gree I have determined lo be oconomteally
practicable and 11,at I have selecled the practicable method ol lreatmenl, slorage, or dlsposal currently available lo me which mlnlmltes tho present and lutura threat to human
health and the environment OR, If I am a small quantity generator, I h11vo made a good lailh eNort to minimize mywas\8 gonerollon and select the best waa1a management metrlOd
thaf is available to mo and that I can afford.
Printed/Typed Name 'J?., .er L. (ao..,--{;S
Signature ~ Cni.:~ Month Day Year
~~ ZI
, 7. Transporter , At:Knowled ement of Receipt of Materials
Prin Signature •
Printed/Typed Name Signature Month Day Year
i9. Discrepancy Indication Space
'I pt,,. C I pbs.
b I l'bs. d I pbs.
20. Facilify Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
j
' l
IMPORTANT:
• 1 . ' . l ';;,, _ _.;,•·,\ 'I ti,:,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ,. i I
TYPE (on a 12-pitch (elite) typewriter) OR USE Fl.RM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBL!!'
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
storage. or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev:9/86 (DHEC 1988A) tof both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States fr
" a1;other country are responsible !or completing the mamfesl Federal and State regulattons also require generators and transporters ot hazardous waste and
.• o~ners or operators ol hazardous waste treatment, storage. or disposal facilities to complete the following informoti.on. . . . I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest Ooeumenl Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manliest by the geneiator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please contact S.C.
..
OHEC at [phone] about obtaining an Identification number. •.
2; Page 1 of: Enter the total numbe< of pages used to complete this manifest. i.e., the lifst page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)] plus:
number of continuation sheets EPA Form 6700-22 Rev. 9/86A (DHEG 1988A) ii any. . ·
A:. .Slate Manifest Document Numbei-: .. Leave blank.
4.
a: State Generator Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest !arms.
Generator's Phor1e Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in'the event ol
5.
6.
C.
D.
1:.
8 ..
E ..
F ..
9.
10.
G:.
H;.
11'.
12..
13::
14.
emergency including nights,' weekends. and holidays. ·
Trans.port 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
Slate Transporter's ID Number: Leave blank.
Transporter's Phone Number: ·Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. I
Transporter 2 Company Name: If applicable, enter the company name of !he second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 6700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they wilt be transponing the was
U.S. EPA ID Number:I1 applicable, enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
State Transporter's ID Number: Leave blank.
Transporter's Phone Number: Enter a telephone number including area code :where an authorized agent ol the seco_nd transporter can be reached in ti
event of an emergency including nights, weekends. and holidays.
Designated Facility Name and Site Address: Enter lhe company name and sile address of the treatment. storage, or disposal racility designated :o receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit ide~lilication number of the designated treatment. storage, or disposal facility identified in item 9 .•
State Facility's ID Number: Leave blank. ·
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends, and holidays.
U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste os identilied in 49 CFR 171-177. II additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1966A) Continuation Sheet.
Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE t
OM = Metal drums. barrels, kegs TT = Cargo tanks {tank trucks) CM = Metal boxes. cartons, cases. roll offs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cart~ms. cases
OF = Fiberboard or plastic drums. barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
Total Quantity: Enter total quantity ol waste described on each line, relative to the units used in item 14. I
Unit (weight/volume): Enter the appropriate abbreviations from Table II {below) for the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C ar.d DI
identity the hazardous waste on each line.
J. Additional Descriptions tor Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listed in section 11 above. t-k>te: Before any hazardous waste can be accepted !or treatment. storage or disposal in South Carc-lina, the
generator must obtain prior authorization from the lreatment. storage or disposal facility. I
K. Handling Codes for Wasles Lisled Above: Leave blank.
TS. Spec::ial Handling lnstrucllons and Addilional Information: Generators may use this space to indicate special transportation, treatment. star.age or dispo
Information or Bill of Lading Information. For international shipments, generators must enter'in this space the point of departure (city and state) !or those
shipments destined for treatment, storage, or disposal outside the jurisdiction al the United States.
16. Generator Certification: The generator muSt READ, SIGN (BY HANO IN INK), and DATE the certification statement. If a mode other than highway is used .•
word "highway" should be lined out and the appropriate mode{rait, water.or air) inserted in the space below. II another mode in addition to the highway mod
used, enter the appropriate additional mode {e.g.,.and. rail) in the space below.
TRANSPORTER SECTION .
17: Transporter 1 Ac::knowledgement: Enter the name of the person accepting the waste on behalf ol the first transporter. That person must acknowledl
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE ol receipt.
16. Transporter 2 Acknowledgement: Enter, if applicable. the name ol the person accepting the waste on behalf ol the second transporter. That person mus!
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt.
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized representative ol the designated racility's owner or operator Tnust note in this space any discrepancy bet we
the waste described on the ·manifest and the waste actUal!y received at the facility. Owners and operators of facilities who cannot resolve signiticant
discrepancies within 15 days receiving the waste mus! submit lo the Department a letter with a copy of the manilesl describing the discrepancy and attempts to
reconcile il The treatmenl storage.or disposal facility must enter the actual weight ol waste in pounds in lhe spaces provided ii the amount varies any from,,
specified by the generator in item 13 or ii lhe generalor uses a unit or measure other than pounds.
20. Facility Ownei-or Operator Certilicalion: Prinl or type the name of the person accepting the waste on behalf ol the owner or operator or the lacility, That person
must acknowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HAND IN INKfand entering the DATE of receipt. ·
IF ASSISTANCE 15 NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED 1
""!'.sci'!F. THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. .
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South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa:ste M;t
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holiday~ [phone]
LUSE PRINT or TYPE writer Form A roved. 0MB No. 2050-0039 Expires 9-30-88
T
R A
N s p
0 R T
E
R
F
A
C
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I T y
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
l. Generator's U.S. EPA ID No.
N C D O 7 6 1 4
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
B. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
2. Page 1
of lnformaiion in the shaded a<eas is nor
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Uni! >fW&sfli~~,i-
No. Type 'MJVrj, \'.fYH?;;?J"i1/fr/81
d.
:'.,~~ s~:t~ 1~~;~r!'.1ii~-f :;k ;:$',:;:!:r1,1~it5:;~;:~}J:!:!:t":1;:1~t:;,i!;,;f1sw1:::~!
a. l!:.iliJ-10 I 2 I 7 I 7 14 J-11 d IO I 2 l:)):_:;:ic.Li_J-I 1-1 IWi : , , :,, \ \ ~ :·•:-::;
b LLJ=l , , , , 1-1 , , , 1:,-,:,;;;(,c1,d;Lt)-::_l , !--:L, ,,J[[!i
15. Special Handling Instructions and Addltion81 Information
GSX Work Order No.: 71273
16. GENERATOR'S CERTIFICATION: I hereby declare lhal !he conlonts ot lhl:9 consignment are fully and accurately described above by proper a hipping name and are clasa,ried.
packed, markod. and laheled,and are in all respects in proper condition lor transport by highway according to applicable lnlemational and national government rogulation.1 and
lhe laws of Iha Stale ol South Carolina.
111 am a largo Quan11ty generator, I certify that I have a·program in place to reduce the volume and todclty or wastegeneratod lo the dog,_ I have determined to be economically
preciicable and that I have selected the practicable method ol troe.lment. storage, or dlspoaal currenlly available to me which minimizes the present and future tnrNI lo human
health and the environment: OR, 111 am a smnll quantitygonerator, I hnvo made a good laith ettortlo minimize mywesl.e generation and select the beat wute management methoel
!hat is available to me and thal I can afford.
Printed/Typed Name "/<o L, C,a,:ts
Signature ;;:/ ~6.-Month Day Yea,
\._ .:, ,fi
17. Transporter 1 Ac,;11:nowledgement ol Receipt of Materials
Printed/Typed Name Month Day Year
u
18. ranspor1er 2 Acknowledgem
Printed/Typed Name Signature Monttt Day Yea,
19. Discrepancy Indication Space
• I Jibs. C I jibs.
b I jibs. d I jibs.
20. Facility Owner or Operator;'Cer1ifica1ion of receipt of hazardous malerials covered by this manifesl except as noled in Item 19.
Prinled/Typed Name Signature Montll Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolole (DHEC 1988 (Rev. 10/861)
' ·' • I ' '., ' .. ' STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST 'I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Fedeial Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatme1·
storage, or disposal lici!ities to use the U.S. EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)] and, ii necessary, the continuation sheet U.S. EPA Fo
8700•22A Aev.-9/86 (OHEC 1988A) foi both inter-stale and intra-stale lransportalion, Transporters who transport hazardous waste into the United States fr
• another country are responsi61e for completing lhe manilesl Federal and State regulations also require generators and transporters of hazardous waste and
owners or operator~ or hazardous waste treatment, storage, or disposal facilities to complete the following inlormat!on. I GENERATOR SECTION
1.
2;
Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manifest by the geneiator beginning with 00001.11 your company does not have a U.S. EPA 1denlification Number. please contact S.C.
OHEC at [phone] about obtaining an identification number. I
Page 1 of: Enter the total number of pages used to complete this manifest. i.e., the first page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)] plus t
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any. ·
A:. State Manifest Document Number: .. Leave blank.
e:
3.
4.
State Generator Identification Number: Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
Generator's Phol1e Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the event of
emergency including nights: weekends. and holidays. ·
5. Transpor11 Company Name: Enter the company name of the first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: 0Enter a teleph0ne number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends. and holidays. 1 · 1:. Tn11nwporter 2 Company Name: If appllcable, enter the company name ol the second transporter who will transport the waste. If more than 2 transporters
8 ..
E ..
F ..
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the w_as
U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identilied in item 7.
Slate Transpor1er's ID Number: Leave blank.
Transpor1er's Phone Number: Enter a telephone number including area code ~here an authorized agent of the second transporter can be reached in ti
event ol an emergency including nights, weekends, and holidays.
9.. Designated Faci1ily Name and Site Address: Enter the company name and site address ol the treatment, storage, or disposal facility designateCl to receive the
waste listed on this manifest The address must be the site address, which may dilfer from the mailing address.
·u.s. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment. storage, or disposal facility identified in item 9 .• 10.
G:. State Facility's ID Number: Leave blank. . ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
11:
emergency including nights, weekends, and holidays. ·
U.S: DOT Descriplions: Enter proper shipping name, hazard class and ID Number (l!N/NA) !or each waste as identified in 49 CFR 171-177.11 additional soal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation from Table I (below) for the fype ot containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartoris. cases. roll oHs
OW= Wooden drums, barrels. kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car1ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap. cloth, paper or plastic Oags
13.: Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
· 14, Unit (weight/volume): Enter the appropriate abbreviations !ram Table 11 (below) !or the unit of measure:
Table II
I
I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and DI
identity the hazardous waste on each line. · ·
J. Additional Descriptions for Materials Li sled Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carclina, the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank. ·
TS •. Special Handling lnstrucllons and Additional lnformalion: Generators may use this space to indicate special transporta!ion. treatment. storage or dis po
information or Bill al Lading Information. For international shipmenls, generators must enter"in this space lhe point ol departure (city and state) !or those
shipments destined for treatment, storage, or disposal outside the jurisdiction ol the United States. I
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used,
word "highway .. should be lined ou·t and the appropriate mode (rail, water.or air) inserted in the space below. II another mode in addition to tr.e highway mod
used, enter the appropriate a_dditional mode {e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION . . ,
17: Transporter 1 Acknowledgement: Enter the·n"ame of _the person accepiing the waste on behalf ol the first transporter. That person mus) acknowledl
acceptance of the waste described on the manilest by signing (BY HANO IN INK) and entering the DATE ol receipt. · ,
18. Transporter 2 Acknowledgemenl: Enter, if applicable. the name ol the person accepting the waste on behalf of the second transponer. That person must
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HANO IN 1NK) and entering the DATE ol receipt.
FACILITY SECTION ' I
19. Discrepancy lndicalion Space: The authorized representative ol the designated facility's owner or operator must note in this space any discrepancy bet we
the waste described on the manifest and the waste actUa!ly received al the facility. Owners and operators ol facilities who cannot resolve signi!icant
discrepancies within 15 days receiving the waste must submit lo !he Department a letter with a copy ol lhe manifest describing the discrepancy and a~emols,,
reconcile iL The treatme~t. storage, or disposal facility mus I enter the actual weight of waste in pounds in the spaces provided ir lhe amount varies any tram t
specified by the generator in item 13 or ii the generalor uses a unit ol measure other than pounds.
20. Facility Ownei-or Operator Certilicalion: Print or type lhe name o/ the person accepting the waste on behalf of the owner or ·operator ol the lacility. That person ·
musl acknowledge acceptance of !he wasle described on !he manifest by SIGNING (BY HANO IN INKfand entering the DATE al receipt
IF ASSISTANCE IS NeEDEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY 01:Sl(lN,',TfQ 1
R,'.CEf•'E THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I .South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Streel Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
I PLEASE PRIITT or TYPE {Form desi ned for use on elite 12-itch wriler
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
Form A
2. Page 1
ol
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded areas is not
required by Federal law, but is by State la·.--.
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F
WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield,
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping N_ame, Hazard Class, and ID Number}
d.
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71274
16. GENERATOR'S CERTIFICATION: I hereby declare that !he contents olthis consignment are fully and accurately described above by proper ■hipping name and are cla:udil'd.
packed. marked. and labeled, and are in all respects in proper condition !or transport by highway according to applicable lnlarnalional and national government r..,;utatlons and
the laws or the State ol Soulh Carolina.
111 am a large quantity generator, I certify that I have a program In place to reduce the volume and toxicity of waste generated to the d..,;ree I have determined to be economlcalty
prac1icabla end that I have selected 1he practicable method ol lreetment. storage, or disposal currently available to me which mlnlmltes the present and future tt'lr-t to human
heellh and the environment OR, 111 am a small quantitygonorator, I have made a good faith effort to minimize mywastegenerotlon and select the bCl1t wa,10 m•nagemont mettiOd
that is availat:lle to ma and that I can afford.
Montn Day Year
If a I p1,s. e I pbs.
b I libs. d I libs.
•>----------------::: 20. Facility Owner or Operator; Certif!callon of receipt of hazardous malerlals covered by this manifest except as noted In Item 19. I Prinled/Typed Name · Signature
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)1
Month Day Year
'
IMPORTANT:
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST . '
TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEG I BL !
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev: 9/86 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United Sta!es tr
"another country are responsiO!e !or completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operators ol haza.rdous waste treatment. storage, or disposal lac1lities to complete the fortowrng information
GENERATOR SECTION . I
1. .
2;
A.
B:
3.
4.
5.
6.
C,
0.
7:.
8 ..
E..
F ..
9.
10.
G:.
H;.
· 11·.
12..
Generator's U.S. EPA ID Number• Manilesl Document Number: Enter the generator's U.S. EPA twelve d1g1t 1dent1f1cat10n number and the unique hve d1g1
number assigned to this manifest by the Qeneiatorbeginning with 00001. If your company does not have a U.S. EPA ldenlilicati9n Number. please contact S.C.
OHEC at (803) 734·5200 about obtaining an Identification number. · · I
Page 1 ol: Enter the total numbe<ol pages used to complete this manifest, i.e., the liist page EPA Form 8700·22 Rev. 9/86 {OHEC 1988 (P:EV 10/86)] plus t
number of continuation sheets EPA Form 8700·22 Rev. 9/86A (OHEC 1988A) if any.
Stale Manifest Document Number: .. Leave blank.
State Generalor Identification Number: leave blank. . I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest !arms.
Generator's Phorie Number: Enter a telephone number wilh area code where an authorized agent al the generator can be reached in the event ol ..
emergency including nights: weekends, and holidays. ·
Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the lirst transporter identified in item 5.
Slate Transporter's ID Number: Leave blank. ·
Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event of.
an emergency including nights, weekends, and holidays. I
Transporter 2 CompanY Name: If applicable, enter the company name of !he second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in lhe order they will be transporting the was
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
Slate Transporter's ID Number: leave blank.
Transporter's Phone Number: Enter a telephone number including area code :,"llere an authorized agent ol the second transporler can be react'led in ti
event ol an emergency including nights. weekends, and holidnys.
Designated Facility Name and Site Address: Enter the company nnmc and site address of the treatment. storage, or disposal racility designatea to r~ceive the
waste listed on this manilesl The address must be the site address. which may differ from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment, storage, or disposal facility identified in _item 9 .•
State Facility's 10 Number: Leave blank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event ol an
emergency including nights, weekends. and holidays. ·
u.s: DOT Descriplions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as idenlilied in 49 CFR 171-177. II additional spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons, cases. roll offs
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF = Fiberboard or plastic drums. barrels, kegs OT = Dump truck CF = Fiber o·r plastic boxes. car1ons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, c!oth. paper or plas1ic bags
13.'. Total Quantity: Enter total quantity ol waste described on each line, relative to the units used in item '14. I 14. Uni! (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gal!ons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management ~egulation R.61-79.261 Subpar1s C ar,d 01
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Usled Above: In lhe spaces provided, enter the authorization number(lrom the S.C. DHEC Authorization Request Fo
lor each waste stream listP.d in section 11 above. Nole: Bel ore any hazardous waste can be accepted !or treatment. storage or disposal in South Carc!ina. the
generator must obtain prior authorization from the treatment, storage or disposal lacility. I
K. Handling Codes for Wastes Listed Above: leave blank.
15 .. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation. treatment. storage or dispo
information or Bill or Lading Information. For international shipments, generators must enter'in this space lhe point of depar1ure (city and s:ate) !or those
shipments destined !or treatment, storage, or disposal outside the jurisdiction of the United States. 1.
16. Generator Certification: The generator must READ, SIGN (BY HAND tN INK), and DATE the certification statement. II a mode other than highway is used.
word "highway" should be lined out and the appropriate mode (rail. water.or air) inserted in the space below. JI another mode in addition to the highway mod
used, enter the appropriate a_dditional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION · . 11: Transporter 1 Acknowledgement: Enter lhe name of the person accepting the waste on behalf of the first transporter. That person musl acknowlet
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name ol lhe person accepting the waste on behalf or the second transporter. That person must
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
FACILITY SECTION . ■
19. Discrepancy Indication Spac_e: The authorized representative al the designated facility's owner or operator must note 1n !his space any discrepancy_ betw~
the wasie described on the manifest and the waste actUa!ly received al the racility. Owners and operators of facilities who cannot resolve s1gn1ficant
discrepancies within 15 dJys receiving the waste must submit to the Department a letter with ri copy of the manifest describing the discrepancy ar:d a~emc1s :o
reconcile it The treatment, storage. or disposal facility must enter the actual weight of waste in pounds in the spaces provided if the amount var.ies any from ti
specified by lhe generator in item 13 or H the generalor uses a unit al measure other than pounds.
20. Facility Ownei-or Operator Certification: Print or type the name ol lhe person accepting the was le on behalf of the owner or operator al the lacrlily. Thal person
must acknowledge acceptance al the waste described on the manifest by SIGNING (BY HANO IN INK)° and entering the DATE al receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT. STORAGE. OR DISPOSAL FACILITY DESIGNATED 1
. RSCE!'.'E THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8;00 am TO 5:00 pm.
I South Carolina Department of Health
and Env_ironmental Control
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manile11I Document No. WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
0 0 0 3 5
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
ol
Bureau of Solid & Haz.ardous Wiste Mgt
2600 Bull s" .. \ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Exoires 9.30.aa
Information in the shaded Meas is no!
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Uni! ,.1':.wuta·Nt.,abei\P
No. Type WtNri. ;'/{\\':(,t;,j;t'Jf:\:'.t/
a. Hazardous Waste, Solid, nos ORM-E
N NA 9189 1 D T 2 0 Y
~llyr:·;·,,'a~,-y.-19f~}
:~1 IE IO IO I 6 l~f
b ..
.-•' .:··,·,-:,.·,,•,•',,•'";:•'{
=: LI ...... _._.,_..,: ffl
0 l-----------------------µ_1_+yµ_1_..1-yf--__p::.::::_::: ..... ::;::, ... =.,.= .... =.~ ...
~~.._..,___.j%l C.
-~\~:
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71275
16. GENERATOR'S CERTIFICATION: I hereby declare lhal the conlonts ot thlsconslgnmenl era lully and accurately described 11,bovo by proper shipping name and are clasai!led.
packed, ma1k&d, and 1a·baled,and are in all rospacts in proper condition tor transport by highway according to applicable International and national govern merit r~ulations arw:I
tna laws ol tho Stale ol South Carolina.
II Jam a large ciuenlity generator, 1 certify !hall have a program In place to reduce the volume and toxicity ofwaslagenarated lo the d~r&e I have determined lo be economically
practicable and thal l have selected the practicable method of treatment, storage, or dlsposa.l currently available to me which mlnlmi1ea the preMnl and luhJro throat to tluman
heafth and the environment OR, II I am a small quantity generator, I have made n good faith etlor1 to minimize my waste generation and select the best waste management method
that is availatile to me and that I can afford.
Printed/Typed Name
_j
Signature Month Day Year
19. Discrepancy Indication Space
• I jibs. C I jibs.
bl jibs d I jibs.
20. Facility Owner or Operator; Certilicalion ol receipt ol hazardous materials covered by this manifest excepl as noted in Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 6700-22 (Rev. 9/86) Previous Editions arc Obsoloto·(DHEC 1988 (Rev. 10/86))
I
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters ol hazardous waste and owners or operators of hazardous waste treatmel
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev.-9/86 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
another country are responsiOle !or completing the manilesL Federal and State regulations also require generators and transponers al hazardous waste ar.d
owners or operator~ of haza.rdous waste treatment. storage. or disposal facilities to complete the following information. I GENERATOR SECTION
1.
2:
Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manilesl by the geneiator beginning with 00001, II your company does not have a U.S. EPA ldentificalion Number. please contact S.C.
OHEC at [phone] about obtaining an identification number. I
Page 1 ol: Enter the total numbe-r of pages used to complete this manifest, i.e., the lifst page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P,EV t0/86)1 plus t
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any. ·
k Slate Manifest Document Number': .. Leave blank.
s: State Generalor Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manilest forms.
4. Generator's Phof1e Number: Enter a telephone number with area code where an authorized agent of the generat.or can be reached in the event ol
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
O. Transporter's Phone Number:
0
Enter a telephOne number including 8.rea code where an authorized agent ol the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. j
1:. Transporter 2 Company Name: If applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 transporters
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
8 .. U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit ID number al the second transporter identified in item 7.
· E.. Slate Transporter's ID Number: Leave blank. I
F .. _ Transporter's Phone Number: Enter a telephone number including area code ~tiere an authorized agent of the second transporter can be reached int
event of an emergency including nights, weekends, and holidays.
9. Oesignaled Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage. or disposal lacility designatea :o receive the
waste listed on this manilesl The address must be the sile address. which may diller lrom the mailing address. 1 10;-u.s. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage. or disposal facility identified in .item 9.
G:. State Facility's ID Number: Leave blank.
H;., Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends. and holidays. · ·
11'. U.S. DOT Descriptions: Enler proper shipping name, hazard class nnd ID Number (UN/NA) tor each waste as identified in 49 CFR 171-177. If additional spa'
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number al containers for each waste-and the appropriate abbreviation from Table I (below) for the type of containers.
TABLE I
OM = Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons, cases. roll otfs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. canons, cases I OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13.: Total Quantity: Enter total quantity ol waste described on each line. relative to the units used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit ol measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Subpans C ar.d DI
identify the hazardous waste on each line. ·
J. Addilional Descriptions tor Materials Listed Above: In the spaces provided, enter the authorization number (rrom the S.C. DHEC Authorization Request For
for each waste stream list~d in section 11 above. Nole: Before any hazardous waste can be accepted tor treatment. storage or disposal in South Carolina. the
generator must obtain prior authorization lrom the treatment, storage or disposal facility. I
K. Handling Codes for Wastes Listed Above: Leave blank.
15 .. Special Handling Instructions and Additional Information: Generators may use !his space to indicate special transponation, treatment. storage or dispo
information or Bill of Lading Information. For international shipments. generators musl enter'in this space the point or departure (city and s:ate) !or those
shipments destined lor treatment. storage. or disposal outside the jurisdiction of the United States. ',; 1·
16. Generalor Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used.!
word "highway .. should be lined out and the appropri2te mode(rail, water.or air) inserted in the space below.If another mode in addition to the highway mod
used, enter_the appropriate a_dditional mode (e.g.,.and. rail) in the space below.
TRANSPORTER SECTION·
17: Transporter 1 Acknowledgement: Enter \he name of the person accepting lhe waste on behalf or the first transponer. That person must acknowledl
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt. · .
18. Transporter 2 Acknowledgement: Enter, ii applicable. the name ol the person accepting the waste on behalf ol the second transporter. That person must
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt.
FACILITY SECTION I
19. Discrepancy lndicalion Space: The authorized representative ol the designated facility's owner or operator must note in !his space any discrepancy betwe
the waste described on the ·manifest and the waste actUally received al the facility. Owners and operators or facilities who cannot resolve significant
discre~an.cies wilhin 15 days receiving lhe waste musl submit to the Department a letter with a copy ol lhe manifest describing lhe discrepancy and ar.emptsl
reconcile 1L The treatment. storage. or disposal facility must enter the actual weight ol waste in pounds in the spaces provided if !he amount varies any lrom t
specified by the generator in item 13 or if the generator uses a unit ol measure other than pounds.
· 20. Facility Ownei or Operator Certilicalion: Print or type the name of the person accepting the waste on behalf ol lhe owner or operator ol the facility. That person
must acknowledge acceptanc'e or the waste described on the manHest by SIGNING (BY HAND IN INK)and enlering the DATE of receipt. ·
1F AssrsTANGe Is N~Rotto IN <;QM1,~nT10N o~ TH1s MANIFEST, CONTACT THE TREATMENT, sToRAOE, OR 0IsPOSAL FACILITY oEsrGNATEo I
RECEIVE THE WASTE OR THE S.C. DH[cC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
E
N
South Carolina Department of Health
and Envir9nmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-542'
Form A roved. 0MB No. 2050-0039 E,p;res 9-30-88
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manifest
Document No. WASTE MANIFEST N c D o 7 6 o 1400036
. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
. Generator's Phone [phone]
. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc,
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
2. Page 1
of Information in the shaded Meas is nol
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity 14.Unit
No. Type 'MN~
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71276
l D T 2 0 Y
·:=··.
~~t I ..
16. GENERATOR"S CERTIFICATION: I hereby declare thal the contents oflhis conslgnmenl are fully and accuralelydescribad above by proper ahipping nam• and are claaa.ilied.
packed. marked, and ta.beled. and are in a11 respects in proper condition for Iran.sport by highway according to applicable international and nallonal government rogulaliona and
the laws ol the State ol Soultl t;arolina. '
If I am a large Quantity generalor, I certify Iha! I have a program In p1acalo raducelh• volume and toxlcltyofwast•ganarat.:t lo th• degree I haved•tarmln.:t to be oeonomlcally
practicat:ola and that I have ••!acted th• pracllcable method of treetment, 1lorage. or dlsposal currently avaHabla to ma which mini mixes the praMnl and future tr'lrMl to f'lu""'n
f'lealth an·d the environment: OR. II I am a small quantityganara1or, I have made a good lalth eNort to minimize my wasle generation end select the be11 wa11e manag•m•nt meU'lod
t1'181 is availat:ole 10 me and ttiat I can aNord.
Printed/Typed Name Signature Month Day Year
Printed/Typed Name Month Day Year
19. Discrepancy Indication Space
a I pbs. C I pbs.
b I jibs. d I jibs.
20. Facility Owner or Operator, Certification ol receipt ol hazardous materials covered by this manifest except as noted In Item 19,
Printed/Typed Name Signature Month Day Year
Form 6700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
r: ·~ ;
IMPORTANT:
STATE OF SOUTH CAROLINA1Ns{~u,cTIONS FOR UNIF~RM HAZARDOUS WASTE MANIFEST I
TYPE [on a 12-pitch (elite) typewriter) OR USE Fl.RM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBL .
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators ol hazardous waste treatmel
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, ii necessary, thE:! continuation sheet U.S. EPA Fa
8700-22A Rev.-9/86 (DHEC 1988A) !of both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States fr
another country are responsiDle for completing the manifest Federal and State regulations also require generators and transporters of hazardous waste ano
owners or operators or hazardous waste treatment, starnge. or disposal facilities to complete the following information.
GENERATOR SECTION I
1.
2;
Generator's U.S. EPA 10 Number~ Manifest Document Number: Enter the generator!s U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manifest by the geneiator beginning with 00001.11 your company does no! have a U.S. EPA Identification Number. please contact S.C.
OHEC at [phone] about obtaining an ldenlilication number. I
Page 1 of: Enter the total numbe-r of pages used to complete this manitesl, i.e .. the lifst page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P,EV 10/86)] plUs t
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any. ·
k State Manifest Document Number. .. Leave blank.
B: State Generalor Identification Number: Leave blank. . I
3. Generator's Name and Mailing Address: Enter the name and mailing address al the generator who will manage the returned manifest !arms.
4. Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event al
emergency including nights.' weekends, and holidays. ·
5. Trana.port 1 Company Name: Enter the company name of the first transporter who will transport the waste.
e. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5. I C. Slate Transporter's 10 Number: Leave blank.
0. Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent al the rirst transporter can be reached in the event al
an emergency including nights, weekends, and holidays. * • : · · I
7:. Transporter 2 Company Name: If applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
8 .. U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
· E.. Slate Transporter's ID Number: Leave blank. ·
F .. Transporter's Phone Number: Enter a telephone number including area code :,,,'here an authorized agent al the second transporter can be reached in ti
event ol an emergency including nights, weekends, and holidays. .
9. Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated ta r~ceive the
, waste listed on this manifest The address must be the site address, which may differ from the mailing address.
10: .. u.s; EPA ID Number: Enter the U.S. EPA twelve dig[! identification number of the designated treatment, storage, or disposal facility identified in item 9 .•
G:. Slate Facility's ID Number: Leave blank. ' ·
·H;. Facllily's Phone Number: Enter a telephone number including area code where an authorized agent al the facility can be reached in the event ol an
emergency including nights, weekends, and holidays, · · ·
11: U.S. DOT Oescriplions: Enter proper shipping name, hazord class and ID Number (UN/NA) rorcach waste as identified in 49 CFR 171-177.11 additional soal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12... Containers (no. and type): Enter number of containers rar each waste and the appropriate abbreviation rrom Table I (below) rar the type ol containers.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. cartons, cases. roll offs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or p!astic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap. cloth. paper or plastic bags
13 .. Total Quantity: Enter tolal quantity al waste described on each line, relative tO the units used in item 14. I
14. Unit (weight/volume): Enter the appropriale abbreviations lrom Table II {below) far the unit al measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C ar:d DI
identify the hazardous waste on each line. .•
J. Additional Descriptions !or Materials Listed Above: In the spaces provided, enter the authorization number (lrom the S.C. OHEC Authorization Request For
!or each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted !or treatmenL storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal racility. I
K. Handling Codes for Wastes Listed Above: Leave blank.
15 .. Special Handling Instructions and Additional lnlormalion: Generators 'may use this space lo indicate special transportation. treatment. storage or dispa
information or Bill of Lading tnlormation. For international shipments. generators must enter'in this space the point of departure (city and s:ate) lar those
shipments destined !or treatment, storage. or disposal outside the jurisdiction of the United Slates. .
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. If a made otherttian highway is used, I
word "highway" should be lined out and the appropriate made (rail. water .or air) inserted in the space below. II another mode in addition to the highway mad
used. enter the appropriate additional mode (e.g .•. and. rail) in the space below.
TRANSPORTER SECTION · · · · ,
'11: Transporter 1 Acknowledgement: Enter the name al the person accepiing the ~aste on behall of the first transporter. That person must ackno~ledl
acceptance al the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt. •
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalf or the second transporter. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt.
FACILITY SECTION . I
19. Discrepancy Indication Spac_e: The authorized representa!ive al the designated facility's owner or operator ~us! not~ in this space any discrepancy betwe
the waste described on the manifest and the waste actUally received at the racility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit lo the Department a letter with a copy of the manifest describing the discrepancy and anemotl
reconcile it. The treatmenl storage. or disposal facility must enter lhe actual weight of waste in pounds in the spaces provided ii the amount varies any lrom t
specified by !he generator in item 13 or ii the generator uses a unit of measure other !han pounds.
20. F.lci!ity Ownei-or Operator Certification: Print or type lhe name al lhe person accepting the was le on be hall of the owner or operator of the racility. That person
, must acknowledge acceptanc'e of lho waste described on the manifest by SIGNING (DY HAND IN INK) and entering the DATE al receipt.
IF ASSISTANCE Is Neeoeo IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
~ECEIVC, THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
T
R I
0 R T
F
I
South Carolina Department of Health
: and Environmental Control I . . . .
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Str~i Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved, 0MB No. 2050-0039 Expires 9·30-88
UNIFORM HAZARDOUS 1. Generator's
WASTE MANIFEST N c D 0
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
,. Generator's Phone 919
5. Transpor1er 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7, Transpor1er 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
NC 27577
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
2. Page 1
of Information in the shaded areas is not
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers
No. Type
13. Total Quantity 14. Unit ; L°'Wa.11a Numbo1'\ei
WW~ '.t;:::\':,)/_:<~:tD&~tf
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
1::~~~,7::~r:~:~,!l:~r11·:t:~~r::::i;11·!::!sYt~:1::!~~~~~f1r:!1:1,:!::i1:!(~l]~l:r~!~!l~
a.l!:..MJ-I012171714l-lli11012hb;iPi?;fa0·Lt..J-I J J J J 1-1 J J J Fit
b Lt..J-1 1-1 1l~lllill~!ldL,LJ-,1 _____ ,, .. hl~J .. ,,.,~.J!i
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71277
2 0 Y
1'.~ ,_J....,.L....J._ . .J···•,'.t.:.:.~.:.t.· Jt~•.~~'-'-"· ,.
' " ···••'••··--····-··-·······•
<\ '~~-~~~,:?;;:
,:~;::
16. GENERATOR'S CERTI_FICATION; I horebydoclare that tho conlent3 olthl., con.,ignmont are fully and accurately described above by proper 11hipping name and are clasailled.
packed. marked. and labeled. and are in all rospect3 in proporcondilion for1rensport by highway according to applicable International and naUonal govern men! r~ulatio1u and
U'le tews of the State ol South Carolina.
111 am a large quantity generator. I certify th al I have a program in place to reduce the volume end toxlcltyolwastageneralod lothedegr-I have determined lo be economically
practicable and thal I have selected the practicable method ol lreatmenl. storage, or dlspos.sl currently available to me which minimize, the pres.en! and future trlr-110 human
health and \he environment; OR, ii I am a small quanlitygonorator, I have mado a good laith effort lo minimize mywasle generallon and select the best waste management method
Iha! is available to me 11nd !hat I con nfford.
Printed/Typed Name ~ L. ~q:.
Signature -~ u-.i.-6.. Month Day Year
o. er
17. Transporter 1 Ac.:,mow!edgemenl of Receipt of Materials
Printed/Typed Name
{._, ' ,. Signature ' I ,. v ;:;,, ~-L, ,., V
18. T ransparter 2 Acknowledgefnent of Receipt of MateriatS
Printed/Typed Name Signature Month, Day Year
1 9. Discrepancy Indication Space ,
• I pt,,. C I pt,,.
bl pt,,. d I jibs.
20. Facility Owner or Operator. Certification ol receipt ol hazardous materlals covered by this manifest except es noted In /!em 19.
Printed/Typed Name Signature Monlh Day Year
A Form 8700-22 (Rev. 9/86) Previous Editions arc Obsoloto (DHEC 1988 (Rev. 10/86))
,.
'
IMPORTANT:
STATE OF souTH CAROLINA 1Ns;~ucT10Ns FOR uNi'F6RM HAZAAoous WASTE MANIFEST I
TYPE (on a 12-pilch (elile) lypewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL .
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage. or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fo
8700-22A Aev:9/86 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into the Unlled States Ir
1 a~other country are responsible !or completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operators al hazardous waste treatment, storage, or disposal racifities to complete the rollowing information,
GENERATOR SECTION I ,.
2:
Generator's U.S. EPA ID Number -Manllesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number ass.fgned to this manifest by the generator beginning with 00001. llyour company does not have a U.S. EPA Identification Number. please contact S.C.
OHEC at [phone] about obtaining an Identification number, I
Page 1 of: · Enter the total numberol pages used to complete this manifest, i.e., the liiSt page EPA Form 8700-22 Rev. 9/66 [DHEC 1966 (REV 10/86)1 plus t
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. ·
A:. State Mantles! Oocu·ment Number: .. Leave blank.
B: State Generator Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms
4. Generalor's PhoJ1e Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event al
emergency including nights." weekends. and holidays. · s. Transport 1 Company Name: Enter the company name ol the lirst transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. 1 Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent al the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. . I
T.. Transporter 2 Company Name: II applicable, enter the company name al the second transporter who will transport the waste. If more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa
8 •.. U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number al the second transporter identified in item 7.
E,: Slate Transporter's 10 Number: Leave blank. ·
F ... Transporter's Phone Number: Enter a lelephone number including area code '.""here an authorized agent of the second transporter can be reached. in II
event ol an emergency including nights, weekends, and holidays.
9:. Designated Facility Name and Site Address: Enter the company name and site address al the treatment, storage, or disposal lacility design a tea 10 receive the·
, waste listed on this manifest The address must be the site address, which may differ lrom the mailing address.
10;" U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number al the designated treatment, storage. or disposal facility identilied in item 9 .•
G:. Slate Facility's ID Number: Leave blank. ·
· H;. Facilily's Phone Number: Enter a telephone number including area code where an authorized agenl al !he facility can be reached in the event of an
emergency including nights, weekends, and holidays.
11·. U.s: DOT DescriJ)lions: Enter proper shipping name. hazard class and ID Number (UN/NA) lorcach waste as identified in 49 CFR 171-177. If additional spa.
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ~
12.. Containers (no. and type): Enter number ol conlainers 10r each waste and the appropriate abbreviation from Table I (below) lor the type of containers.
TABLE I
OM = Metal drums, barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons, cases. roll oHs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. car1ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13.: Total Ouantily: Enter total quantity ol waste described on each line. relative to the units used in item 14. I
14. Unit (weight/volume): Enter the appropriate abbreviations !ram Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Sub pans C and l
identity the hazardous waste on each line. ·
J. Additional Descriptions for Materials Li sled Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listP.d in section 11 above. Nole: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carc:-lina. the
generator must obtain prior authorization from lhe treatment. storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
15 .. Special Handling Instructions and Additional Information: Generators may use this space to indicale special transportation. treatment. storage or dispo
information or Bill or Lading Information. For international shipments, generators must enter in this space the point ol departure (city and state) !or those
shipments destined !or treatment. storage, or disposal outside the jurisdiction of the United States. .
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE thecertilication statement. II a mode other than highway is used .•
word .. highway" should be lined out and the appropriate mode (rail, waler.or air) inserted in the space below. JI another mode in addition to the highway mod
used, enter the appropriate a_dditional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION .
17: Transporter 1 Acknowledgement: 'Enter the name al the person accepiing the waste on behalf of the first transporter. That person must·acknowlet·
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt. ·
18. Transporter 2 Acknowledgement: Enter. ii applicable, the.name al the person accepting the waste on behall al the second transporter. That person mus!
acknowledge accepmnce ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt
FACILITY SECTION I
19. Discrepancy Indication Spac_e: The authorized representative of the designated facility's owner or operator ~us! note in this space any discrepancy betw
the waste described on the manifest and the waste actually received at the facility. Owners and operators of lacilities who cannot resolve signihcan1
discrepancies within 15 days receiving the waste must submit to the Department a lefter with a copy of the manifest desC:ribing the discrepancy and ar.emo1s :o
· reconcile il The treatment. storage. or disposal facility must enter the actual weight of waste in pounds in the spaces provided if the amount varie. s any from ti
specified by the generator in item 13 or ii the generator uses a unit or measure olher than pounds.
20. Faclllty Owner or Operator Certification: Print or type the name ol the person accepting the waste on behaJI of the owner or operator ol the facility. That person
must aci(.nowledge acceptance ol lhe waste described on the manilest by SIGNING (BY HAND IN INKfand entering the DATE ol receipt.
IF ASSISTANCE IS NEEOED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESl(;IIATEO I
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
F
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 8"11 S"ee\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
E PRUIT or TVPE (Form desi ned for use on elite 12· itch writer Form A roved. 0MB No. 2050-0009 Expires 9-30-88
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST c D o 9 7 6 o 4 7 1 4
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone 9 1 9 9 3 4-9 7 11
5. Transporter 1 Company Name
Willms Truckin Co.
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route 1, Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0 3 7 5
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
a.
c.
d.
15. Special Handling Instructions .ilnd Additional Information
GSX Work Order No.: 71278
lnlormation in the shaded a<eas is not
required by Federal Jaw, bul is by State law.
16. GENERATOR'S CERTIFICATION: I horobydoc1aro thnt the contenls of this consignment are lully and accurately ducrlbed above by proper ehipplng name and are cJanili.:i.
packed, ma,kod, and labeled, and oro in nll respects in propor condition !or tran.5port byhtghwoy according to opplicable lnternationol and na!lonal government re,gulatlona and
trie lews ol the State ol South Carolina.
111 am a large quantity generator, I certify thal I have a progrnm In place lo reduce !he volume and loxlclty of waste generated 10 the de,gree t have delermlnod to be economically
pract1cab1e and th al I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threal to human
health and lhe environment;OR, Ill am a small quantity generator, I have made a good lallh e"ort to minimize my waste generatlon and select the btt1t waste management method
that is av.11ilable to me and that I can aNord.
Printed/Typed Name
17. Transporter 1 AcKl)O-~ledgement ol Receipt ol Materials
19. Discrepancy Indication Space
Signature
Signature~
"
Signature
20. Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manifest except as noted In Item 19.
Prinled/Typed Name Signature
ao ele fOHEC 1008 (Rev. 10/88)}
Monttl Day Year
Monttl Day Year
a l._._.._._.._._~Pbs c ,._! .1....1....L..'--'-.J!lbs
b I pbs. d I pbs
Month Day Year
STATE OF SOUTH CAR.OLIN A INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pHch (elite) typewriter] OR USE Ft.RM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators ol hazardous waste treatm:I
storage, or disposal licilities to use !he U.S. EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)] and, ii necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev.-9I86 {OHEC 1988A) foi tioth inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States tr
,_ another country are responsible for completing the manifesl Federal and State regulations also require generators and transporters at hazardous waste ano
owners or operators of hazardous waste treatment. storage, or disposal facilities to complete the !allowing information.
GENERATOR SECTION I ,. Generator's U.S. EPA ID Number a Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA ldentirication Number. please contact S.C.
OHEC at [phone] about obtaining an Identification number. I
Page 1 of: Enter the total numbe-rof pages used to complete this manifest, i.e., the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (~EV 10/86)1 plus t
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any.
Slate Manilesl Document Number. .. Leave blank.
4.
St.ate Generator Identification Number: Leave blank. · I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest !arms.
Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event al
emergency including nights.' weekends, and holidays. ·
5. Transport 1 Company Name: Enter the company name of the first transporter who will lransport lhe waste. I 6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's 10 Number: Leave blank. o.· Transporter's Phone Number: "enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. · · I
T.. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 lra_nsporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transpon1ng the was
U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. 8 ..
· E .. St.ale Transporter's ID Number: Leave blank. • I
F •. Transporter's Phone Number: Enter a telephone number including area code '.""here .:in authorized agent of the second transporter can be reached int
event of an emergency including nights, weekends, and holidays. . .
9. Designated Facilily Name and Sile Address: Enter the company name and site address of the treatment. storage, or disposal facility design a tee :a receive the
. waste listed on this manifest The address must be the site address, which may differ from the mailing address.
10.'u.s. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment, storage, or disposal facility identified in item 9 .•
G:. Stale Facility's ID Number: Leave blank. ·
· H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the racility can be reached in the even! ol an
emergency including nights, weekends. and holidays.
11: U.S. DOT Descriptions: Enter proper shipping name, hawrd class and ID Number (UN/NA) ror each waste as identified in 49 CFR 171-177.11 additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ·
12.. Containers (no. and type): Enter r,umber or containers for each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. roll otts I
OW= Wooden drums. barrels, kegs TC = Tank cars CW = Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Oum·p truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13.: Total Ouantily: Enter tolal quantity of waste described on each line, relative to the units used in item 14. I
T4. Unit (weight/volume): Enter the appropriale abbreviations from Table II (below) for the unil of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter haiardous waste numbers as specified in South Carolina Hazardous Waste Management ~egulation A.61 • 79.261 Subparts C ar:d DI
identify the hazardous waste on each line.
· J. Addilional Descriptions !or Materials Listed Above: In the spaces provided. enter the authorization number (lrom the S.C. OHEC Authorization Request For
, . . •. • for each waste stream listed in section 11 above. t-klle: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carc-lina. the
-~ generator must obtain prior authorization from the treatment, storage or disposal lacility. I
K. Handling Codes for Wasles Listed Above: Leave blank.
~' 15 .. Special Handling lnslructlons and Addillonal Information: Generators may use this space lo indicate special transportation. treatment. storage or dispo
information or Bill of Lading Information. For international shipments. generators must enter in this space the point or departure (city and s:ate) !or those
shipments destined tor treatment. storage. or disposal outside the jurisdiction of the United Slates.
16. Generator Certification: The generator musl READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used .•
word "highway" should be lined out and the appropriate mode(rail, water.or air) inserted in the space below.If another mode in addition to the highway mod ·
used. enter the appropriate a_ddilional mode (e.g.,.and_ rail)·in the space below.
TRANSPORTER SECTION 11: Transporter 1 Acknowledgement: Enter the name al the person accepting the waste on behall or the first transporter. That person must acknowledl
acceptance ol lhe waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter. ii applicable, the name or the person accepting the waste on behalf al the second transporter. That person must
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipl
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized representative ot the designated facility's owner or operator must note in this space any discrepancy betwe
the waste described on the ·manifest and the waste ac!UaHy received at the facility. Owners and operators ol facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit to the Department a letter wilh a copy of the manifest describing !he discrepancy and artemotsl
reconcile it The treatment. storage. or disposal lacility must en fer the actual weight of waste in pounds in the spaces provided if the amount varies any trom r
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Ownei-or Operator Cerlilicalion: Print or type the name of the person accepting the waste on behalf al the owner or operator ol the facility. That person ·
mus! acknowledge acceptance al the waste described on the manflest by SIGNING (BY HAND IN INK)and entering the DATE of receipt
IF ASSISTANCE IS NE60&D IN C:QMPL&TIQN QF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734'5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt.
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
(Form desi ned for use on elite 12· itch ewriler
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generalor's U.S. EPA 1D No.
3. Generator's Name and Mailing Address
Channel Master
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
4. Genera1or'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
C D O 7
10. U.S. EPA ID Number
S C D O 7 0
11. U:S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
Hazardous
NA 9189
Waste, Solid, nos ORM-E
Emergency & Holiday.: (803)734-~24
Form A roved. 0MB No. 2050--0039 Et ·,es 9-30-e.B
lnformallon In the shaded areas is n01
required by Federal law, but is by State law.
12. Containers 13. Total Quantity 14. Uni1 ,:l\W&ita~
No. Type WINd :S'f-/f,1j\';lAWii:R'!
l D.T 2 0 y
·;.,·r,i, ,,
I I I
b. u_j-1 ,-1 J _ ,;1':s;;;,!1:iid LL.J-: 1 _,1, ___ , ___ t,. J _ -'= 1, _1,_Jf;;: ;;:1iii~::;t;:;I:::+kn~1,::::,#;:',;~;;:1:,:,~1.m:;~;;t;~.-
15. Special Handling Instructions and Addilional lnformalion
GSX Work Order No.: 71456
1 e. GENERATOR'S CERTIFICATION: I hereby declare that Iha contents ol this conalgnrn•nt are fully and accurately ducrlbod above by proper shipping name and are claM,lfted.
packed. markod, and 1a·beled, and are In all respecla In proper condition for transpor1 by highway according to appllcable lntarnallonal and national govemmant r.gulatlOf'la &11<1
u,a taws ol !he State of Soulh Carolina.
111 am a large quantity generator, I certify that! have a program In place to reduce the volume and toxlcltyolwaatagonerated totha d~r-I have determined to be Konomblty
practicable and that I have selected the practtcable method ol trealment, sloraga, or disposal currenlly ave.Hable to ma which mlnfml1e1 the praaenl and lutur• lhtMI to human
h•altti and the environment.: CA, lfl am a small quanlltygeneralor, I have mado a good laith eNort to minimize my wasle generation and Hlect the bell w .. t• managemenl ~
U'lat is availatile 10 me and that I can allord.
Printed/Typed Name of, ~
17. Tran:iporter 1 A1,;-,,nowledgemenl of Receipt of Materials
Printed/Typed Name • / . aOnJf $@9e,,p,,t!.-J ~
18. Transporter 2 Acknowledgement of Receipt ol Materials
,__,,.
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. facility Owner or Operator; Certification of receipt of hazardous materials covered by this manilesl except as noted in Item 19,
Printed/Typed Name Signature
PA For,:,, 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (~ev. 10/86))
Month
D
.;fff?& Montn Year
Month Day Year
• lu...,_._,.__.J....,Jpbs. ' ... 1 .L..L...L.w...Jllbs.
b I jibs. d I J lib,.
Month Day YNI'
STATE OF SOUTH CAROLINA INSTRUCTIONS Fo'R UNIFORM HAZARDOUS WASTE MANIFEST ,·,
IMPORTANT: TYPE (on a 12-pitch (elite) lypewriter) OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
·•~ GENERAL INFORMATION: Federal Regulalions require genarators and tra~sPo~ers of h;zardous waste and_owners or operators ol hazardous waste treatmel
, storage, or disposal licililies lo use the U.S. EPA Form 8700·22 Rev. 9/86 [DHEC 1988 (REV 10/86)1 and. ii necessary, th& continuation sheet U.S. EPA For
•.; 8700•22A Rev:9186 (OHEC 1988A) loi both intCr•stale ::rnd intra•statc lr;insportallon. Transporters who transport hnzardous Waste into the United States fro
'.
another country are responsi!Jte for completing the manilesl. Federal and Slate regulations also require generators and transporters ol hazardous waste and
owners or operators or hazardous waste treatment, storage, or disposal fac1htres to complete the followmg informatron. '
GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manllesl Document Number: Enter the generator's US. EPA twelve digit ident1f1cation number and the umcue live d1g1
number assigned to this manifest by lhegeneralorbeginning with 00001.11 your company does not have a U.S. EPA ldentjlication Number. please con:act S.C.
DHEC at [phone] about obtaining an ldentilicatlon number. · I
2;. Page 1 ol:. Enter the total number of pages used to complete this manifest, i.e., the lifst page EPA Form 8700-22 Rev. 9186 [DHEC 1988 (REV 10186)] plus:
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) H any. · .
A.. State Manifest Document Number: .. Leave blank. · · ·
B:· Stale Generator Identification Number: Leave blank. · , · J
3. Generalor's Name and Maillng Address: Enler the name and mailing address of !he generator who will manage the returned manifest rorms.
~. Generator's Phorie Number: Enter a telephone number wilh area.code where an authorized agent of the generator can be reached in lhe even: ol
emergency including nights, weekends, and holidays.
,S. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
6: U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item S: .
C:,, Slate Transporter's ID Number: Leave blank. · · ·
0. Transporter's Phone Number: Enter a teleph~ne number including area code where an authorized agent of the first transporter can be reached in the evenfol
an emergency inc:luding nights, weekends. and holidays. . . . ' '· · . · . ·
T.. Tran~porter 2.Company Name: II applicable, enter the c"Omp~~y name Oithe se~Ol1iir311's"POrterwho wm"tra"n·spOrt the waste. If more than 2 trans;,oners wa.
be uSed. use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC. 1966A) continuation sheet and lisl the transporters in lhe o~der they will be transoor:.ing trie was:I
8 •. ·: U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. Stale Transporter's 10 Number: Leave blank. ·,. . ·
F •. T,ansporter's Phone Number: Enter a telephone number including a'rca code w.here an authorized agent of the second transpor1er can be reacr.ec in ti
~:.event ol an emergency including nights, weekends. and holidays.
9. Designated Facilily Name aiid Site Address: Enter the company name and site address of !he treatment, storage, or disposal lacility designated to receive the
· waste listed on this manifest The address must be the site address, which· may diller lrom !he mailing address. .
. _10;. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of lhe designated treatment, storage, or disposal facility identified in item 9. I
G:. Slale Facility's ID Number: Leave blank. ·
H;. Faclllly's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in the event of an
emergency including nights, weekends, and holidays.
11: .. ~.s: DOT Descriptions: Enter proper shipping name, hazard class and 10.Num.ber (UN/NA) for each waste as identified in 49 CFR 1 71 • 1 Ti. II aCCi:icnal spal·
• 15 needed. use a U.S. EPA Form 8700-22A Rev. 9186 (DHEC 1988A) Conllnualton Sheet. •
· 12... Containers (no. and type): Enter number ol containers lor each waste and the appropriate abbreviation lrom Table I (below) for the type ol containers.
TABLE I
OM :c Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. canons. cases. ro!I cHs I
OW :c Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. car1ons, cases
OF :c Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes, canons. cases
TP = Tanks portable CY= Cylinders B_A = Burlap, cloth, paper or plas11c :lags
13 .. Tola! Quantity: Enter total quantity al waste describe"d on each line, relalive to the units used In ilem 14. I
'u. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) lor the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid only)
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 SuCpa~s C ar.d OJ
·-identity !he hazardous waste on each line.
J.' Additional Descriptions tor Malerials Llsled Above: In !he spaces provided, enter the authoriUJlion.number(lrom the S.C, DHEC Authorization Request For
lor each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted for lreatment storage or disposal in South Carc-lina. the
generator must obtain prior authorization lrom the treatment, storage or disposal facility. J
K. Handling Codes !or Wasles Listed Above: Leave blank. · ·
TS. Special Handling lnslrucllons and Addilfonal Information: Generalors may use this space lo indicate special transportation. treatment. storage or dis po
.: .. ~ ·-information or Bill or Lading Information. For international shipments, generalors must enter in this space the point ol departure {city and s:ate) !or tnose
· • · shipments destined !or treatmenl. storage. or disposal outside the jurisdiction or lhe United States. · ·
16. Generator Certil\calion: The generator must READ,.SIGN (BY HANO IN INK), and DATE lhecertilicatlon statement. II a mode other than highway is ·used. ti
word .. highway" should be lined out and the appropriate mode (rail. waler. or air) inserted In the sPace below. II another mode in addition to tr.e highway r.ioc:e
used, enter the appropriate additional mode (e.g.,_and_ rail) in lhe space below.
TRANSPORTER SECTION 11: TransPort;r 1 Acknowledgement: Enter the''name ol lhe.person accepting lhe waste on behall of ihe first transporter. Thi3(pers0ii rr.usl ack.nowledl
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18 .. Transporter 2 Acknowledgement Enter, if applicable, lhe name of the person accepting the waste on behalf ol the ·second transporter. That person mus:
acknowledge acceplance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized represenlative ol the designa!ed facility's owner or operator mus I note in I his space any discrepancy betwe
the wasle described on the manilest and the waste actUally received al the facility. Owners and operators ol facilities who cannot resolve signilicant
discrepancies within 15 days receiving lhe waste must submit to the Department a letter with a copy ol the manifest describing the discrepancy and ar:emots I
reconcile il The Ireatmenl slorage. or dlsi;,osnl lacillty must enter lhe actual weight ~I waste in pounds in lhe spaces pro¥ided ii the amount varies any from rr:
speciried by lhe generator in item 13 or ii the generator us~s a unit ol meRslJre other than pounds. . . ·
20. Facility Owner or Operalor Certilicalion: Print or type the name ol the person accepting.the was le on beha/1 ol the owner or operator ol the IJ.c1lity. That person
must acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HANO IN INK}' and entering the DATE of receipt
1, AssI1TANce Is Neeoeo IN coMPLeTI0N OF THts MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DJSPOSAL FACIL1rv oesIc~,AT&0 rl
RECE"!VE THE \\'ASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734•5200 WE~KOAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
LEASE PRINT or TYPE (Form desl ned for use on elite 12-llch ewriler
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo. Manlfeat Document No. WASTE MANIFEST N c D O 7 o 0 0 0 6 7
3. Generator's Name and Mailing Address
Channel Master
P, O. Box 1416, Smithfield, NC 27577
4. Generalor's Phone [phone]
5. Transporter l Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
of
Bureau of Solid & Haz.ardous Waste Mgt.
2600 Bult Street Columbia, SC 29201
Phone: (BOJ) 734-5200
Emergency & Holiday>: (803)734-5-424
roved. 0MB No. 2050-0039 E.x 'res 9-30-88
lnlormalion in the shaded areas is not
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13.TotalOuantity 14.Un~ ,_·L'._"'!&Stll·~:t_
No. Type Wr.Ni:i \{/i:l/,.!H}\:.,..¥~~
L Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71457
I. D T 2 0 Y
, 9. OENERATOR"S CERTIFICATION: I hereby decl•re lh•I lhe contents of Chia con•t-.inment•re fully and accura1elyde1erlbe,d above by proper •hipping n•m• and are eia-1\,ed.
packed. ma,lo.ed. and la"beled.and are In all respect• In proper condlllon forlransport by highway according to app11cable International end nation al government r..gulallOf'I• arod
tr'le laws ol lhe Stale ol South Carotlna.
If I am e largo quan\ity genora1or. I certify that I have a program In place to reduce the volume and loxlcltyol waste generated lo the degree I have delermln.cl to be economk:.aJty
practicable and th al I have selected the practicable method ol treetmont. storage, or dispose.I currently avellabte to me which minimizes the present and luture tl'lrNI to human
health and the environment OR. II I am a smn11 quantity generator, I hove made a good lailh elfort to minimize my waste genera\Jon and Hlect the beat wa11a management~
that is available to mo and that I con arlo,d.
Printed/Typed Name Signalure
Prinled/Typed Name Signature
19. Discrepancy Indication Space
oZ ~
a .._J '-'--'--'--'
b .._J '-'--'--'--'
20. Facility Owner or Operator; Cer1ilicalion ol receipt ol hazardous malerials covered by this manifest except as noled In Item 19.
Printed/Typed Name Signature
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolele [DHEC 1988 {Rev. 10/86))
Jibs.
Jibs.
Month
0
Monlh Day Year
-
CI Jibs.
d J Jibs.
Moolh Day y..,
! '
"STATE OF SOUTH CAROLINA INSTRUCTIONS Fo"R UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter( OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
~~·::.GENERAL INFORMATION: Federal _Regulations require generators and trnnsporters ol hazardous wasle and owners or operators of hazardous was1e trea1mel
.. storage, or dispOsal ficilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)) and. if necessary, Iha con1inuation she_et U.S. EPA For
•· · 8700-22A Aev:9/86 (OHEC 1988A) loi both inler-sf:lle and intra-stale tr;msporlatfon. Transporters who transport hazardous waste into lhe United Slates Ira
another country are responsible !or completing the manHest. Federal and State regulations also require generators and transporters of hazal~ous waste ar.d
owners or operators of hazardous waste treatment, storage, or disposal facilities to complete the following inrormation. '
GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manilest Document Number: Enter .the generator's U.S. E~A twelve digit iden.tiflcalion number and tt'le uiiicue five digI
number assigned to lt'lis manilest by ·the geiierator beginning wilh 00001. If your company does not have a U.S. EPA ldenlilicatiOn Number. please contact S.C. ·
, ._ ..... OHEC at [phone] about obtaining an ldentificalion number. · . I
1
• _ 2::":_Page 1 ol:. Enter the total number of pages used to complete this manirest, i.e., the first page EPA Form 8700-22 Rev. 9/86f0HEC 1988 (REV 10/86)] plus 1
· ·. number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1966A) ii any. · ... ~-ii:. Si.ate Manifest Document Number: .. Leave blank. · ·
•· ~ a:~ State Generalor ldenliflcallon Number: leave blank. . J
3. Generator's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage the·returned manifest forms.
4 .• Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent ol the generalor can be reached in !he event ol
emergency including nights, weekends, and holidays.
: · · .5.: Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
t-' .~ 6.-U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the lirst transpor1er identHied in item 5. I : •·.; .''c_.._t-Slale Transporter's 10 Number: Leave blank. · · · ~·~ ~ O •.. Transporter's Phone Number: Enter a telephOne number including area code where an aulhorized agent of the first transporter can be reached in the evenlc:i! :,'.; 1: , , an emergency including nights. weekends, and holidays. ' ; · · . ' · · . 1.
~··: T.. Tran~porter 2 Co~pany Name: II applicable, enter the cOmp~·~y name Qi the seCOri.dir3rlS'Por1er who will° tr8'n"spor1 the waste. II more than 2 trans::,orters ·
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in.the order they will be transpor:ing the was
8 .• U.S. EPA 10 Number:!! applicable, enter the U.S. EPA twelve digit ID number ol the second transporter identified in ilem 7.
I, E:. Slate Transporter's ID Number: leave blank.
·• F .. Transporter's Phone Number: Enter a telephone number including a·rca code w_here an authorized agent of the second transporter can be reacl",ed in ti
_ •: event ol an emergency including nights. weekends. and holidays.
: , 9. Designaled Facility Name and Sile Address: Enter the company name and site address al the treatment. storage, or disposal facility desit;,nated to receive the
i waste listed on this manifest The address musl be·the site address, which· may differ lrom the mailing address. I
t·:• ~ t 10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identilicalion number of the designated treatment, storage. or disposal facility identified in item 9. I
~.: .• ·G:. Stale Facility's ID Number: leave blank.
, :-_. H;. Fac:lllty's Phone Number: Enter a telephone number Including area code where an authorized agent ol the facility can be reached in !he event or an
emergency including nights, weekends, and holidays.
,_ ., • 11:_ ~-S~ DOT Oescripllons: Enler proper shipping name. hazard crass and ID .Num~er (UN/ NA) for each wasle as identili~d in 49 CFA 171-1 ii. ti aCCi:icnal spa I
· , · 1s needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Con11nuat1on Sheet. . \-.
. • ~ -12.. Containers (no. and type): Enter number of conlalners for each waste and the appropriale abbreviation lrom Table I (below) for the type ol containers.
•;.; TABLE I
,, • .1.,. OM a Metal drums. barrels, ke9s TT= Cargo lanks (tank trucks) CM= Metal boxes, cartons. cases, roll ctts
: ·'·OW= Wooden drums, barrels, kegs· TC= Tank cars CW= Wooden boxes. cartons, cases
_ '; .. ; OF-= Fiberboard or plaslic drums, barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. canons. cases
: TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity ol waste describ8d on each line. relative to the unils used In item 14.
14. Unit (weighl/volume): Enler the appropriale abbreviations lrom Table II (below) lor the unit ol measure:
Table II
I
I
P = Pounds L = liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in Soulh Carolina Hazardous Waste Management Regulation A.61-79.261 Subpar:s C ar.d DI
· --"identity lhe hazardous waste on each line.
·J •. · Additional Oescriplions tor Materials Listed Above: In the spaces provided, enter the authorization.number {from !he S.C. OHEC Autt'lorization AeQuest For
for each waste stream listP.d In section 11 above. Nole: Belo re any hazardous waste can be accepted !or treatmenl storage or disposal in Soulh Carc-lina. the
generator must obtain prior authorization lrom the treatment. storage or disposal facility. J
· K. Handling Codes !or Wasles Us led Above: Leave blank.
15. Special Handling Instructions and.Addillonal lnformaiion: Generalors may use this space to indicate special transportation. treatment. storage or dispo
information or Bill ol Lading lnlorma!ion. For international shipments, generators must enter in this space lhe point of departure (city anc s:ate) tor tnose
shipments destined !or treatment. slorage. or disposal outside lhe jurisdiction of the United States. · I
16. Generator Certiliealion: The gener'ator must REA0,·sIGN (BY HANO IN INK), and DATE the cer1ilication statement II a mode other 1tian tiighway is used, t
word "highway" should be lined out and the appropriate mode (rail. water ,or air) inserted In the space below. II another mode in addition 10 the nighway mode
used. enter the appropriate additional mode·(e.g., and_ rail) in the space below.
TRANSPORTER SECTION . . · ·, . , 11: Ti-ai1Sp~rter 1 Acknowledgement: Ente_r.the.name'or the person accePting the waste on behalf ol ihe first transporter. That person rr;us1 ack.nowleCI
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt -
18: Transporter 2 Acknowledgement:. Enter, if applicable, the name ol the person accepting the waste on behalf of the second transporter. That person mus:
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt 1 FACILITY SECTION ,. , .
19. Discrepancy lndicafi_on Space: The authorized representative ol the designated facility's owner or operator rrlust note in this space any discrepancy betwe
the'was!e described on the manifest and the waste actt.ially received al the facility. Owners and operators al facilities who cannot resolve s1gnilicant
•r.· ·., discrepancies w1lhin 1 S days receiving the waste must submit to the Oepar1men1 a letler with a copy ol the manifest describing the discrepancy ar.d a:-:em.::al
rec~ncile il The lreatme_nl storage, or disposal lacillty must enter the actual weight ~I waste in pounds in the spaces provided ii the amoun! varies any trom t
si,ecilied by lhe generalor in item 13 or ii the generntor uses a uni! of mcas11re olher than pounds. . . ·
r ~ • · 2q. Faci9ty Owner or Operaior Certlllcatlon: Prlnl or type th~ riame ol lhe person accepting-tho was!e on beholl ol lhe owner or operator ol the lac1l1ty. ThJt person
must acknowledge_ acceptanc'e of the waste described on the manifest by SIGNING (BY HANO IN INK)' and entering the DATE of receipt
'"ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT. STORAGE, OR DISPOSAL FACILITY DESIc,uTEO 1 AECE!VE !HE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (80~) 7J4,5200 WE~KOAYS FROM 8:00 nm TO 5:00 pm,
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wute ~gt
2600 Bull Streel Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5'24
I UJ.SE PRINT or TYPE (Form desioned for use on elite H2-dtchl .. ·-ewrilerl Form A' roved. 0MB No. 2050-0039 E.rpires 9-30-&8
UNIFORM HAZARDOUS [1, Generalor'sU.S.EPAIDNo. Manlree1 ,.J2. Page1 Information in the shaded a,eas is not
ST Document No, of . ed b Fed 11 b . S WASTE MANI FE N, C, D, Q, q, 7, ~. Q, , .. 7, 1, , .. ('\ ·n. r1 ;.. 1 roquir y era aw, vt»by tatelaw.
I
I
I
I
I
I
I
I
I
I
3. G;~:~~•; ~a~~;;dt ~~ing Address .~u=~=;:~fj\~,.:., :~·.:~=~::.\:'.({~j;~).:'
P. 0. Box 1416, Smithfield, NC 27577 li\sia1t'Gimn1Dt'11>/.• .. c -·•·.:\·"•:";.,_-.,
4. Generator's Phone I 919 l 934-9 711 '•'','::::',:?(;_-,,,..:cc,:,:-J:r• •·· -.•_•;~_;':_ ,Xe'. V
5. Transporter 1 Company Name
~illms TruckinQ Co. Inc,
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood. SC 29125
6. U.S. EPA ID Number C/$iiie--t lO',/--
•S• C, D• Q, 7• 31 71 n, q, 71 Q. o/1''-----, ·.sPtiont\"::.,-An>/7~7-'·1111-
8. U.S. EPA ID Number
I I I I I I I I 1 • I I
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity U.Unil t:wa:ita~','•:'-'
No. Type 'M.Nd '.)f,\:"<:···,::'<"·,::/_~--,<}}
' ' I ' ' ' '
d.
0 I I O I ' '
15. Special Handling lnstruction_s and Additional Information
GSX_Work Order No.: 71458
, e. GENERATOR'S CERTIFICATION: I hereby dec1are 1hat the conlenls olthls consignment are lully and accurately described abova by proper ■hipping n1m1 anCI are c1a...,.t11<1.
packed. marked, and 11,:beled,and are in all respects in proper condition for lransport by highway according to 11ppllcable lntarnatlonal and n1t1on11I governm1n1 re,gul1t1on1 and
1.l"le laws cl the St.ate ol Soultl Carolina.
111 am a large quantity genere.1or, I cor1ify lhat I have II program In place lo reduce the volume and toxicity ol waste genaraled to the de-Qr_ I h■Ye de!armlned lo be oeonomk-ally
prachcabte and that I have selected the praclicable method ol treetment, storage, or dlspoaal currently available lo me which minimizes the presant and lutura tn,_, to nvman
neal!h and !he enYironmcnt: OR. ii I am a small quantity gonoralor, t have mado a good raith otrort 10 minimize my waste generation and select the t,,o1t was ta man1gemt1nt metr'lOd
lhal is availat>!e to me and tho! I con nllo,d.
I Printed/Typed Name J<,°r1e,;-{, Cx,Js I Signature j1/', _ A • -~ ~ Monltl Day Year
i-~\+-1:1:. ~T=r•~n;s;po~n=e=r~t~A=c=,n=o=w=l=ed;g;e:m;e~nt~o=l~R=cc;e;io;1;0:1; M=•=t•=ri;a1;, ======~~~==~=======:-?:~==·=\...,:====~~=~==~:~=~:=~===============':; G!~:8'~~•2.~-~•~{,~~
11
R,7:~;/~ loik~~~-~•~T~~~N~•~m~:~,~~-~~-~/""~/4~H~~~A'~c~ __ 1IS_ig~~~~t'l,~re~¾~~~-~-~~~~~~~~~~--------'~~~~~P-~~•2=~~~~~·~·?.~~~
1 a. Transporter 2 Acknowledgement ol Aeceipl of Materials Al-',C'-"'-==:::..::.:..::===========--~------------------------------f
I-TAE4-...;..P_n_·n_,ed_1_ry_p_ed_N_•_m_e _______________ 1_si_g_na_1_u,_, _______________________ ,_M_o.1,ntt1.....JL...D.1.a_y_,._Y_w1,...-4 I , I , I ,
19. Discrepancy Indication Space
: • LI _,_.,_ ..... 1_·.J...JJ!bs. c !1....1 ..... -'-.1-L.Jltt:,, IC bl pbs. di pt>s. i 20. Facility Owner or Operalor; CenUicatlon ol receipt ol hazardous materials covered by this manifest excepl u noted In Item 19.
Prinled!Typed Name . I Signature I ~PA Form 8700'22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
Mooltl Day Yeor
I , I , I ,
·11 .,1,::~ti~.·:•i1, .(;., .... ·:-, ..... {.·tli··
'll~r:-;; ~-, STATE OF SOUTH CAROLINA INSTR~~~T~O~S Fo"R UNIFO~M HAZARDOUS WASTE MANIF~ST . :J
IMPORTANT: TYPE (on a 12-pitch (elite} typewriter) OR USE FIRM POINT PEN -PRESS OOWN HARD All COPIES MUST BE LEGIBL .
t\::: GENERAL INFORMATION: Federal .Regulations require genP.ralors and lra~spo~ers ol hazardous waste and owners or operators ol hazardous waste.trea1mel
... storage, er dispOsal ficililies to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)) and. if necessary, thEI continuation sheet U.S. EPA For
.., · 8700-22A Rev.-9/86 (OHEC 1988A) loi both inter-stale and intra-stnte lrnnsporlalion. Transporters who lransport hazardous waste into the United S1a1es lro
-~-·· another country are responsible for completing the man!lesl. Federal and Slate regulations also require generators a_nd transporters ol hazardous waste and
owners or operators of hazardous waste treatment, storage, or disposal facilities to complete the following information.
GENERATOR SECTION . I
1 •. Generator's U.S. EPA 10 Number. Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number anel the unicue live digit
-<J: .... : ·. number assigned to !his manifest by the generalor beginning with 00001. If your company does not have a U.S. EPA ldenlll1cat1on Number. please contact S C.
-.-........ ,.QHEC at [phone] about obtaining an ldent1hcalion number. • I
.--:·· 2.D°. Page 1 of: Enter the total number of pages used 10 complete this manifest, I.e .• the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) plus t
.:..:,;. ,_..._ n'!mber of contmuallon sheets EPA Form 8700-22 Rev. 9/B6A (DHEC 1988A) rl any.
; _1 A.,' Stale Manllesl Document Number. .Leave blank. , : ·
":""·"'"a:• State Generator ldenliflcallon Number: Leave blank. · · · . . . . ~ , J
:; ·_ 3._ Generator's Nam~ and Maillng Address: Enter the name and mailing address of the generator who will manage Iha returned manilesl !arms. ·, , ]
• 4. ~ Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of
.: ,. · emergency including nights, weekends, and holidays .
. 5 •. Transport 1 Company Name: Enter the company name of the lirsl transporter who will transport the waste. _. , I ·,:.; ~ e::.
1
U.S. EPA ID Number: Enter the U.S. EPA twelve dlgil identilicali.on number of the lir~t lransporter identified in item 5.
: ·c.'; Slate Transp_orler's ID Number:. Leave blank: · . .
• 0. , .. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol the first transporter can be reached in the event of
) :,· t'·, .';an en:,ergency_in~luding nighls, weekends, and holidays... ... ... ··-• .. ·-· . -··· . '. · ·: .. .'. · . ·• M.. T.. -· Transpor1er 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the wasle.11 more than 2 transporters w ·
·'. i r-•:. ,' be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continualion sheet and 1ist the transporters in the order they will be 1ransoor.ing the was:
,,,-8-:u.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
;· L.E ... Stale Transporter's ID Number: Leave blank. · 1
}~ F.i Transporter's Phan~ Number: Enter a telephone number including area code w_here an authorized agent al the second transpor1er can be react-.ed int
~:, :;::;-::-:; event ol an emergency including nighls, weekends. and holidays.
·: 9._:•' Onlgnated Facilily Name and Sile Address: Enler the company name and site address of the treatment, slorage, or disposal facility designated to receive the
.--: • · waste listed on !his manilest The address must be the site address, which· may dUler lrom !he mailing address. • I
"f'i.1,..10;, U.S. EPA 10 Number: Enter the U.S. E~A twelve digit Identification number of the deslgnaled treatment, storage. or disposal racility identified in item 9 .
...:., • G:. Slate Facillty's ID Number: Leave blank. · • '.
•: • H;. Faclllly's Phone Number: Enter a telephone number including ~rea code where an authorized agent ol the facility can be reached in !he even! ol an ~i: ..... emergency includlng nights, weekends. and holidays .
• 11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) ror each waste as idenlilied in 49 CFA 171 -t ii. ti aCCi:icn.al spal
" •"is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Conlinualion Sheet.
. .12.. Conlalners (no. and type): Enter number ol conlainers lor each waste and the appropriate abbreviation lrom Table I (below) for the type ol con1arners.·
;•, TABLE I
OM a Metal drums, barrels, kegs TT = Cargo tanks (lank trucks) CM = Metal boxes. cartons. cases. roll oHs I
:'• ·•• .•. ~ OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
:-.:::::; OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
· TP = Tanks portable CY= Cylinders · BA= Burlap, cloth, paper or piastre bags
13 •. Total Quantity: Enter total quantity of waste describe'd on each line, relative to the units used in item 14. I
14. Unil (weighl/volume): Enter the appropriate abbreviations from Table II {below) lor the unit of measure:
Table II
P 1111 Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons {liquid only)
I.· Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C ar.d DJ
.-•~;~ .... -identity the hazardous waste on each line. · ,'::~ i•~-Addillonal Descriptions for Materials Listed Above: In the spaces provided, enter the authorlz:oUon.number(lrom !he S.C. DHEC Authoriz:a1ion Reciuest For
ror each waste stream listP.d in section 11 above. Nole: Bero re any hazardous waste can be accepted lor lreatmenl slorage or disposal in South Carelina. !he
~:·._.,,. ... ,., generator must obtain prior authorization !ram the treatment, storage or disposal facility. . , ; I
~: K. . H11ndllng Codes lor Wasles Listed Above: Leave blank. · , , ~ 15. Special Handling Instructions and Addillonal Information: Generators may use this space lo indicate special transportation, treatment. storage or dispOs
~ · ... ---information or Bill of Lading lnlormalion. For international shipments, generators must·enter in this space lhe point of departure (city and stale) !or those
'... 'shipments destined !or treatment. slorage. or disposal outside the jurisdiction of the United Slales. · I
16. 6eneralor Certification: The gener8tor must READ,.SIGN (BY HANO IN INK), and DATE the certification statement. II a 'mode other than highway is used, t
word "highway" should be lined oul and !he appropriate mode (rail, water.or air) inserted In the space below. II anolher mode in addition to tr-:e hignway mode
used. enter the appropriate additional mode (e.g.,.and_ rail) in the space below. ·" TRANSPORTER SECTION . · · --11: Transporter 1 Acknowledgement: Enter the riame ol the person accepling the waste on behall of ihe first lransporter. That person rnusl acknowledl
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18 .. Transporter 2 Acknowledgement Enter, if applicable, the name of the person accepting the waste on behalf ol the second transporter. That person rr.us:
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt I
. ' FACILITY SECTION .
19. Discrepancy Indication Space: The authorized representative of the designated facility's owner or operator must note in this space any discrepancy betwe
th~ waste described _on the manilost and the wasle actUally received at the facility. Owners and operalors of facilities who cannot resolve si;nilicant
~'1 discrepancies w11hin 1S doy1 r1celvlng the woale must 1ubmlt lo the Oeportmenlo lanerwilh o copy olthe manlfeal describing !he discrepancy and ar:emotsl
reconcile lL The 1,ea1ment storage, or disposal racil!ty must.enter the actual weight<?' waste In pounds in the spaces provided ii the amount varies any from ft1:
specilied by the generator in ilom 13 or II !he generator uses a unit or meas11re other than pounds. .
• 20. Facility Owner or Operator Cerliflcatlon: Print or type th~ n.ime ol lhe person accepting.the was le on behall or the owner or operator ol the IJ.crlity. Thal person
· 'must acknowledge acceptance of the waste d~scribed on the manifest by SIGNING.(BY HAND IN INKf and entering the DATE of receipl
t• Als1sTANCE 1s NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL F•cIurv oES1G,i.reD Tl
~e:C!:IV': THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (603) 734•5200 WEEKDAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
LEASE PRINT or TYPE (Form de.si ned for use on ellle 12-itch ewriler
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
3. Generator's Name and Mailing Address
Channel Master
N C D 0
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transp0r1er 2 Company Narl)e
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, -1 Box 255
Pinewood SC 29125
0 1 4
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
of
Bureau ol Solid & Haz.ardous Waste Mgt.
2600 Bull StJeel Columbia. SC 29201
Phone: [phone]
Emergency & Holidays.: (803)73-4-5-424
roved. OMS No. 2050-0039 E.ie>ires 9-30-M
Information in the shaded a,eas is not
required by Federal law. but is by State law.
11. U.S. DOT Description (including PropefShipplng Name, Hazard Class, snd ID Number} 12. Containers 13. Total Quantity ,.c.Unil l'.Wutatunl>w~-:-!-
No. Type 'M.Nd ~;(\-',,'.·.•2;:;'.<)"/t~j°
L
b.
e.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
~1::.:~,~1:~~;,~,i~t~i:.·· . . .
a. IE..ili.J-! 0 I 2 I 7 I 7 14 1-11 I 1 I O I 21 •••••ih:•SI )i c. Lt_j-11.....1.....1-.1-L...J
b. LLJ-1 1-1 ... 1m:,;:~.1::m1t~:w:::J ..... ·. J:.L I
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71459
1t. 01E:N!RATOR'S CERTIFICATION: I hereby declare that Iha contents of this con1lgnmenl ere fully end accuratelydetcrlbed 1b0ve by proper lhlpplng n1m1 anCI er■ c.lau.tled,
packeCI, marked. and la.beled, and are In all respeCl!I In proper condition lor transport by highway according toeppUcabla lnlern1tlonat end national govarnm1n1 r~1.1lat1on1 al'\d
U'l■ 1aw, ol tt,1 State ol South Carolina.
1111m I la,ge qu1nt11'y generator. I cor1ily thet I havo a program In place to reduce Iha volume and toxicity ofwa:,le generated to the da,gr-I have delarmlna-d lo b-9 .conomlca.111
practicable and that J have salec1ed the practicable method ol treetment, slorege, or dlsposal currently available to me which mlnlml:re1 the praMnl and futura u,,_t to hum.an
health and the environment OR, ii I am n smoll quantity generator. I hove mado a good faith effort to minimize my waste generation and select the boil wut1 management m,c,'1'10<1
trial is available to me and lhat I con olford.
Printed/Typed Name /1/ L, t!ea..:is. Signalure C»/4 Month Day Yoat
0 Ii'" (, !?<7
17. Transporter 1 Ac.:Knowledg
0 Jme Montn · Day v .. ,
,_ ~
· ranspcrter 2 Acknowledgement ol A eipl of Materials f
Prin\ed/Typed Name Signature ~onttt Day Yw
19. Discrepancy Indication Space
a I l't.. ' I !'bs.
b I pbs. d I !'bs.
10. ,1c:dlfY Owne, c, Ope,Itor: Cert/llcatlon of ,ecelpl ol haza,dous ma1e,lal1 covered by this manllesl excepl II noted In llem 19.
Prinle,d/Typed Name Signature Month Day Year
PA Form 8700-22 (Rev. 9/86) Previous Editions nre Obsolole {OHEC 1988 (Rev. 10/86)}
'
"'·' "
.. , j . I· ,, J'
STATE OF SOUTH CAROLINA INST.RUCTIONS Fa°R UNIFORM HAZARDOUS WASTE MANIFEST ··I
lMPORTANT: TYPE (on a 12-pitch {elite) typewriter) OR USE FIR~ POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
• p . . . . .
•:. ·,:: GENERAL INFORMATION: Federal _Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
, storage. or disposal licililieis to use the U.S. EPA Form 8700-22 Rev. 9/B6 (DHEC 1988 (REV 10/86)1 and. ii necessary. th~ continuation sheet U.S. EPA For
: . · 8700-22A Rev:9186 (OHEC 1988A) loi both inter-stale and intra-stale transportation. Transporters who transport hazardous waste into the United States lro
another country are responsible for completing the manHesl Federal and State regulations also require generators and transporters of hazardous waste c1:nd ·
owners or operators of hazardous waste treatment. storage. or disposal facilities to complete the following information. I
1. Generator's U.S. EPA ID Number. Manllest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unic:ue five digit
(: • .. ·• number assigned to this manifest by the generator beginning wilh 00001. llyour company does not have a U.S. EPA ldentilication Number. please con:act S.C.·
t' . ., . ...., OHEC at [phone] about obtaining an Identification number. I
: :· 2:. Page 1 ol:. Enter the total number of pages used to complete this manifest. i.e .• the riist page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10186)1 plus t
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) ii any.
GENERATOR SECTION
;'" _ _, A.~ Stale Manifest Document Number: .Leave blank. · · · : •
~-·· a:• SU.le Generalor Identification Number: Leave blank. · J
: 1 Generator's Name and Mailing Address: Enter !he name and mailing address ol the generator who will manage the returned manifest !arms.
~., .... •·•· Generalor's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of
! • ~;· . emergency including nights, weekends, and holidays. · . i ~ .: ,5.':· Transport 1 Company Name: Enter !he company name ol the llrsl transporter who will transport the waste. I · ; ~ ~~ &.:. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the lirst transporter identified in item 5. c:t state Transporter's ID Number: Leave blank. · · ·
D. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent of the firs I transporter can be reached in the event or
an en:iergency_inc;luding nights, weekends, and holidays.. ... . .. ··-· ··-· . -··· . ·. · -.', · · 1·
T.. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will lranspOi-t the waste.11 more lhan 2 transporters ·
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:ing the was
· 8 •. U.S. EPA 10 Number:lf applicable, enter the U.S. EPA twelve digil 10 nuinber of the second transporter identified.in item 7.
E.. Stale Tr.anspor1er's ID Number: Leave blank. 1 : • F •. Transporter's Phone Num~er: Enter a lelepho~e number including a'rca code v.:here an authoriZed ag·enl orttlJ Second transporter can be reacr.ec int
J event ol an emergency including nights, weekends, and holidays .
. 9. Oesignaled Facility Name and Site Address: Enler the company name and site address of the treatment, storage, or disposal facility designated to receive the
wasle listed on this manifesl The address must be·1he site address, which° may dllfer lrom the m8ilin"g addresS. · · .
i ;· 'I _10.: U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment, StC?rage, or disposal lacility identified in item 9. I
.~..:~ G .. Slate Facility's ID Number: Leave blank. ·
H;. Faclllty's Phone Number: Enter a telephone number Including area code where an authorized age.ri(Of the· racility can be reached in the evenc ol an
emergency including nights. weekends, and holidays; . ' ,.. · · ·
11~ U.S: DOT Descriptions: Enter proper shipping name, hazard cla. ss and ID Number (UN/NA) for each waste as identified in 4.9 CFR l 7 l • l 7i. !I aCdi!ionat spa.
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet , • , , __ .
! . .-··. · 12.. Containers (no. and type): Enter number ot Containers !or each was le' and the appropriate abbreviation from Table I {below) lor the type ol cor1tainers.
1 TABLEI '
;
I :-
OM= Metal· drums, barrels, kegs TT= Cargo lanks (tank trucks) CM= Metal boxes. cartons, cases. roll oHs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
· oF·= Fiberboard or plastic drums. barrels, keg~ OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
t4. Unil {weight/volume): Enter the appropriate abbreviations from Table II {below) !or the unit of measure:
I
I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards. G = Gallons (liquid only)
I. Waste Number: Enter hazardous wasle numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Sucpar1s C ar.d 01
... identify the hazardous waste on each line.
J. · Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorizotion.number (from the S.C. DHEC Authorization ReQuest Form
lor each waste stream lislP.d in section 11 above. Note:· Before any hazardous waste can be accepted for treatmenl storage or disposal in South Care-I in a. the
genera1or mus! obtain prior auth6rization lrom the treatment, storage or disposal facility. I
K. . Handling Codes for Wastes Usled Above: Leave blank.
15. Special Handling lnslrucllons and Additional lnlormalion: Generators may use this space lo indicate special transportation, treatment. storage or dispo
..•• information or Bill of Lading lnrormation. For international shipments, generators must enter in this space lhe point of departure (ciry and s:ate) !or tnose
· shipments destined !or treatment. storage, or disposal outside the jurisdiction of the United Slates. · · I
~6. Generator Certillcalion: The generator must READ,.SIGN {BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used. t
· word "highway" should be lined out and the appropriate mode(rail, w.iter.or air) inserted In !he space below. If another mode in addition to tl"',e highway mod
used, enter the appropriate additional mode {e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION . · • 11: Transporter 1 Acknowledgement: Enter the name ol the person accepting lhe waste on behalf ol ihe lirst lransporter. That person must ack.nowledl
acceptance of the waste described on the manifest by signing {BY HANO IN INK) and entering the DATE of receipt. ·
18. Transport~r 2 Acknowledgement: Enler, if applicable, the name of the person accepting the waste on behatr of the second transponer. That person mus:
acknowledge acceptance ol the waste described on the manifest by SIGNING {BY HANO IN INK) and entering the DATE of receipt I
FACILITY SECTION .
19. Discrepancy Indication Space: The authorized representative of the designated facility's owner or operator must note in this space any discrepancy betwe
the waste described on the manHest and the waste actUally received at the facility. Owners and operators of facilities who cannot resolve sig:nilicant
discrepancies within l 5 days receiving lhe waste must submil lo the Department a letler with a copy ol the manifest describing the discrepancy ar.d a~em::iil
reconcile il The treatmenl slorage, or disposal laclllty mus I enter the aclual weight ~I waste in pounds in the spaces provided ii the amount varies any from t
specilied by the generator in item 1 ::S or ii the generator uses a unit ol meas11re other lhan pounds. , .
20. Facility Owner or Operator Certlllcatlon: Prinl or type th~ r1ame 01 the person accepting.the waste on behalf al the owner or operator al the lac1ltry. Thal person
must ac~nowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE ol receipt
1' ASSISTANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILITY OESrG,i•TEO t
AECEWE !HE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WE~KOAYS FROM 8:00 am TO 5:00 pm,
I South Carolina Department of Health
and Environmental Control·
Bursau of Solid & Hazardous Waste Mgt
2600 Bull Soeo\ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (603)734-542'
I LEASE PRINT or TYPE (Form desianed for use on elile f12-nitchl "'-ewriler)
UNIFORM HAZARDOUS ]'· Gene,elo,'sU.S.EPAIONo.
Form A
M11nlf11 ■1 'nl 2. Page 1 . Ooc!!menl J:o. ol
1
roved. 0MB No. 20.S0-0039 Expires 9-30-M
Information in lhe sh1ded atHJ is not
required by Federal law, but is by Stale la ...
I
I
I
I
WASTE MANIFEST N, c,, D· O· n 7, ~ o, 6, 1, J, , .. O, "' Q, ,,
3. Genera!or's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
,. Generalor's Phone I 919 I 934-9711
5. Transporter 1 Company Name
Willms Truckino Co. Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
NC 27577
6. U.S. EPA ID Numbor
1Sr C, D, O, 7, 1, 7, n. a.?.<>
8. U.S. EPA ID Numbor
0 I I O o O O I O O O I
10. U.S. EPA ID Numbor ,.
·cJStaio':t·--.,··""'' ,··.-., s·o'-='<··:;· . ,. ~-: )"· '.-"" ,,,.,,,
();'\'I:'· •·· a'Pfiono\:.,:An,/:l/;7"''11 .. ·.
"i{~"i) '.'·''··::"·'· . ··'· :«·, ,,,, ::---!i.,.);._;,,, ~:(;-·-·' ··':
cc ' < ···•· ·. / ,. ,; ;fr{'.
:':/· :·:::.-: .. : ,_,;;-·,.::;,:\_:: ;-,;;":.::>:..:::·
, s, c, D, o, 7, o, 3, 7, ' Cl 8 J~j)';i;";:~1i~1i;:·:fJt:i1 £}~::'.st&~1:1
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class. and ID Number) 12. Containers 13. Total Quantify 14. Unit CW&slll'ttaber:t
No. Type WIN~ ;=<·"\i~:/'L .<_:~,'':_-~-?l
I L ···1 ·F "'0-T' 9-'', ~ Hazardous Waste, Solid, nos ORM-E :;i 1 1 1 1 't
~ !-..'.N::;A::,_9.:..'.,l'.:'.8:..9 _________________________ _j_..J'l.. . ..l'l:l_.l'.:D'...t'T:..J-_L'L'.J..'.:. ,2.1''.:'.0-/-..'.Y_J..\:.t.l!::1 f:::::I Q:::::I Q:::::'::D:!1;!'/-l.
I i ~b_. _______________________________ _j._..1•LL'.I--.J•--i~L·L·L •. ..l'Ll----1-<:.:' :="·=··=• .. =···="=· .. =···=,.=.i~;f;;,jr
R c. ......... ,.~.,. ···-·" ,.,,
I
I
I
I
I
I
I
.:i,~1 I~
' ' ' ' ' ' ' ;; I I \j,
d.
; ' I ' 0 I '
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71460
1e. GENERATOR'S CERTIFICATION: I hereby declarelhat lhe conlents olthl3 c:onalgnmenlare lully and accurately de1crlbed ebove by proper shipping name and are cla ... ned.
packed. marked, and laheted,and are In all re:11pect:11 in proper condition for lran:11port by highway according lo app11cablo lnternelional and national goYetnment re,gvlation• ar,(I
tne laws ol the State ol South (;arollna.
111 am a largo c:ivantrty generator, I cor1ity Iha! I have e program In place lo reduce the volume and toxlcllyol waate generaled lo lhe degrN I have determined 10 be economically
prac11cabte and that I have Hlacted 1he praclieabte method of lroelmenl, :storage, or dl:11poul currently 11vaUable to me which minimizes the presonl and lvtura thrNI to l'\uma:"I
hutlh and the environment; OR, II I am a small quantity gonoralor, I hove made a good laith ertort 10 minimize my wute generation and Hlecl the bell wuta manegom•nt ~thod
that is 1v1ilable to me and that I con ollord.
Printed/Typed Name Month Day Yw
,o,.f,Z.i:;,,r,,
i 17. Transporter 1 Au-:nowledgemenl ol Receipt ol Materials /-I /
I~~ ~l~~t+lt>.cS
~ 18. Transporter 2 Acknowledgemenl of Receipt of Malerials
!Signature l /,/ , 1• · • , {\ A rt 7 ~, ·
T Printed/Typed Name ISi.gna~ure Month Day Yw
I -~-+--------------------..1...;_ _______________________ .._l·_.,_.l.._,,..__1..__---i,
F ...
19. Discrepancy lndic~tion Space
I ~,__ ______ _
;:: 20. Facility Owner or Operator; Certilication of receipt ol hazardous mnlerials covered by this manilesl excepl as noled in Item 19.
Prinled/Typed Name I Signature
PA ,a,m 8700-22 (ROY, 9/88) PteYIOUI Edition, nra Obaolate (OHEC 1988 (Rev. 10/88))
Month Dey Year
I ' I ' I '
IMPORTANT:
;Ii•,",,· .•. , ., .... ;,!q. r,s,: .. ,· 1-•.• ·•~·:1,1).
STATE OF SOUTH CAROLINA INSTRUCTIONS Fo'R UNIFO~M HAZARDOUS WAsn{ MANIFEST • , ~,
TYPE (on a 12-p;lch (e!;le) lypewdlerJ OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL •
·. CENERAL INFORMATION! Federal _Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
. storage. or disposal licililies 10 use !ho U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 and. ii necessary, th~ continua1ion sheet U.S. EPA Fo
· 8700-22A Rev:9/86 (OHEC 1988A) ior bo1h Inter-stale and lntra-st.ile tr.1nsportatlon. Transporters who transport hazardous waste into the United States Ir
another country are responsiOle for completing the manifest Federal and Stnte regulalions also require generators and transporters al hazardous waste and,
owners or operators of hazardous waste treatment, storage, or disposal fac11it1es to complete the following mformat1on.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number. Manilesl Document Number: Enter the generator's U.S. EPA twelve digit ident1f1cat1on number and the unicue t1ve d1g1
i · ' · number assigned to this manifest by the generator beginning with 00001. llyour company does not have a U.S. E~Alde_ntification Number. pl~as_e°'con:~ct S_,C_._
-·~ OHEC at [phone] about obtaining an Identification number. · ' I
· 2.:. Page 1 of:. Enter the lotal number ol pages used to complete this manifest, i.e .• the fiist page EPA Form ~700·22 Rev. 9/86 [OHEC 1988 (REV 10/86)161us :, .
[
t...n. number or continuation sheets EPA Form 8700·22 Rev. 9/86A (DHEC 1988A) ii any.
A,~: State Manliest DOcumenl Number. .. Leave blank. · · · · . :\< •.• • • • • : bi·,
·e;--Stale Generator Identification Number: Leave blank.··· · • · , I
3. Generator's Name and Mailing Address: Enter the name and mailing address ol lhe generator who will manage the returned manifest rorms .. , ...
/. .&. · Generator's Phor\e Number: Enter a telephone number wllh area code where an authorized agent ol the generator can be reached in the event ol
emergency including nights. weekends. and holidays. · " ~
5. Transport 1 Company Name: Enter the company name ol the first transporter who wili transport the waste. .•1, ·
· · 6. • U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number of !he first transporter idenlified in item 5. .
C.n.St.ale Transporter's ID Number: Leave blank. · ·
0. Transporter's Phone Number: _·Enter a telephOne number including area code where an authorized aQerit Of ttie first transporter can be reache~ in the event O!
an e"'.'ergency_inc:;ludirig nights, weekends, and holidays... ... ... ___ ··-· . -···· . '.' · :· .. ·:. . · .
T.. Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 trans;,orters 1 ·
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1_988A) continuation sheet and list the transporters in the order they will be lransoor.ing the was
8.. U.S. EPA 10 Number:lf applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
'-E .. Slate Transporter's 10 Number: Leave blank. •
F .. Transpor1er's Phone Number: Enler a telephone number including area code "".here'iin 'a\Jthor;zed aQ"~~i'OfthE! seion~'lr'ansporter can be react:ed in II
event of an emergency including nights, weekends, and holidays. · · '~ ~· -r
9.. Designaled Facility Name and Site Address: Enter the company name and site address of the lreatment, storage, or disposal lacility designated to receive the
1
:. waste listed on this manifest The address must be the site address, which· may dlller lrom thitffi"811in'g"'a'ddl'eSS~-.. --.,..,~-,-, .-· -· · i• .• • •
J. 1. 1o.; U.S. EPA ID Number: Enler !he U.S. EPA twelve digit ldenlification number of the designated treatmen!, st~'r3g~. Or Cfisposat 1acility identified in item 9 .. I
.1• . G:. State Facility's ID Number: Leave blank. · · ·
H;. Facility's Phone Number: Enter a telephone number Including area code where an authorized ag·en-1 of the· la.Cility can be reached in the-everlt of an
emergency including nights. weekends, and holidays.
11~ U.S. DOT Descriptions: Enter Qroper shipping name, hazard class and ID Number(UN/NA) for each waste as identiried in 49 CFR 171-1 ii. !I aCCi!ionat spa.
is needed, use a U.S. EPA Form 8700·22A Rev. ~/8_6 (DHEC 1988A) Continuation Sheet. "'.-~ .,..,1 ,,..,.,-,.,.,.~.,. , ••• ..,.. ...... _ •• • .-•• ~•~· • _ ,
12... Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) lor the typ~'ol co'ntainers. · . TABLE I . • ' • -.... . . . • . . . ..
OM c Metal ~rums, barrels, kegs TT= Cargo tanks (tank truc~s) CM = ... ~ .. \~1~1 ~oxes. cartons. cases;_r?ll ~(Hs ~, ... ,,
OW 11;11 Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity ol waste describe"d on each tine. relative to the units used in item 14._ ~-,,..-·-..
14. Unil (weight/volume): Enter the appropriate abbreviations from Table II {below) !or the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as speciried in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Subpar1s C ar.d]
identify the hazardous waste on each line. . ·
J .. Addilional Descriptions lor Materials Listed Above: In the spaces provided, enter the authorlzollon.number (from the S:C. DHEC·Aulhorization·AeQuHI For
for each waste stream listP.d in section 11 above. Nole: Be lore any hazardous waste can be accepted for treatment. storage or disposal in South Carc-lina. !he
generator must obtain prior authorization from the treatment, storage or disposal lacility. , · -· --~ · -~ • · · · · -J -... ~ :.-.r-, .•
K. Handling Codes for Wastes Listed Above: Leave blarik. · · -., •
15. Special Handling Instructions and Addilfonal lnformalion: Generators may use this space to indicate special transportation, lreatmenl. storage or dis DO
information or Bill ol Lading Information. For international shipments. generators must enler in lhis space the point ol departure (city and s:ate) tor tnose
shipments destined lor treatment, slorage, or disposal outside lhe·jurisdiclion ol the United States. · . • ~ .. . .,,, ,_ , .. ·
16. Generator Certification: The generator must REA0,·s1GN (DY HAND IN INK), and DATE lhecertilication statement. II a mode other than highway is used .•
word "highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. U _anothe_r. mode in addition to u·.e nig~way T,P.d.
used, enter the appropriate additional mode (e.g.,.and. rail) in the space below. · · ·
TRANSPORTER SECTION . · ,
_ ,7: Trin_sporter 1 Acknowledgement: Enter the ·nariie·of:the person ~cceP.ting the waste on behalf ol ihe lirst transporter'. That pefsOn rr:'us~·~Cknow1ed1
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering !he DATE ol receipt. •r , ,., •
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting lhe waste on behalf ol the second transporter. That person mus:
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt 1
• •
FACILITY SECTION . I ls. Discrepancy lndicalion Space: The aul_horized representative ol the designated facility's owner or operator mus·t note in this space any discrepancy betwe
the waste described on the manilesl and the wasle aclUally received al !he facility. Owners and operators ol lacilities who cannot resolve si;nilicant
discrepancies within 15 days receiving lhe waste must 1ubml1 to the Oepartmant a lener with o copy of !he manHe'sl describing the discrePancy and ar.emctl
reconcile IL The treatment. storage, or disposal lactllty musl enter the ac!Ua1 weight C!' woate In pounds In the spaces provided if 1ho amoi.,nl varies any trom r
specified by the generator in ilem 13 or II the generator us~s a unit ol mens!Jre other than pounds. . · . a
20. Facility Owner or Operator Cerllllcation: Print or type th~ name or the person accepting.the waste on be hall or the owner or operator ol the l.:1c1li1y. Tnat person ·
must acl<nowledge acceptanc·e of !he waste described on the manifest by SIGNING (BY HAND IN INK)' and entering !he DATE of receipt
I~ AS$1STANCE Is NEEDED tN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT, STORAGE. OR DJSPOSAL FACILITY DesIc:11neD I
AECE:v<. THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. .
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haz.ardous Waste Mgt.
2600 Bull StreeL Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)7l'-5"2~
I LEASE PRINT or TYPE (Form desioned for ~se on elile r12-nilchl .. ·-ewrilerl
UNIFORM HAZARDOUS 11, Generalor'sU.S.EPAIDNo.
Form A nroved. 0MB No. 20S0-0039 Expires 9.30.e,a
Manllaet
1
12. Page 1 . Document ~o.. ol l Information in the shaded a<eu is n01
required by Federal law, but is by State law.
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WASTE MANIFEST N,C,D,0,9, 7, 6, 0, b, 7, 1, , .. 0, 0, 0• ,, ,
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
,. Generalor'sPhoie( 919 I 934-9711
NC 27577
~lilf~~:~¼0\~-~;:.:tXttt:ij:;_;1~):i
-~111;~~f}~!~Jf {\:(::-;:;.:-·,, ~: l-(:'.~-~~(:)}/i}f \'.
5. Transporter 1 Company Name 6. U.S. EPA ID Number 'C/'Sta~··,.-····· ·ft 1D:(,·,/· · -··JJ,;,_: ·-._.~.-;,=-,,.,J/,': Y",':;
1-,-.-t:,.r•=:=:po=lc!!:!;.~;_2_~;_:;_mu"P"~-"~'-"~c!.:ll':s.,..;C,,.o,,,_._ -·_,Ic!.n,.,c...,_, --------'~u.S?J~L;.;1<_'L'EP-=~~l..\~!l'N-;u~-~,1.r•w71.•~ "'..;0.21-B.."..a.°'-4-~D,d ·•· •s·······.•~:,~~,~:',2/i~~:,:::; , '.'.
1 1 1 1 1 1 , , • • • , -"r:Nf···<,"-"··········.-..·'s~\~k.l\:.;,.•,.: .. :.'·' .,-,'.~•!;;..i~·iu.<,'.'·=-•1
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 3, 7, '
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity U. Unit l'W&slli tbnber'··+
No. Type Wt/Vrl -:::g~f,~_·.-··,;':)ii"_j"~ ... .{j
I ~ L Hazardous Waste, Solid, nos ORM-E _:fiF ;·orrt9·;;~
N l-.;N:..'.A::.....:9::l:.:8:..:9::._ _______________________ 4-L•·-1.'.•l:...j:D:._1.'.•T:..j..._'L'L'L:2:...,L.:O+_;Y_l,.:fl.j,::F=l::Q::1::0::1::6::1'..:'.i:.:j·.
I :TE b. -~~-j·--·---· ·~· ·-~· ... ;~-
01-----------..:....------------------.+-.J'Ll'LII-L'i-L'L'.L '.l1__j __ 1,.:'i.j ::1 ::::::::::::::::!';:;~';_j·•
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GSX Work Order No.: 71461
,e. GENERATOR"S CERTI_FICATION: I hereby declare that !he content• ollhb con•lgnm•nl ■r• fully and accuralelyde,crlbed aboYe by proper •hipping name and are cta ... flaod.
packed. marked. and labeled. and are In all respects in proper condition for lransport by highway according to applicable lntarn•llonel and natlonal go.,,ernmaru re,;ulations al">d
V'I• 1•w• ol 1he S\4.te ol South Caroline.
111 am· a large quantity generotor, I cer1iry that I haYe a program In p1aee to reduce the Yolume and to:idclty of waste genara1ed to tha dogrN I ha Ye delermlned 10 be .conomle.ally
pract1c1ble and that I ha.,,e selected Iha practicable method of treelment. :,tor age, or dlapoaal currently available lo me which mlnlmlzat the prasanl and future U'lrNI \0 hum.n
health and Iha environment: OR, 111 am a sma11 quantity generalor, I hove made a good feilh atfortto minimize my westa generation and .. lac! the b-ell w11!11 managemenl mett'IOd
trial is availat!le to me and thnl I can nllord.
I Prinled/Typed Name ,.('/ · I Signalure ,1/;_.. _ n _/ /1 _ _j_ _ Month Day Year
-+-------r--,,, ....... 3,_-e.r __ L_._C_· _"'-_ts _ _._ __ ...,;,..r~_·-...,;;r ...... -_,"'?._.___;;~~--------''-°' ... ~--'i.;;;-z.. •.• c;...?-;"-'-.1'-i
~ 17. Transporter 1 Aumowledgement ol Receipl of Materials ""
1s;gnalur~ ~ Mont:, Day Ye.u
I I I I I ' I ~ Pr;"JJ;;-:;)"J /lorr-:;;r
~~1~8~._T_ra~n~•~~~"~•~r~2~A~c_;kn_;o~w_le~d~g~•..;m~•n..;l~o~l_;R~•c~•~ip~l~o~IM=al~•~ria~l~s ___ ..,..; _________________________ _;,'-----'."."'"-'-i'
I -TRE....,_P_n_,,_ed_,_r_yp_ed_N_•_m_• ______________ ls_ig_n_•_'"_'" __________ ..;.. __________ __.M_o.,_n_111...__0._•Y__._Y_.oar-ll
F A
19. Discrepancy Indication Space
I ~1------~------~ 20. Facility Owner or Operalor; Certification of receipt of hazardous malerials covered by this manifest except as noled In Item 19.
Printed/Typed Name 'Signature I EPA Form 8700-22 (Rev. 9/86) P,evious Ed;Uons are Obsolete {DHEC 1988 (Rev. 10/86){
• I jibs.
b I jibs.
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F, I , I , ~
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Mon111 Day Year
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STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
··1.i
1··•,;,.
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL.E?.
. GENERAL INFORMATION: Federal Regulations require genP.rators and transporters of hazardous waste and owners or operators ol hazardous was1"e treatmel
s10rage, or disposal licilities 10 use the U.S. EPA Form 8700-22 Rev, 9/86 [DHEC 1988 (REV 10/86)] and. ii necesSary, th& continuation s·he_et U.S. EPA Fo
· 8700-22A Rev:9186 (OHEC 1988A) for' bolh inter-stale and intrn-slntc trnnsportatlon. Transporters who transport hazardous waste into lhe United States Ir
another country are responsible !or completing the manifest. Federal and Stale regulations also require generators _and.transporters of hazardous waste an-d'
owners or operators ol hazardous waste treatment. storage, or disposal facilities to complete the following information.
GENERATOR SECTION I
1. Generalor's U.S. EPA ID Number -Manifest DoCumenl Number: Enter the generalor's U.S. EPA twelve digit identification nuriiber and the unicue five digit
number assigned to this manilest by the generator beginning with 00001. U your company does not have a U.S. EPA Identification Number. please contact S.C .
. DHEC at (803) 734~5200·about obtaining an·ldentification number.· · I
2.:. Page 1 of:. Enter the Iota! number of pages used to complete this manifest. i.e .• the riist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/.86)1 ~lust
, • number of conlinualion sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) ii any.
A.·. State Manilest Document Number. .. Leave blank. · e: ·· Slate Generalor ldenliffcallon Number: Leave blank. I
3. Generalor's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage the returned manifest form~_.,. ..,..,..
o1 •. Generator's Photie Number: Enter a telephone number with area code where an authorized agent al the generator can be reached in the event ol ,
emergency including nights. weekends. and holidays .
. . 5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
;'. • 6.: U.S. EPA ID Number: Enler the U.S. EPA twelve digit identification number or the lirsl transporter identified in item 5. I ·c:>-Stale Transporter's ID Number: Leave blank. · ·
r.... 0 .. Transporter's Phone Number: 0Enler a teleph0ne number Including area code where an aulhorized agent of the first transporter can be reached in the even! ol
1·'.),, an e"'.'ergency in~luding nights, weekends, and holidays. . . . . ' · · ·. · ' • , · 1· 'r.: · Transporter 2 Company Name: 1f applicable, enter !he c'~mp~~y name c;; the seC7'~'d"tra,;-s·porter who wlli' tr~'n,spOrt the waste. II more !Mn 2 tr.ans;,orters .
. · . be used. use a U.S. EPA Form 8700-22A Rev. 9/86 {OHEC 1988A) continuation sheet and list the transporters in the order they will be transco~ing the was
8 •. · U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit 10 number of !he second transporter identified in item 7 .
. E .. SI.ale Transporter's ID Number: Leave blank. I
F •. Transporter's _Phone Number: Enter a telephone number including a·rca code "".here an aulhorized ~ij~nt'of 1h~ seC:0t1d transporter can be reacr:e-: int
· event ol an emergency including nighls, weekends. and holidays. · · · r ·
9. Designaled Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage.or disposal facility designatea :o receive the
waste listed on this manifest The address must be·the site address. which· may differ from the mailing address .. ,.--· -• :, . _,a; U.S. EPA ID Number: Enter the U.S. EPA twelve digit Identification number ol the designated treatment, storage. or disposal facility identified in item 9 .•
G:. Slate Facility's ID Number: Leave blank. ·
H;. Faclllly's Phone Number: Enter a telephone number Including area code where an authorized agent of the facility can be reached in the even! of an
emergency including nights, weekends, and holidays.
11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) lor each wa. ste as identified in 49 CFR 1 71-177. II aCCi!icnar spa I
is needed, use a U.S. EPA Form 8700-22A Rev. 9(86 (OHEC 1988A) Continuation $heel , ,:-. _ .~" -~ . ~, . _.
12.. Containers (no. and type): Enter number ol containers lor each waste and !he appropriate abbreviation lrom Table I (below) lor the type ol cOntainers. TABLE I . ' . .
OM c Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) .CM= Met~! boxes. cartons. cases. roll c_Hs
OW III Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF :a Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
• TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity ol waste described on each line. relative to the units used In item 14.
14. Unil (weight/volume): Enter the appropriate abbreviations !ram Table II (below) lor the unit of measure:
Table II
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P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter ha'zardous waste numbers as specified in Soulh Carolina Hazardous Waste Management Regulation R.61-79.261 Sut:ipar:s C ar.d 01
·• identity the hazardous waste on each line.
J. . Additional Deacriplions lor Materials LI sled Above: In the spaces provided, enter the aulhorization.number {lrom the S.C. OHEC Authorization Request For
for each waste stream fislP.d in section 11 above. Nole: Before any hazardous waste can be accepted lor treatment. slorage or disposal in South Carc:-lina. lhe
generator must obtain prior authorization lrom the treatment, storage or disposal facility. • • I
K. Handling Codes for Wastes Listed Above: Leave blank. (
15. Special Handling Instructions and Additional lnlormalion: Generalors may use !his space to indicale special transportation, treatment. storage or d1spo
. information or Bill ol Lading Information. For international shipments, generators must enter in this space the poinf ol departure (city and s:ate) for tnose
shipments destined !or treatment, storage, or disposal outside the jurisdiction of the United Stales. · . -• ~ , . . , I
16. Generator Certillcalion: The generator must READ,.SIGN (BY HAND IN INK), and DATE thecertirication statement. If a mode other than highwaY is uSed.
word ~highway" should be lined out and the appropriate mode (rail, water.or air) inserted In the space below. II another mode in addition to tr.e nignway r.iod . _
used, enter the appropriate additional mode (e.g .• ,and. rail) in the space below.
TRANSPORTER SECTION n: Transporter 1 Acknowledgement: Enter the name of the person accepting the wasle on behalf ol ihe first transporter. That person rr.,ust ackn;.wl_•dl
acceptance of the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgemenl: Enter, if applicable, the name ol the person accepting the waste on behalf of the second transporter. That person mus:
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt. I
FACILITY SECTION .
...
19. Discrepancy lndicalion Space: The authorized representative ol the designated facility's owner or operator must note in this space any discrecancy betwe
the wasle described on lhe manifest and the waste actUally received at !he lacility. Owners and operators ol facilities who cannot resolve significant
dl1c,epanciet w1tMin 15 days receiving the waste must submll to lhe Oepartmenta 1eller wilh a copy ol the manifest describing !he discrepancy ar.d a~em,:,11
reco~~ile it The treatment. ~!~rage, or disposal lacillty m.ust enter !he actual weight ~f waste in pounds in the spaces proyided ii the amount. varies any trom t
s0ec,l1ed by the generator 1n 11cm 13 or II the generator us~s a unil of meast1re olher than pounds. . .
20. Facility Owner or Operator Certlllcallon: Print or type th~ name ol the person accepting.the waste on behall ol lhe owner or operator or !he facrl1l'f. Th3I person
musl acknowledge acceptanc·e of !he waste described on the manifest bY SIGNING (BY HAND IN INK).and entering the DATE ol receipt 1, 0~1tTANCU 11 NUOIO IN COMPL&TION OF THIS MANIFEST, CONTACT THE T. REATMENT, STORAGE, OR DISPOSAL FACILITY OESIc:11neo I
RECEIVE THE \\'ASTE OR THE s.c. DHEC MANIFEST SECTION AT (B0:3) 734•5200 WEEKDAYS FROM e:oo nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Ha.z.ardou.s Waste Mgt.
2600 Bull Stre~it. Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (S03)7J4-5424
I PLEASE PRINT or TYPE (Form deslaned for use on ellle r12.ni1ch1 .. ·-ewrller) ·
UNIFORM HAZARDOUS 1'· Gene,ato,·,u.S.EPAIDNo.
WASTE MANIFEST . N• C• D• o, g, 7, ~. o, 4, 7,
Form A
Menlf••• 12. Page 1 Oocumer,l No. of 1
roved. 0MB No. 2050-0039 E.ipire.s 9-30-88
lnlormation In the shaded MHS is not
required by Federal law, bul is by State law. I, 4,n,n,n,7.0
I 3. Generator's Name and Mailing Address
,., Channel Master
P. 0. Box 1416, Smithfield,
4:Generalor'sPhone{ 919 l 934-9711
NC 27577
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5. Transporter 1 Company Name
Willms TruckinQ Co. Inc.
7. Transporter 2 Company Name
9. De.signaled Facility Name and Site Address·
GSX Services of SC, Inc.
Route, I Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
, S, c, o, o, 7, 3• 7, n. Q, .,, Cl
8. U.S. EPA ID Number
I I I I I I I I I I I I.
10. U.S. EPA ID Number
, s, c, D, o, 7, o, 3, 7, '
, II):/.·''
il'tioM'·i .. AO,Ln 7-'-< ,,,
. ··' jfl():'.;,,_':•,,. '.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number) 12. Containers 13. Total Quantity It Unit l'Wutll trMnber~+
No. Type WtN~ ; /':·:·/:·:/ -,j[-.' =:::)~,;::t:
L
b.
C.
Hazardous Waste, Solid, nos ORM~E
NA 9189 , ,ID ,T ; , ,2 ,0 Y
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GSX Work Order No.: 71462
,e;. CENERA TOR·s CERTIFICATION: I horobydocl•ro lhal lho contents of lhl:,c0n1ignment are fully end accuretelydoscrlbod above by proper 1hipplng n..-n• end ar• cta1 .. h.-d.
paci..od. mari..ed. and 1a·beled. and are In 1111 ro:tpecls in proper conditlon lor lranspor1 by highway according 10 appticab1a lntornallonal and national government ra,;;1.1tat1on1 af'd
trio laws 0l 1he Stale ol Soult\ Carolina.
111 am a large Quantity generator, I certily that I hava a program In place to reducatha volume and toxlcltyofwute generated lo the dogr-I have determined to be economic:.ally
pract1cab1e and that I have selecled the practicable melhod ol lrealmant. storege, or dlsposal curronlly available to ma which mlnlmLr:at tho pra,,enl and future in,-1 \0 ,....,,,,.n
haa!1h and tho environment OR, Ir I om o smoll quonUtygonorotor, I have mado o. good leith oHor1 to minimize mywute oonaretlon and select tho bo1t wuta management~"'°°
trlat is available lo me and 1ho1 I con allord,'
Printed/Typed Name l. Ll"I.. {:; I Signatu,e Montn Day Year
1 0., g'jz_., 61 ,P. 7
17. Transporter 1 A<,;1mowledgement of Aeceipl of Materials _u
Printed/Typed Name_ A Y}) , ~ 1\.-m't:.,5 ' I ~SCI N
Montn Day Yut
1 ,'6,z...6,S,7
18. Transporter 2 Acknowledgement of Receipt ol Materials I
Printed/Typed Name I Signature .Montn Day Year
·1 .. , I , I ,. I 19. Discrepancy Indication Space
:; • L.I .w....1...LJ..Jl'b,. IC b!. pt,,.
,r, pt:s.
d ~I ~ ....... ~~l't:s. i 20. Facility Owner o, Ope,aio,; Certification of rece;pt of hazardous materials covered by this manifest except as noted in /lorn 19.
Prinle-d/Typed Name I Signature
IEPA Form 6700-22 {Rev. 9/86) P,ev,ous Edl!oons ore Obsolole [DHEC 1988 (Rev. 10/86))
Montn Day Yw
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STATE OF SOUTH CAROLINA INSTRUCTIONS Fo'R UNIFORM HAZARDOUS WASTE MANIFEST. II
tMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIR~ POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
·· ·: GENERAL INFORMATION: Federal _Regulations require generators and lrnnspor1ers of hazardous waste and owners or operators ol hazardous waste treatmel
, s1orage. or dispOsal licililies to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and. ii necessary. th{:! continuation sheet U.S. EPA Fo
· 8700-22A Rev:9/86 (OHEC 1988A) loi both intcr-slale and intra-stale lr;insporlation. Transporters who transport hazardous waste into the United S1a1es tr
another counlry are responsible ror completing the manifest Federal and State regulalions also require generators and transporters ol hazardous waste and
owners or operators of hazardous waste treatment. storage, or disposal facilities to complete the !allowing information. · I GENERATOR SECTION
1. Generator's U.S. EPA ID Number. Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and !he unicue five digit
2;,
A.
a:
3.
number assigned to this manilest by the generalorbeginning with 00001. If your company does not have a U.S. EPA Identification Number. please con:act S.C.
OHEC at [phone] about.obtaining.an identification.number. . I
Page 1 of:. Enter the total number of pages used to complete this manilest, I.e., the liist page EPA Form ~700-22 Rev. 9/86 [DHEC 1988 (REV 101:s6JJ ~iu·s t
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
State Manliest Document Number: .. Leave blank. · ·
Slate Gene,ator Identification Number: Lea·ve blank. ~ · • I
Generator's Name and Mailing Address: Enter the name a~d mailing address of the generator who will maiiag8 !he returned manHest lorms. (-' .. , ., .. •• ~ >
Generator's Phorie Number: · ·Enter a telephone number with area code where an authorized agent of the generalor can be reached in the''event ol
emergency including nights, weekends. and holidays.
' 5 Transport 1 Company Name: Enter the company name of lhe lhst transporter who will transport the waste. ·1-~, . ~ ·. ·s: · U.S. EPA ID Number: Enter the U.S. EPA twelve digit idenlificalion number of the first transporter identilied in ilem 5. ~,
'• ·' c;! Slate Transporter's ID Number:, Leave blank: · _
t
O. Transporter's Phone Number: Enter a telephone number Including area code where an authorized agent of the lirst transporter can be reached in the event _or
an el"l'.'ergency_ inc;luding nights, weekends, and holidays... .. ... ··-.. _ .. , -.. ,. . . '. · · .' · ·:·. · I"·
T.. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. II more than 2 l~ans;>orters ·
be used, use a U.S. EPA Form 8700-22A Rev. 9/ 86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoor.ing the wa
8 .. U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. Stale Transpor1er's ID Number: Leave blank. ,
F .. Transporter's Phone Number: Enter a telephcin"e number including area code 'lf'.here an aUthOriie"d a~;entOftiiE! secon·d transporter Can be reached in ti
event ol an emergency including nighls, weekends, and holidays. • .. · ·: · -·r
9. Designated Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal facility designated :o receive the
waste listed on this manifest. The address must be·the site address. which· may dlller lrom the mailing idd'ress~·· -· ·-· -· ·" -· ' ·: . -
1Cl U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of lhe designated treatment. storage. Or disposal facility identified in item 9 .•
G:. Slate Facility's ID Number: Leave blank. · •
H;. Faclllty's Phone Number: Enter a telephone number Including area code where an authorized agent of the facility ciln be reached in the event or an
emergency including nights. weekends, and holidays.
11: U.S: DOT Descriplions: Enter proper shipping name, hazard class and ID Number (UN/NA) lor each waste as identified in 49 CFR 1 71 • 1 ii. II aCC:i!ionaf soal
is needed. use a U.S. EPA Form 8700-22A Rev. 9186 (DHEC 1988A) Continuation Sheet. ~. ,u ,t<~"'""'"" __ ,...,,-. . .,, . ,. . . ,
12.. Containers (no. and type): Enter number al containers lor each waste and the appropriate abbreviation lrom Table I {below) for lhe typ~ ol con1a1ners. TABLE I ' . ~ . , ,. · · r -.
OM• Metal drums, barr'els, kegs TT= Cargo lanks (lank trucks) CM= Metal boxes. cartons. cases. ro(! ~~Hs _:. _ ••
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. car1ons. cases ·
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck ·. CF= Fiber or plastic boxes. canons. cases
TP = Tanks por1abte CY= Cylinders BA= Burlap, cloth. paper or plas11c bags
13 .. Total Ouanlily: Enter total quantity al waste described on each line. relalive to the units used In item 14 .. __ ~-__ ., ·
14. Unit {weight/volume): Enter lhe appropriate abbreviations !ram Table II (below) !or the unit of measure:
Table II I
P: ?ounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liQuid only)
1. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpar.s C ar:d]
•· identity the hazardous waste on each line. ·
·J. Additional Desc,iplions for Malerials LI sled Above: In the spaces provided, enter the authorization.number (from !he S.C. DHEC Authorization Reciuest For
for each waste stream listed in section 11 above. t-k>te: Before any hazardous waste can be accepted !or treatmenl storage or disposal in South Carclina. !he
generator musl obtain prior aulhorization from !he treatment, slorage or disposal facility. ~ · ·1
K. . Handling Codes for Wasles lisled Above: Leave blank. ·, . · 1s: Speei.al Handling lnslruc!lons and Additional lnlormalion: Generators may use !his space to indicate special 1ranspor1ation, lrea1ment. storage or dis po
-· ... inlormation or Bill al Lading Information. For international shipments, generators must enter in this space !he point of depat1ure (ciry and s:ate) !or tnose
, shipments destined for treatment. storage, or disposal outside the jurisdiction of the United Slates. · •. · . . · • .. . · , .
1Ei. Generalor Certilication: The generator must REAo,·srGN (BY HANO IN INK), and DATE lhe c;:er1ilicalion statement II a mOde other than highway is used .•
word '"highway" should be lined out and the appropriate mode(rail, waler.or air) inserted In !he space below. If anothei mode in addition 10 the highway mod
used. enter the appropriate additional mode (e.g.,.and. rail) in the spa~e below. . · _.
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,TRANSPORTER SECTION \--. • \ ·, _ .1.r/·. /l . .,-·· . 11: Transporter 1 Acknowledgement: Enter thE! narr,e ol the person'3cce. piing the waste on behalf of the:lirst:tr3nspo_rter:That person rr:ust acknowtecll
, acceptance ol the waste described on lhe manilest by signing·{BY HAND IN INK) and entering the DATE al receipt · · ■
18. Transporter 2 ACknowledgement: Enter. ii applicable, the name of the person accepting the waste on behall or the second 1ranspor1er. That person rr:us:
acknowledge acceptance or the waste described on lhe manilest by SIGNING (BY HANO IN INK) and entering the DATE or receipt
FACILITY SECTION · · · J
l 9. Discrepancy Indication Space: The authorized representalive ol the designated facility's owner or operator must nole in this space any discrepancy betw
the wasle described on lhe manifest' and the waste actlially received al lhe facility. Owners and operators of facilities who cannot resolve si;nitic:an1
dlserei,ancies within 15 days receiving lhe waste must submit to the Department a letterwilh a copyollhe manilesldescribing the discrepancy and a:-::er:i;>tl
reconcile il The treatment. storage, or disposal lacility must.enter the actual weigh! ~f waste in pounds in the spaces proyided if !he amount varies .any from 1
specified by the generator in item 13 or ii the generator uses a uni! of meas11re olher lhan pounds. , .
20. Facility Owner or Operator Certllleatlon: Print or_type lh~ nameol the person accepting.the waste on behalfol lheowner or operator al the lac1l11y. Thal ::ierson ·
must acit:nowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE ol receipt
1, ASs1STANCE 1s NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSl'OSAL FACILITY oes,cns.TEO I
At:CE'1'JE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WE~KOAYS FROM 6:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Ha.urdous Waste Mgt.
2600 Bull Streel Columbia. SC 29201
Phone: (80J)734-5200
Emergency & Holidays: (803)73-C-542,
I PLEASE PRINT or TYPE (Form desioned for use on elite 112-oitchl .... ,ewriter) Form A roved. 0MB No. 20'50-0039 E.J:oires 9.30.a,a
UNIFORM HAZARDOUS 11. Generalor'sU.S.EPAIONo. 0 Ma.nlleat 2. Pagel lnlormetion in the shaded Meas is no1
WASTE MANI FEST N. C. D. 0. g' 7' ,;, O, 4' 7, 1, , .• o:co:"07'1:0:, . of 1 required by Federal law. but is by State law.
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5. Transporter 1 Company Name 6. U.S. EPA 10 Number ·cf:siaie·:r'··· ··,;II):/,-,;·.<!···.'·. ,.;.•,;o·,se.,•--.
Willms Truckin~ 'co. Inc. S, C, D• Q, 7• '• 7• n, Q, ?, Cl o:-it ·•· · · · · a'l'hon4 \,.,. 110-1/-7,; 7.i,.,,,
7. Transporter 2 Company Name
9. Oesignaled Facility Name and Site Address
GSX Services of SC, Inc.
Route, I Box 255
Pinewood, SC 29125
8. U.S. EPA 10 Number
I I I I I I I I
10. U.S. EPA 10 Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Cl~ss, and ID Number}
~ ... ~. S'IOT\ .. '.t:':.:
I I I I
12. Containers 13. Totai"Ouantity
No. Typo
U.Unit fWalll'tMubet''~·
'MN~ :-:._.;i::/: :::·-:~;:-;.~\"•,fr}
I~ .. Hazardous Waste. Solid' nos ORM-E iW• ;o,rj·g,';,_
~l-~N~A:.....:9~1~8~9:__ ____________________ ~ __ J-L'._t•l+D~t•T+.J'Ll'Ll't2~,~0+~y~~(~j•=~='=O~J=O~J=6~•~¥~··
I A
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15. Special Handling lnstructions·and Additional lnlormation
GSX Work Order No.: 71463
, 15. CENERATOR"S CERTIFICATION: I hereby declare that lhe conlentsot this con1lgnmenl are fully and accurately described above by pro~r shipping name end are e1a, .. f1ed,
pa eked, marked. and la'beled. and are in all rospeets in proper condl!lon lor lranspor1 by highway according to applicable lnlernationol and national govuriment r99uta110n, a"4
u,e la-• ol the Stale ol South Carolina.
111 am a large quanhty gericretor, I certify that I havo a program In place lo roducethevolumo and toidcltyol waste generated lo the degr-I have determined 10 be .,conomleally
practicable and Iha! I have selee1ed Iha practicable method ol lreolment. llloroge. or disposal currently available lo me which mlnlml1.01 tho pre Mn! and future U'\r-1 to l'u,1,...r,
tiealth and Iha environment; OR, 111 am a smotl quonlitygonorator, I hove modo o good loith ollor1 lo minimize mywaslo goneretlon and ,eleet the be■! ... a■ ta manaoemenl rY>9U'IOd
tl"lat is availatile 10 me and thnt I eon allord.
" •
I Printed/Typed Name e Month Day Year
r;::-tl-1~1~.~T•=•n=•=Po~n=e=r=lA~c=•=no=w=led;:ge;m::jnfltt~:1::Re:c:ei~;~ot;M:,i~~rtia~~•:i;r~-~===~~;=======~=~=~~~~~~~~=~=~~~~~~~~=============~'~0~,~•?~-~•:
7
:·~b~,.(!.-~~-;,
7
~~
.... Prinl~/Typed NamA Month Day Year
I Signature ~ ~~
I/
1 <,;;,,nature /J \ l I ~ ~L. ;...i----:JQ10:,~!;f_ <>-l>'bh'--r.tj'J'~D.M~~Lli-.:.__ ____ _::::t==~rd:J.Q&d~~~i..-.:.__ _____ Ll•Ll'-LI''L!.•-J
a 18. Transpcr1er 2 Acknowledgemerit of Receipl of Materials
C ' ~ • -~ I I .
/J f ( ~ t--,P::-n-:-.n-ted,-i::Ty_p_ed,-N-:-,-m-e--"--t-.---'--------r.cc-7'-,;,'---'------,---'t---i------------,,:-,M,-o-nlh,--:O,-a_y_Y"ear--1.
l .. ~+------------------.I.---------------------....J'....J'....J'....J'....J'....J''-l
I Sigf>tl!ure '--....,
F .. 19. Discrepancy Indication Space
I ~ f---------------~ 20. Facility Owner or Ope,alor; Certmcallon of receipt ol hazardous materials covered by this manlfesl except 83 noted In /!em 19.
· Prinled/Typed Name I Signature I EPA Form 8100-22 (Rev. 9/86) Previous Editions are Obsolote {DHEC 1988 (Rev. 10/86)1
Month Day Yw
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I\,' , . I,: T1 ·, A.;t.1: .. 1, ·:-t,·\\
STATE OF SOUTH CAROLINA INSTRUCTIONS FO.R UNIFORM HAZARDOUS WASTE MANIFEST :i
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter} OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
. / .
·~GENERAL INFORMATION: Federal Regulations reciuiregenP.rators and 1rnnsporters ol hazardous waste and owners or operators ol hazardous waste treatmel
. storage, or dispOsal licilitieis 10 use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 {REV 10/86)] and, ii necessary, the conlinualion sheet U.S. EF'A Fo
· 8700-22A Aev.-9/86 (OHEC 1988A) ror both inter-slate and intra-state trnnsportatlon. Transporters who transport hazardous waste into the United States Ir
another country are responsible !or completing the manilesl. Federal and Slate regulations also require generators and transporters ol hazardous waste and
owners or operators of hazardous waste treatmenl, storage, or disposal facilities lo complete the followrng information.
GENERATOR SECTION I
1 .. Generator's U.S. EPA ID Number. Manifest Document Number: Enter !he generator's U.S. EPA twelve digit idenlillcat1on number and the umcue five d1g11
. number assigned 10 !his manifest by the generator beginning wilh 00001. llyour company does not have a U.S. EPA ldenlilication Number. please con:act S:C.'
OHEC at (80:3) 7:34~5200.about obtaining an Identification number. I
2;. Page 1 of:, Enter the total number of pages used to_complete this manirest, Le., the first page EPA Form 8700·22 Rev. 9/86 [DHEC 1988 (P.EV 10/86)1 plus:
number of continuation sheets EPA Form 8700·22 Rev. 9/86A (DHEC 1988A) ii any. ·
A,· St.ate Manifest Document Number: .. Leave blank. · · '
e: Stale Generator ldenlHlcallon Number: · Leave blank. · · . I
3. Generator's Name and_ Mailing Address: Enter the name and mailing address ol the generator who will manage the returned manifest lorms.
•· Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the·event ol
emergency including nights. weekends, and holidays .
. 5. Transport 1 Company Name: Enter the company name ol the first transporter who will lransport lhe waste.
f." -· 6."'. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first lransporter identilied in ilem 5.
f: · ·c:'-..State Transporter's ID Number: Leave blank. · · I
1• _ • O. Transporter's Phone Number: "enter a telephOne number Including area code where an authorized agent ol the first transporter can be reached in the event or
;_) , . , an emergency including nights, weekends, and holidays. . • . . . '. ··' '' . · .
T.. Transporter 2 Co-~pany Name: II applicable, enter the cOmp~~y name Oithe se~Ori"ci"trDrl"s'POrterwho will tra·n-spOrt the waste. II more than 2 trans;:,orters I
I· be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transpor:ing the was
8 .• U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in Hem 7.
~ E .. State Transporter's 10 Number: Leave blank. .
F .. ,:ransporter's Phone Number: Enter a telephone number including a"rca code w_here an authorized agerll ofth"e SE?c0nd transporter can be reacr:ed in ti
event ol an emergency including nights, weekends. and holidays.
9. Designated Facility Na;,,e and Sile Address: Enter the company name and site address ol the treatment, storage. or disposal facility desiGnated :o receive the
wasle !isled on this manifest The address mus! be the slle address. which· may diller from the mailing address. · .
10.: U.S. EPA 10· Number: Enter the U.S. EPA twelve digit Identification number of the designated treatment, storage, or disposal facility iden1ilied in item 9 .. 1
G:. State Facility's 10 Number: Leave blank. · .
H;. Faclllty's Phone Number: Enter a telephone number Including area code where an authorized agenl of the facility can be reached in the event of an
emergency including nights, weekends, and holidays.
11~ U.s; DOT Oescriplions: Enter proper shipping name, hazard class and ID Number(UN/NA) loreach waste as identified in 49 CFR 171-1 ii. If aCCitionar spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Conlinua1ion Sheet. _ ... _ ..,,,, .. r~ _ , , . -··· •
12.. Containers (no. and type): Enter number ol conlainers lor each waste and the appropriate abbreviation from Table I (below) for the type ol co·n1ainers.
. TABLE I . -.' (__. --
OM c Metal drums, barrels, kegs TT= Cargo tanks (lank trucks) CM =_Metal box.es, cartons. cases. roll c_tfs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF·= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plas~ic boxes, canons. cases
TP: Tanks por1able CY= Cylinders_ BA= Burlap, cloth. paper or plastic :laGS
13 .. Total Quantity: Enter total quantity ol waste describe"d on each line, relative to the units used In item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) !or the unil of measure:
Table II
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P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid only}
I.· Wasle Number: Enler hazardous waste numbers as specilied in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Sucpar.s C ar:d 01
·-identify the hazardous waste on each line.
J. Additional Descriptions tor Materials Listed Above: In the spaces provided, enter the authorization.number(from the S.C. OHEC Authorization Reciuut For
tor each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted for lreatment. storage or disposal in South Carclina.1ne
genera1or must obtain prior aulhorization from the treatment. storage or disposal facility. ,.,. ·1
K. Handling Codes for Wasles Usled Above: Leave blank.
15. Special Handling lnslrucllons and Additional lnlormalion: Generators may use this space lo indicate special transpor1ation, treatment storage or d1spo
. , informalion or Bill ol Lading Information. For international shipmenls, generators must enter in this space the point of departure (city and s:a1e) tor tnose
· shipments destined for ireatmenl, storage, or disposal outside the jurisdiction of the United Slates. · . , 1·
16. Generalor Certification: The genE!rator must READ,'SIGN (BY HANO IN INK), and DATE the certilicalion statement II a mode other than highway is used,
word Nhighway" should be lined out and the appropriate mode (rail. water .or air) inserted In the space below. II another mode in addition to tr.e high~way moc::
· used, enter the appropriate additional mode (e.g .. _and_ rail) in the space below.
TRANSPORTER SECTION .
11: Transpor1er 1 Acknowledgement:. En\er !he name of lhe person·accepting the waste on behalf of ihe first lranspor1es. That person must acknowiecl:
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt. 1•• • • • -' --r'; i ■
18. T,anspor1er 2 Acknow1edgemenl: Enter, if applicable, the name of the person accepting the waste on behalf of the second transponer. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING {BY HAND IN INK) and entering the DATE of receipt. · ,, ·~ A ...
FACILITY SECTION . . . I
19. Discrepancy Indication Space: The authorized represenlative of the designated lacility"s owner or operator mus! note in this space any discreo·ancy tietwe
the waste described on the manifest and the waste actUally received at the facility, Owners and ,operators al facilities who cannot resolve si;nilicant
dlscre~ancies within 15 days receiving the waste must submit to the Department a letter with a copy of the manifest describing the discrepancy and a~emptl
reconcile it The treatment. storage.or disposal lacillty must enlerthe actual weight~! waste in pounds in the spaces proyided ii the amount varies any tram:
specilied by !he generator in item 1 :3 or ii the generator uses a unit or meas1.1re olher than pounds. . · .
20. Facility Owner or Operalor Certilication: Print or type th~ ~ame ol lhe person accepting.the waste on be hall ol lhe owner Or operator or the lac1l1fy. That person
must aci(.nowledge acceptanc·e ol the waste described on the manliest by SIGNING (BY HAND IN INKfand entering the CATE ol receipt
t, AUISTANCU 19 NB!OBO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILITY CESI0,i•TE0 I
AECEl'✓E THE WASTE OR THE S,C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 nm TO 5:00 pm, '
I .,
I
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haz.ardous Wa.ste Mi;t.
2600 Bull Street. Columbia, SC 29201
Phone; (B03) 73-4.520()
Emergency & Holidays.: (803)73"'-~24
I Dl.LlSE PRINT or TYPE (Form desloned for use on eme [12-pltchl tvnewrllerl .
UNIFORM HAZARDOUS 11. Generalor'.sU.S.EPAIDNo.
WASTE MANIFEST N,C,D,0,q,7,i;,0,1,.1, J,
Form A nroved. 0MB No. 2050-0039 Expires 9-30-e.8
.Manlfe•t 12. Page 1 lnlormetion in the .shaded Meas is not
41 ~~{)~{)71
7~0i, ol 1 required by Federal law. but is by St.ate ra ....
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~ 3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
,. Generalor'sPhonel 919 I 934-9711
S. Transporter 1 Company Name
Willms Truckino Co Inc.
7. Transporter 2 Co_mpany Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood. SC 29125
NC 27577
6. U.S. EPA 10 Number
• S • C• D• O• 7• 1, 7, r. q,'?, q
8. U.S. EPA 10 Number
0 I I I O I ' ' I 0 r I
10. U.S. EPA 10 Number
, S, C, D, 0, 7, 0, 3. 7, 5 9, & '
~i:;t~tttt-}~-~_: ::'_•··-:.:·:,·,. ()_,, .. -:
=tir=~;)ri:;}:t\.·.:-:. :::-:\::::-: _____ = -\_-:::;,_;,\:,-,'..-'-
c/Staiet ,i ro·.,,., .. • , .. , •.. m ' .. a'Pf»M)•.•:·nno '-7~7.a,,·n
'Fi.T"'''• ... ,·,.,w, .. ~i, Phonet•k,:;:/
~;,;~,:~~~~t~rirr~:;~;-;{\:::: :i-~:~tf:i;;,'.f ::i~:1~;1i).;:\:;~\1,::;.:.
11. U.S. DOT Description (including Proper Shipping Name, 1-jazard Class, and ID Number) ~ 2. Containers 1J. Total Quantity l(Ur,it
Typo wvv, No.
' ,1 D 1T . I I ,2 ,0 y
.
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d.
,·i•. 1 I I t ·~}: I I
........... ~-·-·-·--::_.,, :.~1 1-"t ,~if
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71464
1 S. GENERATOR'S CERTIFICATION: I hereby declare that the contents ollhls consignment are lullyand accurately described abov• by proper shipping t1am• at1d ar• c1a_. .. 11ed.
pacl,,ed. marked. at1d libeted,at1d are in all respects In proper condilion for transport by highway according to applicable lnternallonal and t111!1onal gov•rnm•n1 r~ulat1on1 and
ll''lfl laws of Iha State ol South t,;arollna.
If I am a large quantity generator, t cer1ify lhal I havo a program In place to reduce the volume and toxlcltyol waslegeneraled IOthe d~ree I have determined lo be economically
prac1icable and that l have selected lhe p,acUcable method of treetmenl. storage, or dlspos.al currently avallebla to me which minimizes the pres.ant and lutur• ltlrNI to h1,1mal\
heallh and !he environment; OR, ii I am a smo11 quonlirygonorolor. I hove mado a good faith er!ort lo minimize my waste generation and salecl Iha boll wa11a managem•nl metnod
thal is availaCle to me anCI thnl I con allo,d.
l l_4-_P_r_;n_t_ed_/_T_y_p_ed_N_•_m_• _ _'.l'f7~~-~~=-!:_::__~/l::'.;~!j[:_ __ j_S_;g_n_•_•u_r_• __ i,-:?.'.'.::~-~~--;:)..'-fZ. __/5__J/'~~&f!:;: _________ l.f2iJU~~ ~ AB.0.er L, L.o4,-/;s :;;-;, L& --/-:.
~ 17. Transporter 1 Ac:,-,:nowledgemenl ol Receipl of Materials v'
Month Day Year
1 0,1?', 7-00 1-r,7
Month Day. J;r _,,;,,fr u ,--; i Pdn!ed/Typhic~ /./ ,L.._e.,..,e_ I Sign•~ _ _,,/~~-
~T 1-'-8_. ,,.T.,.ra_n..;•Po....,.rt_e_r .;.2_A_ck_n_o_w_le_d"g_em_e_n_l_o_l R_e_c_e..:ip_1.;.ol_M_a_1_er_ia_1s ___ -,-,,,_ ___ , ______________________ -'-cc----::,-
~ Printed/Typed Name I Signature
I
,Month Day Yoar.
Ii-+----------'-------........_ 19. Discrepancy Indication Space
, r: ,
~T F
A
I ~ ~---------------~ 20. Facitil'y Owner or Operalor; Certiricalion of receipl ol hazardous malerials covered by this manilesl except as noted In llem 19.
Prinled!Typed Name I Signature I EPA Form 8700-22 (Re,. 9/86) Previous Edluons are Obsolole (OHEC 1988 (Rev. 10/86)!
' I
b I
jibs.
ptos. d I
Montr'I
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jibs.
pbs.
Day y..,
I ' ., '
. ' J •,,•',.'..,: I • ~ ,1 ' . <~l -~ I
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST '" I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
. GENERAL INFORMATION: Federal _Regulations require genP.rators and lrunsporters ol hazardous was le and owners or operators of hazardous waste tre~tmel
storage, or disposal ricilitil!s to use lhe U.S. EPA Form 8700·22 Rev, 9/86 (DHEC 1988 (REV 10/86)) and, if necessary, lh& continuation sheet U.S. EPA Fo
· 8700-22A Rev:9/86 (OHEC 1988A) foi b0olh inter-stale and intra-state lrnnsportatron. Transporters who transport hazardOus waste into the United States rr
another.country are responsible !or completing !he manifest. Federal and State regulations also require generators and transpor1ers cl hazardous waste ar-.d
·owners or operators ol hazardous waste treatment. storage, or disposal facilitieS to complete \he following information.
GENERATOR SECTION I
1. Gener3tor's U.S. EPA 10 Number-Manllesl Oocumenl Number: Enter the generator's U.S. EPA twelve digit identification number and the un1cue five d1g1
number assigned to lhis manifest by the generator beginning with 00001.11 your company does no! have a U.S. EPA.Identification Number, p1E!·ase con:act S.C.
--,, OHEC at (803) 73~-5200 about obtaining an identilication number. , ..., . I
2:. • Page 1 of:. Enter the total number of pages used lo complete this manilesl, i.e., the Hist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (P.EV l0l86)J i::lus:
, number of continuation sheets EPA Form 8700-22 Rev. 9/BGA (DHEC 1988A) if any. · 'L''"·~· ·A,_ Stale Manifest Document Number. .. Leave blank. ·
a:· Stale Generalor ldenliffcallon Number. . leave blank. . · 1
· I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manilesfrorms.
,. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identilied in item 5. ·I c;'· State Transporter's ID Number: Leave blank. · i .. 0 .• Transporter's Phone Number: Enter a telephOne number Including area code where an authorized agent of the lirst tra'nsporter can be reached in the event ol
:. '.i,: '. an emergency. inc;luding nights, weekends, and holidays.. . . . ' · · · , · · • • . · . '-·~· r.'. Transporter 2 Company Name: II applicable, enter the cOmp~-~y nameOithe se~O~"ci'trans·porterwho will'tra'n'spOrt the waste. II more than 2 lransporters I
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor.ing the wa
8.. U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit 10 number ol the second transporter identified in item 7.
:. E.. Slale Transporter's 10 Number: leave blank. · ·
F •. Transporter's Phone Num~er: Enter a telephone number including a·rea code w:here an aUth0.riZe'd39'E!'A't'Ofth'e SeC:Cind-iransporter can be reacr.e-: in ti
event of an emergency including nights, weekends. and holidays. . .· _ -· ,,: .. ·
9. Oesignaled Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal facility designated :o receive the
waste listed on this manifest The address must be·the site address, which· may differ lrom the mailing·address .. ,. --~ --~ -~i.·ir--· ,,. ~ ~7 ; J ·, ,Ht U.S. EPA 10 Number: Enter the U.S. EPA twelve digit Identification number or the designated treatment, storage: or disposal facility identified i.n item 9. ,
, ..... , G:. Slate Facility's 10 Number: Leave blank. · · •
H;. Facility's Phone Number: Enter a telephone number Including area code where an authorized agehl.ol the'lacility can be reached in the·event ol an
emergency rnc1udmg nights, weekends, and holidays. • _
11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identilied in 49 CFR 171-t ii. II aCCitionaJ spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sh~et. ·~ , . P• ~ ,,.-... :"'r-"-" . , ..,., ..... -~. _..., .. ~---..
_ 12... Containers (no. and type): Enter number ol containers !or each waste and !he appropriate abbreviation from Table I (below) for the type ol containers. TABLE I . •-. .-
OM a Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM =.Metal boxes. cartons. cases: rotc~Hs
OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF :c Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
•· .. TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic ~ags
13 .. Total Quantity: Enter total Quantity or waste described on each line, relative to the units used In item 14.,.., ~,.,.~;. <>r ,_., ..... ,.
14. Unit (weighl/volume): Enter the appropriate abbreviations rrom Table II (below) for the unil ol measure:
Table II
,· I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subparts C ar.d l
• identity the hazardous waste on each line. . --•
J. Additional Descriptions for Materials Listed Above: In the spaces provided, enter the aulhorization.number (lrom the S.C. DHEC Authorization AeQuest For
for each waste stream listed in section, 1 above. Note: Belore any hazardous waste can be accepted for treatmenl.. storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. -:-· I
K. Handling Codes !or Wasles Listed Above: Leave blank. ~ · ·, ,
l 5. Special Handling lnslrucllons and Additional lnformalion: Generators may use !his space to indicate special transportation. treatment. storage or dispo
. information or Bill ol Lading lnlorma\ion. For international shipmenls, generators must enter in this space the point ol departure (city and s:a1e) !or tnose
shipments destined !or trea1ment, storage. or disposal outside the jurisdiction ol the United Stales. · · · -... -. _ ·•
16. Generator Certillcalion: The generator must AEA0,·s1GN (BY HANO IN INK), and DATE the certification statement. If a mode other than highway is used.
word "'highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below.JI another mode in addition to tr-,e highway mod
used, enter the appropriate additional mode (e.g.,.and. rail) in the space below.
TRANSPORTER SECTION ,
11: Trans·p~r1er 1 Acknowledgement: Enter the name of the person accepting the waste on behalf ol ihe first transporter. That persa·n must a~,rn~wlet
acceptance of the waste described on the manifest by signing (BY HANO IN INK) and entering lhe DATE ol receipt. , · :-,,,
18. Transporter 2 Acknowledgement: Enter, if applicable, the name ol the person accepting the waste on behalf ol the second transporter. That person must
acknowledge acceptance ol the waste described on the manifest by ~IGNING (BY HANO IN INK) and E?ntering the DATE ol receipt ,
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in this space any discrepancy be1we
the waste described on the manilesl and the waste actUaHy received al the facility. Owners and operators ol facilities who cannot resolve si;nilicant
discrepancies within 1.5 days receiving the waste must submit lo the Department a lellerwilh a copy of the manifest describing the discrepancy and a~emptl
reconcile it The lreatmenl.. storage, or disposal lacillly must.enter the actual weight (!f waste in pounds in the spaces provided if the amount varies any from!
specihed by the generator in item 13 or ii !he generator uses a unit ol meas1.1re other than pounds. . ·
20. Facility Owner or Operalor Cerlillcation: Print or type th~ name ol the person accepting.the waste on be hall ol lhe owner or operalor ol the lac1hty. Thal person ·
must acl<nowtedge acceptanc·e or the waste described on !he manifest by SIGNING (BY HAND IN INK,. and entering the DATE ol receipL
"ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILITY oes,c:e .. TEO I
RECE!'✓E !HE \\'ASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WE~KDAYS FROM 8:00 am TO 5:00 pm.
' · ., rl•,i
I South Carolina Department of Health
and Environmental Control
Bureau or Solid & Ha.z.ardous Waste Mgt
2600 Bull SI/eel Columbia, SC 2'9201 Phone: [phone] Emergency A Hol;days: (803)73-4-5424
I LEASE PRll<T or TYPE (Form desinned for use on elile (12-pilchl tvnewriter)
UNIFORM HAZARDOUS 11. Generalor'sU.S.EPAIDNo.
Form Ai
Manllaal '12. Page 1 Oocumanl No. of l
roved. 0MB No. 2050-0039 E.toire3 9-lO-a.8
lnlormatlon in the shaded 11eas is not
required by Federal law, but is by State law.
I
I
I
I
I
I
I
I
WASTE MANIFEST N, c, D, 0, q, 7, ~. 0, '·· 7, 1· 4,0,0,0,7,5
3. Generator's Name and Mailing Address Channel Master
~
t:'5t~· ~GTl,lpr~••1~;~~•~~rp~l~~•o:!TI.·r•·s:•r~!1 h~IoCoo~xrnm~•up~Sll•~:k4y~9il:,,!l~a~!i':9~~:lCS:mo:!_:;:~I~-n:\c:i:;. :i:t:•::N:C::2:7:5:7:7::~~~~~~~~~~:~~~~:~~~:~:;·:]~r;•:·~ir-1}}1\j;i~i:!::.i;.;i:/i/i':~~•?~{~i.'.;~:/~i';~•·•··;~~~-~\~:'~::i:ic~:~1/=.':="~· .,. I' 6. U.S. EPA ID Number CU,iiie,t/f · · • 10 :/,.:-•· ·:.\r.•·· •. ~ :
• S• C• D• 0• 7; ~. 7• n. q, 71 ~ • DWt·····'""·, ··a•Pl>ofi.'),.;nn,,,.,,,7-'-·1111
7. Transponer 2 Company. Name 8. U.S. EPA ID Number £\iit;;.t,;;.❖:T"' · iho :\:,}.: · . .-
9. Designated Facility Name and Site Address GSX Services of SC, Inc. Route, 1 Box 255 Pinewood, SC 29125
I I I I I I • 1 I I I 1
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 3, 7, '. 9i fl '.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and JO Number) 12. Containers 13. Total Quantity I( u,;, L·w ... ,.._,_f No. Type wvv; \:.-.. .-,._:·.\' ·-'_.;\;
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71465
,e. CENERA TOR'S CERTIFICATION: I hereby declare that the conlonts olthb consignment are lully end accurately described above by proper shipping name and era c1a..,11a<1,
packed, ma,ked. and ••·baled,and are In all respocta In proper condltion for lransport by highway according to app11eabla lntarnallonal and national government r~uta1.1on1 and
ltle ta ... , ol lhe St.tie 01 South t.::arolino. •
1111m • largo Quantity gonero.tor, 1 cor1iry that I hovo a program In placo 10 roduco !he volume and 1011lcltyol wa,togenaratod lo tho dog,_ I have determlnod to~ oconomic;.ally
pracucable and that I have selected lhe pracllcabla method of lreolmanl. ,1orage, or dl,poaa1 currently avallable to me which minlml:r.1111 the proMnl and luiure trHMI to human
he a Uh and the em,ironmcnt; QA, 111 am a small quantity gonorolor, r ho.vo mado o good laith o"or1 to minimize my wasle generation and ,elac:l uio boil w811e managomenl m-eU'IOd
that is av1ilab!e to me and that l con ollo1d.
I Pr;nled/Typed Name rt? L s;gnalure .,,-7 ;, · /"J _ _L 61=~--± \:-.--:----:::,;.M:::;·,"J~er~-..,!.;.· 77.;::G~c~d.f~_;.:r-..~~\~'~N--~.;;":k..'.;E.-z:;(..h,J~:::£'.:!ilie::... ____ 12.ih.
17.'transOOrter 1 [-.c..:1mowledgement-b1 Aeceipl of Materials '\. \ U ( 'i
Month Day Yoar
1 0, p, ?..t: ,.Po
1 Pdn~lt,~;0\ <~~j\\_ \\,__ :igna\lfe\r,Zc~~ ~ ~Q'\.
o rt!r 2 Acknowledgement of Receipt ol Malerlals R
Monltl Day Year
. I /') 'l,:JJ~ I X:1
•
Month Day Yw T Printed/Typed Name Signature
.• H~ --,--------'----------'-..___. 19. Discrepancy Indication Space
T, I , I ,
·r-pt>s. F
A
I ~ 1----------------~ 10. Facility Owner or Or,,erator; Cer1ilicalion of recefpl or hazardous malerlals covered by !his manifesl except as noled In llem 19.
Prinl!d/Typed Name Signature
I EPA Form 6700-22 (Rev. 9/86) Prev;ous EdiHons ore Qbsolele (DHEC 1966 (Rev. 10166))
• lw....L.J...1.. ...
b lw....L.J...L.-'-
pbs.
l'bs.
C I I
d I I l'bs.
Month Day Yw
I , I I I '
~· ·; .
IMPORTANT:
STATE oF souTH CAA0~
1
.'NA INSTAUCTIONS·~°-~-~".'~.J~M HAZ~~~~us WASTE MANIFEST • , , I
TYPE (on a 12-pitch (elile) typewriler) OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEG I BL ·
-~ GENERAL INFORMATION: Federal Regulations requiregenP.rators and lrnnsporters ol hazardous wasleand owners or operators of hazardous waste !reatmel
. storage, or disposal licililiEis 10 use !he U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)) and. ii necess.iry;the continuation sheet U.S. EPA Fo
.· 8700-22A Aev:9186 {DHEC 1988A) loi both inter-st;ile and intra-stnlc lr.insportatlon. Transporters who transport hazardous wasle into the United States Ire
another country are responsible for completing the manHesl Federal and State rcgulalions also require generators and transporters al hazardous waste and
owners or operators or hazardous waste treat~ent, storage. or disposal facilities to complete the following information. . .. I
1. Generator's U.S. EPA ID Number -Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the umcue live. digit
number assigned to this manifest by the generator beginning with 00001. II your company does not have a u·.s. EPA Identification Number. p!ease,Con:act S.C.
DHEC at [phone] about obtaining an identilication number. · I ~ 2;:. Page 1 of:. Enter the total number of pages used to complete this manilest, I.e •• the flist page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (P.EV 10/86)] plus:
number of continualion sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
GENERATOR SECTION
1----· A.· Si.ate Manllett Documeiit Number: .. Leave blank. · · · · .. :..:.. a:· State Generator Identification Number: Leave blank: · · ,, . · ~~,·•
3. Generator's Name and Mailing Address: Enter !he name and mailing address of the generator who will manage the returned manifest rorms. · · .
•· Gene,alor's Phoiie Number: Enter a telephone number with area code where an authorized agent al the_ g~neralor can be reached in lh_!!. event al
emergency including nighls, weekends, and holidays .
. 5. Transport 1 Company Name: Enler the company name of the lhst transport.er who will transport the waste.
t' :· 6.". U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number al the rirst transporter identified in item 5.
c: State Transporter's 10 Number: Leave blank. · I
' ',.
' . ,
O. Transporter's Phone Number: 'enter a telephOne number including area code where an authorized agent al the fi;st transporter can be reache~ in the event al
an en:iergency_ including nights, weekends, and holidays. · · · ·, . · . · · ,
T.. Transporter 2 Co~pany Name: II appiicable, enter the c~mp~ny name Oi the seC7>~·d·1r.i11"s"Por1er who wili' lra'nspOrt the waste. II more than 2 trans;,orters 1 ·
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be !ranspor:ing the was
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. 8 ..
'.. E.. Slate Transporter's ID Number: Leave blank. · r • r ,,, · • --~ • • 11 ~ I
F •. Transporter's Phone Number: Enler a telephone number including a"rea code ""'.here an authorized agent al the second transporter can be react-.ed int
event ol an emergency including nights, weekends. and holidays. · •· ··•
9.. Designated Facility Name and Sile Address: Enter the company name and site address ol the treatment, ~torage, or disposal facility designated to receive the
was le !isled on this manilesl The address must be·the site ad dross, which' may di/fer lrom·the ffl8111ng ... Bddr8s-5. •· "~ ·, :
.Hi U.S. EPA ID Humbu: Enler the U.S. EPA twelve digit ldenlllication number ol the designated treatment, stor~ge, ~r _dlsp.osal racility identified in itei::i 9 .•
• ~:. Stale Facility's ID Numbe,: Leave blank. ·
H; Faclllly's Phone Number: Enter a telephone number Including area code where an authorized agent or the lacility can be reached in the·event cl an
emergency including nights, weekends. and holidays.
11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste a. s identified in 49 CFR 171 • 1 ii. II ac!c!i:icnal soal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
. ,2.·. Contalne,s (no. and type): Enter number al containers !or each waste and the appropriate abbreviation ,,om ·-rab·1e'f(below)-IO(ihre-type cl cOntainers. TABLE I , ' •·.. .. '. . = ., r •"' .
OM= Metal drums, barrels, kegs TT= Cargo lanks (tank trucks) CM= Metal boxes, cartons. cases. roll ctts
OW= Wooden drums, barrels, kegs TC= Tank cars CW= w0aden boxes. cartons. cases· '
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, c!olh, paper or plastic ~ags
13 .. Total Ouanlily: Enler 101al quanlity of wasle described on each line, relative 10 lhe unils used In item 14. . --.-· ., -
14. Unit {weight/volume): Enter lhe appropriate abbreviations from Table 11 (below) !or the unit of measure:
Table II
I
I
P 11 Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liQuid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste-Management Regul.ition A.61 • 79.261 Su ti pans C ar:d 01
; ·· .. identify the hazardous waste on each line. , •. ·
• ·J. · Addillonal Ducriplicns for Materials Listed Above: In the spaces provided.enter the aulhorizatlon.number(from !he S.C. DHEC Authorization AeQuUI For
for each waste stream listed in section , 1 above. Mole: Be lore any hazardous waste can be accepted for treatmenl storage or disposal in South Care-Jina. lhe
generator must obtain prior authorization lrom the treatment. storage or disposal lacitity. -. · · , : ~ I
K. Handling Codes lor Wastes Listed Above: Leave blank. ,, . ·
15. Special Handling Instruction, and Additional lnlormalion: Generators may use this space lo indicate special transportation, treatment. storage or dis po
information or Bill al Lading Information. For international shipments, generators must enter in this space the point al departure (city and s:a1e) !or those
shipments destined lor treafment, storage. or dispos~I outside the jurisdiction of the United Stales. · r -~ _ 1 ~--. •• ., ,.. -~-••
16. Genera to, Certiflcalion: The generator must READ, SIGN (BY. HAND IN INK), and DATE lhecertification statement. II a mode other than higriwaYis used .•
word Nhighway" should be lined out and !he apprOpriale mode(r3il, water.or air) inserted In the space below.II another mode in addition to tr.e highway.r.iod
used. enter the appropriafe additional mode (e.g.,_and rail) in lhe space below. ' :' ~ ~, '
TRAl!SPORTER SECTION . . • · • , i · / . , •
·,1: .Transporter 1 Acknowledgement: Enter ttie name al !he person accePiing the waste on behalf ol,(h·e first transporter. That_person_,rr.ust acknowlet
acceptance of \he waste described on the manifest by signing (BY HAND 1N INK) and entering the DATE 01 r'eceipt. \. ' r / • ,., ·
18. Transporter 2 Acknowledgement: Enter, if applicable, the name al the person accepting the waste on behalf al the second transporter. That person-must
acknowledge accepiance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipL
FACILITY SECTION J
19. · Discrepancy Indication Space: The authorized representative al !he designated facility's owner or operator must note in this•space any discrepa·ncy betW
u,e waste described on the manifest and tho waste actt.ialty received al the facility. Owners and operators ol facilities who cannot resolve significant
dlsc,epancies within 15 days receiving the waste must submit to the Oepartmenl a tenerwilh a copyoflhe manilesl describing lhe discrepancy and a~emotl
reconcile il The 1teatmenl storage. or disposal facilily must enter lhe actual weight ~f waste in pounds in the spaces proyided if lhe amount vanes any lrom 1
specilied by the generator in item 13 or ii the generntor us~s a unit al mensi.,re other 1han pounds. . .
20. Facility Owner or Operator Cerlilicallon: Print or type 1h~ name of !he person accepling.lhe waste on behall of lhe owner or operator ol the l.ic1l11'l;Th.Jl person
must ac~nowledge acceptanc·e ol lhe waste described on the manifest by SIGNING {BY HAND IN. INK)' and entering the DATE al receipt
'" ASsrSTANCE 1s Neeoeo 1N COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE. OR 01sPOSAL FACILITY oes1G~1.:.reo I
RECE1'✓!: THE \VASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734•5200 WE~KDAYS FROM 6:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
ewriler
1. Genoralor's U.S. EPA ID No.
N C D 0 7 0
M11nlfeet
Oocum111nt No,
1400076
P. 0. Box 1416, Smithfield, NC 27577
,. Generalor"sPhone 919 .934-9711
S. Transporter 1 Company Na_me
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
Form A
1. Page 1
of
Bureau or Solid & Haz.ardous Wute Mgt
2600 Bull Str~t. Columbia. SC 29201
Phone: [phone]
Emergency & Holiday~ (803)7:l-1-541'
roved. 0MB No. 2050·0039 E.ipire., 9.30.ga
Informs.lion in the shaded MHS is n01
required by Federal law, but is by State law.
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity t(Ur,il l'W&it.Nl.nber''·-=--
No. Type 'MN~ ::/i~-~\
a. Hazardous Waste, Solid, nos ORM-E
NA 9189 I D T
a.lE..IRJ-!0,2,71714!-!ld,0,2!~j,Jt/i11;i}c.LLJ-! I I I I !-.! I I I i)/'
b. LLJ-1 1-1 .. ·' ;j/:[@j;;;:;:;d. LLJ-1... J:L , ,JJ'.,!
, S. Special Handling Instructions and Addilional Information
GSX Work Order No.: 71466
iiF ;o1r, 9t1
·.'' ;;:<
2 0 Y ;l•E1D1Q161I
,e. GENERATOR"S CERTI_FlCATION: I herebydecl■ re lhatthe contents ol lhlscon•lgnmenl are fully end accuret,elydescrlbed ebove by proper shipping name and are clas .. tied.
packed. marked. and labeled. end are In all respects In proper condlllon lor Iran sport by highway according to applicable International and naDonat government r~u1auon1 ai"'d
U'le taw1 ol the State ol South Carolina.
If I am a 1erga quantity generator, I certify !hat I have a program ln place to re<lucethevotumo and toxlcltyolwastegonerate<l to !he dog roe I have datermlned to be economic.atty
prac11ca01e and ttlat I have se1ecled tho practicable method ol trealment. slorege, or dlspoaal currently available lo ma which mlnlmiz.u tho preMnt •nd tutu re u-i,-110 human
heallh and the environment: OR, ifl 11m e small quonlitygenorator, I h11ve mado a good laith eNort to minimize mywasta gen oration and select the t>e1t w1111a manegamant .,.,.tl"lod
trlal is available to mo and Iha! I can allord.
Prinied/Typed Name. ("r I .
r"\0.<7Jr L. l ..f)Q-;t'~
Signature
17. TranspOCIE!r 1 Ac.:1<nowledgement ol Receipt of Malerials
Prin!ed/Ty,ped Name ohn Se e,,ft-/--§
Signature
18. Transporter 2 Acknowledgemenl of Receipt of Materials
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operalor; Certification ol receipt ol hazardous malerials covered by lhis manifest except as nofed In lfem 19.
Prinled/Typed Name Slgnalure
• 1..I .w.....1....1.J.
be.;! L..U....1.....1
Monltl Day Year
0!(2..
Montn
"
M .. ontn Day Year
pbs. , r, pt:s.
jibs. d I I jibs.
Monltl Dey Year
EPA Form 6700•22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/66))
·' .-:; -~ '\
I ' ,_ t'•· ~·· -~-~ ~ . ' . ' ' .. -~ STATE OF SOUTH.CAROLINA INSTRUCTIONS FOR.UNIFORM HAZARDOUS WASTE-MANIFEST ' -~':~' ; .r:.· ,1
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
. . ~~-:~~-~; '., .
GENERAL INFORMATION: Federal Regulations require genemtors and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
storage. or dispOsal ficilities to use lhe U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)1 and. if necessary, the continuation sheet U.S. EPA For
8700-22A Rev:9186 (DHEC 1988A) foi both inter-stale and intra-state lrnnsportation. Transporters who transport hazardous waste into the United States Ira
another country are responsible for comPleting the manH,est. Federal and Stale regulations also require generators and transporters of hazardous waste and
owners or operators ol hazardous waste treatmenl. storage, or disposal racililies to complete the following inlormation. I
1. Generator's U.S. EPA ID Number -Manllest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue tive digit
GENERATOR SECTION
number assignedio this manilest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Nuri,ber. please contact S.C:
f-...... : OHEC at [phone] about obtaining an ldenhhcatlon number. · I . •;-2::. Page 1 of: Enter the total number of pages used to complete !his manilest, i.e., !he hrs! page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10l86l) plus t
: • •. number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) 11 any.
(",""" A.~ Stale Manifest Document Number: .. Leave blank.
S:" State Generalor ldentiflcallon·Number. Leave·blank. • • · · J 1-.
1 Generalor's Name and Malling Address: Enter the name and malling address ol lhe generator who will manage the returned manifest lorms.
4. Generator's Photie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol
emergency including nights, weekends. and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
6.-~ U.S. EPA 10 Number: Enter the _U.S. EPA twelve digit identification number or the lir~t lransporler identified in item 5.
C.~-Stale Transporter's ID Number:. Leave blank: · I
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol the first transporter can be reached in the evenfof •
::; an en:iergency inc;luding nights, weekends, and holidays.. ' · · · . · · . · ,
T.. Transporter 2 Company Name: II applicable, enter the cOmp~~y name Oi the seC~~·d·,ral1"s"Porter who wilfoa'nsp0r1 the waste. If m6re than 2 trans;,or1ers viii ·
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor.ing the was■
· S .• U.S. EPA ID Number:I! applicable, enter the U.S. EPA twelve digil ID number al the second transporter identiried in item 7.
1 •• E.. Stale Transporter's ID Number: Leave blank. . ...,
F.; Transporter's Phone Number: Enter a telephone number including area code ½'.here an auth-oriz'ed'ag.ent of the second transpor1er can be reacr.ec! in ti
..... ---; • even! ol an emergency including nights, weekends, and holidays. · · ! , 9.,-Onlgnaled Facility Name and Site Address: Enter the company name and site address ol the treatment, storage, or disposal facility designated to receive the
· waste listed on this manHesl The address must be·the site address, which' may differ lrom lhe mailing address."~ .,. · i • •
t:· 'I 10.: U.S. EPA ID Number: Enter the U.S. EPA twelve digit ldentfllcation number ol the designated treatment, :storage, or dlsposal rac:ility idenI1fied in item 9. I
:.;,. ,.._ ·G:. Slate Facility's ID Number: Leave blank. ·
H;. Facility's Phone Number: Enter a telephone number lncludlng area code where an authorized agenl ol lhe laclllty can bo reached in !he even! of an
emergency including nights, weekends, and holidays. . , .
11'. U.S: OOTOescriplions: Enter proper shipping name, hazard class and 10 Number (UN/NA) lorcach waste as identified in 49 CFR 171 -1 77.11 aCCi!icnal spa'
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. --.
12.. Containers (no. and type): Enter number ot containers !or each wn:ste and tho appropriate abbreviation from Tablci I (below) lor the rvPe ol co.ntainers. ·
TABLE I
OM• Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) ·CM= Metal boxes, cartons. cases. roll cHs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Woode'n boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity al waste describe"d on each line, relative to the units used in item 14. I
14:. Unir(weight/volume): Enter the appropriate abbreviations rrom Table II (below) for the unit al measure:
. Table II
P = Pounds L = Liters K:: Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (li~uid only)
I. Wasle Number: Enler hazardous wasle numbers as specified in South Carolina Hazardous Waste Mana9emenl Regulation A.61-79.261 Subparts C ar.d 01
,, .. , •• identity the hazardous waste on each line. · · · ·
· , J.". Additional Descriptions for Materials Listed Above: In the spac:e:s provided. enter !he authorizoHon.number (from lhe S.C. DHEC Authorization ReQuesl For
for each waste stream listP.d in section 11 above. Noto: Be lore any hazardous waste can be accepted !or treatmenl slorage or disposal in South Carclina. the
generator mus! obtain prior authorization from the treatment, storage or disposal lacility. I
K. ~andling Codes for Wastes Listed Above: Leave blank. · · , . ·
15. Special Handling lnslrucllons and Addil!onal Information: Generators may use this space lo indicate special transportalion. treatment. storage or dis po
information or Bill or Lading lnlormation. For international shipments. gCnerators must enler in this space _1h'.e point of departure (ciry and s:ate) !or tnose
shipments destined !or treatment. slorage, or disposal outside the jurisdiction ol the United States. ·
16. Genera lo, Certillcallon: The generator musl AEAD,'SIGN (BY HAND IN INK), and DATE thecertilicalion slatement. ll a mode other than highway is used. ti
word ~highway" should be lined out and lhe appropriate mode (rail. water.or air) inserted In the sp.ace below. II aricit~er fl1~de iri addition to t~.e hig~way moC:e
used, enter the appropriate additional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION . .
i1: Transporter 1 Acknowftdgement: Enter·the narf!e of the person accepting the waste on beha~f ol ihE!·rirst lrarisporter. That persqn rr:ust acknowledl
acceplance ol the waste described on the manilest by signing (BY HAND IN INK] and enlering the DATE of receipt. ·
18. Transporter 2 Acknowledgemenl: Enter, if applicable, the name al the person accepting the waste on behalf of the second transporter.,That person must
acknowledge acceplance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt ~~
FACILITY SECTION . . .. '•,,, I
19. Discrepancy Indication Spac:e: The authorized represenlativJ~1 the designated facility"s owner or operator must note in this space any discrepa~cy betwe
the waste described on the manifesl and lhe wasle actUnlly ~eceived at the facility. Owners and operators of facilities who cannot resolve signilicant
discrepancies wilhin 1 S days receiving the wosle must submit lo the Oepar1ment a leller with a copy of the manilestdescribing lhe discrepancy ar.d a~em::,tsl
reconcile il The 1reatmenl storage, or dlsposo1 laclllty must.enter the actual weight ~I wasle in pounds in the spaces provide~ if the amount varies any from ti":
sgeclfied by lhe generalor in item 1.3 or ll the gener.:itor uses a unit of mens11re other thnn pounds. . - .
20. Facility Owner or Operator Certlllc:atlon: Print or type lh~ name ol lhe person accepting-lhe was le on behalf ol the owner or operator ol the ,~c!l,ty. Th~t person ·
must ac:C:nowledge acceptanc·e of the waste described on the manifest by SIGNING (BY HANO IN INK) and enlering the DATE ot receipt
1111 A$~ISTANCE IS NEEDED 1N COMF'LETION OF THIS MANIFEST, CONTACT THE T. REATMENT, STORAGE, OR OJSF'OSAL FACILITY OESIG~u.TEO 1
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
. .~ .,.,, .~ ·~ • .t!#?' •;; lt-\ ~
-""'!" ~..-.
South Carolina Department of Health
and Environmental Control
(form de!i ned !or use on elite 12-itch ewriler
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N r. D 0
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name 6. U.S. EPA 10 Number
Manlfael Oocumtml No. 0 0 0 7 7
Form A
2. Page 1
ol
Bure.au ol Solid & Huardou.s Wa.ste Mgt
2600 Bull Street, Columbia, SC 29201
Phone: (BOO) 734-5200
Emergency & Holidays: (803)734-5-42•
roved. 0MB No. 2050-0039 EJ:Ckres 9.30.ga
Information in lhe .shaded ¥eas is not
required by Federal law, but is by Slate law.
l-1W!}iJ1Jl:!!m!.§s!_]TJ;r:iu!5clkJiJJn!&_J;C:.Qoc,__JIJJn!5c~. ______ _.1.iiS.l..];CL!)DLQ01..l7u1..liJlL.2Ll~U~ii:~£~~~~i;Gfii::;f:~:::f:;;~J 1
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13.TotalQuantity 1~.Unil l"WablJbubef\~·
No. Type 'MN~ \:,:-.:,.,:,;·:·•-~':\ t:;:\~<\
L
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
a.1Lili.J-!0,2171714!-!1Jl1012hi'i{;;!:'i)j);c.LL.J-! I I I I !-! I· I I I[;:;
b LL.J-, ,-, ,oo~:l!i~:;11ii1 d l+i~, .• •.. · ... -'=' ,~i!
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 71467
2 0 Y
115. Cl!:NfRATOR'S CERTI_FICATION: I horobydeclaro that the conlenls ol this con1lgnmonl •r• fuUyand accuratelydo1crlbed above by prop.er 1hlpping name al"ld are cLa•a,ft9d.
packed. ITla,kod, and labeled, and are In 11U respecls In proper condillon !or 1,iinsport by highway according to appllcabto lnlarnatlonal and nat.lonal government r~utat10n1 and
tno 1aws ol Iha State ol Soulh Carolina.
II I am a largo quantity generator, I cortity that I hevo a program In place to reduce tho volume and loxiclty ofwasta generated to !he degr-I have determined to be economically
prect1cable and th al I have seloc1ed the practicable method ol lroetment, storage, or dlspoaal currenlly evoilablo to ma which minlmiz.e• tho present and lut\Jre U"lr-1 lO l'luma:i
l'lealth and the environment OR, If I am o small Quantltygoncrotor, I hove made o good lailh oltor1 to mlnlmlz.o my waste generation and select the beat wute mana;emanl m,ett'\od
that is avaitat,le lo me and that I con ollord.
Signature -d. ~ Day Year
Signatur \ Month oa, Year d1 :::, ', cf+..-_
Printed/Typed Name Signature Month Day Year·
, 9. Discrepancy Indication Space
• I jibs. C I !rt:s.
bl jib< dj pbs.
20. Facility Owner or Operator; Cer1ilication of receipl ol hazardous materials covered by this manifest except as noled in Item 19.
Printed/Typed Name Signature Monltl Day Yoat
PA Form 8700-22 (Rev. 9/86) Previous Editions nre Obsoloto (DHEC 1988 (Rev,.10/86))
,l'f°~(._~ :·· .: ·~.: -~'"\♦,:, ,;. t , ·r • '~ · ·:--.,
STATE OF SOUTH CAROLINA INSTRUCTIONS FO.R UNIFORM HAZARDOUS WASTE MANIFEST " ' ~ ,I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter! OR USE FIRM POINT PEN -~RESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
'
·:~.GENERAL INFORMATION: Federal Aegulalions requiregenaralors aiid lro~spo~ers olhazardous waste and owners or operators ol hazardous waste treatmel
,, storage, or disposal lic:ili11es 10 use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)] and, ii necessary, Iha eonlinuation sheet U.S. EPA For
. :. · 8700-22A Rev.-9/66 (DHEC 1988A) rof bo1h inter-state an'd intra-state lrnnsJ)ortaUon. Transpor1ers who lranSport hazardous waste into the United States ho
:T ~· another country are responsible !or completing the maniresl. Federal and State regulations also require generators and lranspor1ers ol hazardous waste and
owners or operators of hazardous waste treatment, storage, or disposal lac1lit1es to complete the lollowmg 1nformahon. '
... GENERATOR SECTION
1. Generator's U.S. EPA ID Number. Manilesl Document Number: Enter the generator's U.S. EPA twelve digll identification number and the umcue five d1g1
~ ·~'' number assigned to this mani!est by the generator beginning with 00001. II your company does not have a U.S. EPA ldentHication Number, please contact S.C. ·
.~ .,.;... ·-· OHEC al [phone] about obtaining an Identification number. I ·.:. 2::. Page 1 ol:. Enter the total number of pages used to complete this manifest. i.e., lhe fiist page EPA Form ~700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)1 ~Jus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) ii any.
A.· Stale Manifest Document Number:, .Leave blank. · a:· Stale Generator ldenliftcallon Number: Leave blank: · · J
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned maniles: lorms .
.c. Generator's Phofle Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the even! al
emergency including nights, weekends, and holidays.
,5. ·· Transport 1 Company Name: Enter the company name al the first transpor1.er who will transpor1 the waste . ... . ·. · 6.:, U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification nui:nber ol the first transpor1er identified in item 5. I-I c.·._, Slate Transpor1er's ID Number:, Leave blank: ·
r-•• ~ 0 •. Transporter's Phone Number: Enter a telephone number Including area code where an authorized agent al the first transponer can be reached in the evenfor
:•'.i 1·,·; , an en:iergency.in~luding nights, v.:eekends, and holidays... .... ... .._._.,_, . -··· . _ .. •·. · ·:,, , ·:. . 1.
T.. Transpor1er 2 Company Name: II applicable, enter the company name of !he second transponer who will transport the waste. If more than 2 trans;>orters ·
• be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) contirwation sheet and list the transporters in the order they will be transoor.ing the was
8 •. U.S. EPA ID Number:1I applicable, enter the U.S. EPA twelve digit ID number of the second transporter idenlilied in item 7.
E.. Slate Transporter's ID Number: Leave blank. I F._.: Transporter's Phone Num~er: Enter a telephone number including a·r~a code Yf'.here an authO~-i~ed 'a9~~r~i\t,~· SeCOnd transporter can be reacl".ed int
r---·. event ol an emergency including nights, weekends, and holidays. ·
, 9 •. · Oesignaled Facility Name and Sile Address:· Enter !he company name and site address of the treatment, storage, or disposal lacility desii;nated to receive the
waste listed on this manifest The address must be the.slle address, which' may differ lrom the maitin"g~iddres~s. ·t1 --~, .., .. , -• • --· .
\'' ,10.: U.S. EPA ID Number: Enter the U.S. EPA twelve digit Identification number al the designated treatment, storage, or disposal lacility identified in item 9. I
·1-G:. Stale Facility's ID Number: Leave blank. · ·
H;. Facility's Phone Number: Enter a telephone number Including area code where an authorized agenl of the facility can be reached in the'" event ol an
· emergency including nights. weekends, and holidays.
11:. ~.s: DOT Descriptions: Enter proper shipping name, hazard class and ID_Num_ber(UN/NA.) for each waste as identHied. in 49 CFR 171-177. If ac'Ci:ional spa.
,s needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Conhnuallon Sheel. -=-•· _ . -•. ~ .. ,, .. ~. . .. . .
12.. Containers (no. and type): Enter number Or containers lor each waste and the appropria1E! abbreviation from Table I (below) lor the type ot co'ntainers.
TABLE I
OM= Metal drums. barrels. kegs TT= Cargo tanks (tank trucks) .CM =,Metal boxes, cartons, cases. rofl otls
OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
oF·= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
· .. ~·. TP = Tanks por1able CY= Cylinders BA= Burlap, cloth, paper or plastic ':lags
13 .. Total Ouantily: Enter total quantity ol waste describe"d on each line, relative lo the units used In Item 14.
t4. Unit (weighl/volume): Enter the appropriate abbreviations from Table 11 (below) tor the unil of measure:
Table II
I
I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons {liquid on1_y)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regu1alion R.61-79.261 Sut:par.s C ar.d DI
.. . . •. ·-identify the hazardou's waste on each line.
. J., Additional Dese,iplions for Materials Listed Above: In the spaces provided, en!er the aulhorization.number(lrom the S.C, DHEC Authorization Request For
!or each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted lor treatment. storage or disposal in sOum Carclina. the
generator must obtain prior authorization from the treatment, slorage or disposal facility. · I
K. Handling Codes for Wasles Usled Above: Leave blank.
15. Special Handling lnstrucllons and Addillonal lnlormalion: Generators may use this space lo indicate special transportation, treatment. storage or dispO
inlormalion or Bill al Lading Information. For international shipments, generators must enter in this space lhe point of depar1ure (City and s:ate) for !hose
shipments destined for treatment, storage. or disposal outside the jurisdiction of the United States. · . . I
1 16. Genera lo, Certilicalion: The gene~ator must READ,.SIGN (BY HAND IN INK), and DATE the cenillcation statement. II a mode other than highwa'f is used. I
word "highway" should be lined out and the appropriate mode (rail, water.or air) inser1ed In the space below.If another mode in addition 10 o·.e hignway mod
used. enter the appropriate additional mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION 11: Transpor1er 1 Acknowledgement: Enter.the n·;~e of the person accepting the waste on behatr ol ihe lirsl transporter. That person ·rr:ust acknowledl
acceptance of.the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt. ·
tS. Transpor1er 2 Acknowledgement: Enter, if applicable, the name al the person accepting the waste on behalf of the second transporter. That person mus1
acknowledge accepIance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy betwe
the wasle described on the mani_lesl and the wasle actt.iatly received al lhe facility. Owners and operators of lacilities who cannot resolve signiricant
dlscrei:,anc!es within 15 doya receiving the woste must submit to the Oepar1ment a leller wilh o copy of the manifest describing the discrepancy and a~em011
reconcita il The treaimenl storage, or dlsposnl laclllly must enler the actual weight ~I waste in pounds in the spaces provided ii the amount varies any lrom t
specilied by the_ generator in ilcm 13 or ii lhe generator US!JS a unit ol me.1sure other than pounds. . .
20. Facility Owner or Operator Certification: Prinl or type th~ name of the person accepting.the waste on behall of the owner or operator al the lacrlity. Thal oerson ·
must ac~nowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK}° and entering the DATE al receipt
1, A$Sr9TANCE Is NEEOEO IN COMPl.ETlON OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILITY OES!G~lATEO I
~ECE1'.'': THE \1VASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734,5200 WE!i:KDAYS FROM 8:00 am TO 5:00 pm,
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phono: [phone]
Emergency & Holidays: (603)73-1-~2•
I l»LEASE PRINT~~ TYPE (Form deslaned for use on elite [12-pilchJ tvoewriter\ Form A roved. OMS No. 2050-0039 E.Jpire! 9.30.ga
UNIFORM HAZARDOUS 11, Genorator'sU.S.EPAIONo. 00~:,.;;~~~~0 .12, Page1 1nlormalion in the shaded atHS is no1 WASTE MANIFEST N,C,D,0,q,7,~-Q,t,,7, J,4,0,0 0,7,81 of 1 requi,edbyFedo,allaw,buliobyStalolow.
I
I
I
I G e
N e
I R
A
T
0
R
I
I
I
I
I
I •
I
T
R
I ..
N s p
0 R T
5. Transp0r1er 1 Company Name 6. U.S. EPA ID Number ·cYSbie''tni';:,';~,;·10 ·-.. ... :•··
r,-. ""r~".~'"':'"'p~'-':"'es"", 2-~""o""rm,,up""~"~""iN-"~"'mo~e..sC,.,,o'-''---'I'-'n-"ce..:..,, -------'~L,-SLJ~L-',;"', ~L~!a'-~L10"'0L,Nu.1..7~Lbe..,!3L,' .1.7.w•"-,i_;q,1w?,SL.'la...4".~'f)""Y .... ·~~'.:"nt,::'~'~-~~-1~ .
I I I I I I I I . I I I I 'F)f··· ,·., ·-··· "\;c·~·'.:) .-.·.y,' .', :··.''..,~~--~ ,,-(:·• ,. "C
9. Designated Facility Name and Site Address
~SX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125 , S, C, D, 0, 7, 0, 3, 7, '
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
L
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71468
l
12. Containers
No. Type
I ,1 D ,T
I ' I
' ' '
• I I I
13. Total Quantity 14. Unit
WIN~
' ' ,2 ,0 y
I ' I I
. ' ' ' '
' ' ' '
, e. GENERA TOR'S CERTIFICATION:· I hereby daclere Iha! lhe conlanls of this consignment are fully and accuratetyde,crlbed aboYe by prop.er 1hlpping name ar,d ara c1a, .. h..:1.
packed. marked, and labeled.and are in All respects in proper condition for Ir ans port by highway according to applicable lnllunatlonal and national govarnman1 ,.,_u1at10na af'ld
tf'la Laws of the Stale ol South Carollna,
If I am a large Quantity generator, I cor1ify thal I have II program In ptaco lo reduce the volume end IOlllcltyol waala genera led lo Iha d09r-1 have delumlne,d to be .conoml(:ally
pr11c11cat1lo and !hal I have selected Iha praclicabla melhod ol lreatment. storage, or dlspoaal currently avallab1e to me which minimizes the pres.en! and lutur• uitul to l'lurnan
l'leal1h and the environment: OR, 111 am II small QUO.ntiry gonoralor, I hove mado a good lailh eNort to mlnimltfl my waste generation and salect ttia bet I .... a,111 manag11m11nt rr.tf'lod
that is availatlle to me and thnl I con nllo,d.
Pri~,1~/Typed Name L t<r (\0, (:'Y-, '
I Signature Month Day Yaat
,o.l?,z.,7,£>,7
17. Transpo'rte'r 1 At.:io:nowledgemenl of Receipt ol Materials V
Prin~l;)ped N3me ,;""""J .
/P7',#,n r ·,,_.,,, / ~~/e Monet, Cay Yur
I A,)' 1/ ,7 i.f,J
18. Transpcner 2 Acknowledgement ol Receipt of Materials
Mont:> Day Year .~ Printed/Typed Name.
,.. • I ' I '
19. Discrepancy Indication Space :: • LI .1....1....L....l-L...Jpbs. ' ILL.wLL.wlit:s. I~ 1------------b I pi,,, d I pt,,.
~ 20. Facility Owner or Operator; Certificalion of recelpl of hazardous materials covered by lhis manilesl excepl as nolod In llem 19.
Printed/Typed Name I Signature I EPA Fo,m 6700-22 (Rev. 9186) Previous Editions ore Obsololo (DH~C 1988 (Rev. 10/86))
Month Day Year
I , I , I ,
•' . ,.
,j,
~, : ,, ~(~:,1,, · ; -~-· ~,, •".'i•"'t,
, _ I•.• 1 . , ., •;~ •'i ', I
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
' 1, :
iMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD
I
ALL COPIES MUST BE LEGIBLE!
; •,.:·.GENERAL INFORMATION; Federal _Regulations require generators nnd trn~sporters of hazardous waste and owners or operators of hazardous wast_e treatmel
• s10rage. or disposal licilitil!s to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and. if necessary, th& continuation sheet U.S. EPA ~or
~ · 8700-22A Rev:9186 (DHEC 1988A) toi both inler-stnte and inlra-slatc tr;inspOrlatlon. Transporters who transport hazardous waste inlo the United States lro
anolher country are responsible for completing the manifest. Federal and State regulations also require generators and_ transporters ol hazardous wasle and
owners or operators of hazardous waste treatment. storage. or disposal facilities to complete the following information.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manilest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number. pf ease contact S.C.
OHEC at {803) 734•5200 about obtaining an identilicalion.number. -I 2.;: Page 1 of:. Enter the total number of p~ges used 10 complete thi_s manilesl, i.e., the fiist page EPA Form ~700-22 Rev. 9/66 {DHEC 1966 (P.EV 10/66ll plus:
number of continuation sheets EPA Form 6700-22 Rev. 9/66A (DHEC 1966A) if any.
A.; Slate Manifest Document Number. .. Leave blank. · · ~ .. · B: .. Slate Generator ldenliflca"tlon Number. Leave blank. . . J
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned maniles! forms. · ·
. 4. Generator's Phone Number: Enter a telephone number wilh area code where an authorized agent of the generator can be reached in !he event or
· · emergency including nights, weekends, and holidays.
·:. 5., Transport 1 Company Name: Enter the company name of lhe first transporter who will transport the waste. I· ,• :'" 6.:;.: U.S. EPA ID Number. Enter lhe U.S. EPA twelve digil identification number of the first transporter identified in item 5.
C.' · Slate Transporter's 10 Number: Leave blank. · ·
••• 1 D. Transporter's Phone Number: 'enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the evenfot
:!-.~·:, anen:,ergency.ln~luding nights,weekends,andholiq~ys... . ... ... ..-···-· ,-.... . . ,_;·.:· . .'. . 1. -·::--T.. Transporter 2 Company Name: If applicable, enter !he company name of the second transporter who will transport the waste. H more than 2 transi,'.)orters w ·
, . - . be used, use a U.S. EPA Form 6700-22A Rev. 9/66 (OHEC 1966A) continuation sheet and list the transporters in fhe order they will be transpor:ing the was·
8 .. U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number ol the second transporter identiried in ilem 7.
1 E .. Slale T,ansporter's ID Num~er: Leave blank. •
1"' F •. Transporter's Phone Number: ~nter a ietephoiie number inclu9ing a·rca code "".here an authorii:ed aQell't'~fih'e Second transpor1er can be reacr:ed in ti
event of an emergency including nights, weekends. and holidays. .-
9.. Designated Facilily Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal lacility designated tO receive the
waste listed on this manifest The address must be !he site address, which· may differ lrom the mailing addres·s. • · ·-.
I; ' 10.:
._:; .. G:.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storag~. or disposal lacility identified i~ item 9. I
State Facility's ID Number: Leave blank. ·
; ,t
H;. Facility's Phone Number: Enler a telephone number Including area code where an authorized agenl of the lacility can be reached in the event of an
emergency including nights, weekends, and holidays.
11: ~.s: DOT Descriptions: Enter Qroper shipping name. hazard class and m.Num.~er(UN/NA) for each waste as identified in 49 CFR 171-17i. H aCdi:ional spat
,s needed, use a U.S. EPA Form 8700-22A Rev. 9/66 (DHEC 1966A) Contrnuat1on Sheet. .,., . ,:-.-... ~-. . , • . , .. _
. 12.. Containers (no. and type): Enter number ol containers lor each waste and the appropriate abbreviation from Table I {be1ow}_lor the type ol co_ntain'ers.
TABLE I
OM a Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) . CM =.M~tal boxes. car1ons. cases. roll q_Hs
1· OW a Wooden drums, barrels, kegs TC= Tank cars ·cw= Wooden boxes. cartons. cases
OF'= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
:1
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: Enter lotal quantity ol waste describe"d on each fine, relative to the units used In item 14. ,.
14. Unit (weighl/volume): Enter the appropriate abbreviations rrom Table II (below) for the unil of measure:
Table 11 I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous.waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Sub para C ar.d 01
· ···identity !he hazardous waste on each tine. •
J. · Addilional Descriptions tor Materials Listed Above: In !he spaces provided; enter the aulhorizalion.number (rrom the S.C. OHEC Authorization ReQuest For
for each waste stream tistP.d in section 11 above. Nole: Be lore any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. !he
generator musl obtain prior authorization from the treatment, storage or disposal lacility. -• J
K. Handling Codes !or Wasles Us led Above: Leave blank.
15. Special Handling lnslrucllons and Addillonal Information: Generators may use this space to indicale special transpor1ation. treatment storage or dispo
•. information or Bill of Lading lnlormalion. For international shipmenls, generalors must enter in this space the point ol departure (city and s:aIe) for tnose
· shipments destined !or treatment. storage, or disposal outside the jurisdiction ol the United Stales. · . I
16. Generalor Certiflcallon: The generator must AEAO,'SIGN (BY HAND 1N INK), and DATE the certification statement. ir a mode other than highway is used. t
word "'highway" should be lined out and the appropriate mode(rail, water.or air) Inserted In !he space below. II another mode in 8ddition 10 the highway mode
· used, enter lhe appropriate additional mode (e.g.,_and rail) in the space below .
. TRANSPORTER SECTION . . ·
11: Transporter 1 Acknowledgement: Enter the name ol lhe Person·accepting lhe waste on behall al ihe lirst lransporter. Thal person must acknowledl
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE ol receipt. ·
18. Transporter 2 Acknowledgemenl: Enter, ii applicable, the name of the person accepting !he waste on behall of the second transporier. That person mus:
acknowledge acceptance ol the waste desc[ibed on the manilcst by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative ol the designated lacility"s owner or operator must note in this space any discrepancy beIwe
the waste described on the manifest and the waste actUal1y received at !he facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 d?YS receiving the waste musl submit to the Department a le!ler with a copyol the manilest desc.ribing the discrepancy ar.d a~emotsl
reconcile iL The treatment. storage, or dlsposnl facillly must enter the actual weight (!f waste in pounds in the spaces provided if the amount varies any !rom 1
specilied by the generator in item 13 or ii the generator uses a unit ol meas\lre other than pounds. . . .
20 .. Facility Owner or O'peralo~ Cerlillcallon: Print or type th~ rlame of the person acceP1ing-lhe was le on beha1I ol the owner or operator ol the l.lcil1ty. Th.lt person ·
must.acknowledge acceptance ol the wasle described on lhe manifest by SIGNING (BY HANO IN INK).and enlering the DATE ol receipt
1, A$S19TANCE IS NEEOEO IN COMPl.ETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILITY OESIG~J:.TEO 1
AECt:11 •1: THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEf;:KOAYS FROM B:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Ha.z.ardous Waste Mgt.
2600 Bull Stree~ Columbia, SC 29201
Phone: (BOJ) 734-5200
Emergency & Holidays: (SOJ)l:34-5424 I '.-'~E PRIHT or TYPE {Form desioned for use on elite r12-oilchl tvnewriter)
I UNIFORM HAZARDOUS I'· Genorator'sU.S.EPAI0No.
Form A nroved. OMS No. 2050-0039 E.Joires 9-30-aa
Manllest _ I 2, Page 1 Information in the shaded IM'HS is no1
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WASTE MANIFEST N, C· D· O· a, 7, ~-n, 6, 7, l• 1 .• i~c{)~(t ~~al ot 1 required by Federal law, bu! is by State la•.
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
4. Generator's Phone( 919) 934-9711
NC 27577
5. Transponer 1 Company Name 6. U.S. EPA ID Number C3:sfiie' · 11 to·-:· · .-:... • ··
1-7-. _Tl,J:.:.,a:.~:.:o-=~"';"',~'-2~~'-:'-:"o""~-"~"'~"-:'-':"-,-'C"o".,_ -..,Ia.:.n,_,c~.,_ ______ _.:..,_s.,;~'-;"_:L,EP-"D;,_1..,~"''N~:'-'~-~.,_r•'--'7,._•= n.~o."-.,__"A. °'--4-~:;:;,D<if .~: i ~~:'.'An, 1,.7 f, 7"" ~, ''.
I I I r r I I I I I I ' F/f·• .. .,,.-.,. ~l'iffl,.>;·_ ... ·,,.c,,.,,.,,_,',C•~,,_-·•
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 3, 7, 1
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number) 12. Containers 13. Total Quantity 1(Unil l'W&'StaNl.dbefC··~f·
No. Type WIN~ ,·.-•.•:->'.·.,'> <i.f\
I:. a. ·::il·F ·i·Crt1··~:.g\·~ ~ Hazardous Waste, Solid, nos ORM-E ;~{ . -:.:.
~~_;N::;A~::_9.:.1.::8::_9 __________ ~--------------+.J'L . ..J'~l+D'....~•T:.+-L'L'.l..'.:'2.l'.::'.O+_;Y_l.:':!.1!::lf:::::ID:::::i::D::l::6::!12:f-l'
' ... " ... ·.,: . ' .... , .
I~ b. :j , •R,
I I I I O I O . _ _., 1> ol-----------------------+-1-1--t-Lt_L.Llc....L--t--J.;::.:::::==:==!;:.j
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1 S. Special Handling Instructions and Additional lnlormalion
GSX 1,Jork Order No.: 71469
, e. C£MERATOR'S CERTIFICATION; 1 h11r11bydoclar11 lhlll the contents ol this con,ignmenl .,. fully end 11ccur11telydoscrlbed 11bov11 by proP4r 1hlpp!rig name lll"ld .,. c111, .. t1..:1.
packed. marl<&d, and la.be1ed, and are In all rospecls in proper condition lor transpor1 byhlghway according to applicable lnlematlonal and national gov.rnment r~ulauona al"d
tl'le ta .... , ol 1h11 State of Soult\ Carolina.
II I am a largo quantity ganerntor, I certify thal I have a program In place to reduce the volume and toxlcltyofwaslegonaraled lo tho dO';,lr-I have determined to be economic.ally
prect1cable and that l have selecled the practicable method 011,eetment. storage, or dlsposal curran!ly available lo ma which mlnlmizn the pruonl and h.Jt\Jra u·uoat to r11.1m.an
health and The environment; OR, if I am a small qu.anlitygonorotor, I hove mndo a good faith ollor1 lo minimize mywasto generation and :,elect the bot I wuta manar;iemenl n-i.thod
l1"1at is availatlla to me and that I con allord.
Printi,d/Typed Name I
'P'l()o._G',C
T t,.;.._ Tr~ nsporte,_10.t:Know1edCUH'11"ent ol Receipt of Materials
Signature
" -\
Month Day Yw
, o, /TrZ..,7 .~.7
A Montn D1y Yur
1A,~Qi1 ir;l I ~ P,ir ed/Ti~ed Na"(\ \ \ ~ \. f"'..\-. " 'e• ~ \ \
o 18. Transporter 2 Acknowledgement of RecEiipf"'OI Materials R~:...:.c==:::..::..:.:.:::::::::::::=========....:..-~-----------------------------~ .
T Printed/Typed Name Signature Month Oay Yw
I Re+----------------1..------------------~..,_..,_t....L-'---t -I· I I ' I '
19. Discrepancy lndica!ion Space
F • IL.L..L..l-L.L.JJ!bo. ,i-~.• ~~~l't:o.
"
I~~-=-::,-=---=--__,,-,,,.....,,...-~ 20. Facility Owner or Operator; Certilicallon ol receipt or hazardous materials covered by !his manifest except as noled in 11am 19.
Printed/Typed Name Signature
bl pt:o.dlr pt,,.
Montn Day Year
I tPA Form 8700-22 (Rev. 9/86) Previous Editions ore Obsolete fDHEC 1988 (Rev. 10/861!
I , I ' I '
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STATE OF SOUTH CAROLINA INSTRUCTIONS F6R UNIFORM HAZARDOUS WASTE MANIFEST. I
IMPORTANT: TYPE (on a 12-pilch (elile) lypewriler] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal _Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
SIOrage, or disposal licilitiCs to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 and. ii necessary, th& continuation sheet U.S. EPA For
B79<)-22A Rev: 9186 (DHEC 1988A) loi both inler-slale and inlra-slale tr.insportatlon. Transporters who transport hazardous waste into the United Slates lro
another counlry are responsible for completing the manifest Federal and State regulations also require generators and transporters at hazardous waste and
owners or operators or hazardous waste treatment, storage, or disposal facilities to complete the !allowing information. . . I
1. Generator's U.S. EPA ID Number -Manllest Document Number: Enter the generator's U.S. EPA twelve digit identilicalion number and the umcue ftve drg1!
number assigned to thismariilest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:act S.C .
. .., OHEC at {803) 734-;5200 about obtaining an ldenlilication number. I
GENERATOR SECTION
2;·. Page 1 of:. Enter the total number of pages used to complete this manilest, i.e., the Hist page EPA Form ~700·22 Rev, 9/86 (OHEC 1988 (P.EV 10/86)1 plus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) H any.
A.. State Manifest Document Number: .·.Leave blank. · ·
B: · State Generator ld.enlifJcallon Number. Leave blank. . J
3. Generator's Name and Maillng Address: Enter the name and mailing address of the generator who will manage !he returned manifest lorms... _
.-. Generator's Phor\e Number: Enter a telephone number with area code where an authorized agent al the generator can be reached in the even! ol
emergency including nights, weekends. and holidays.
5. Transport 1 Company Name: Enter the company name of lhe first transport.er who will transport the was.le.
· . 6 •.. ~ U.S. EPA ID Number: Enler the U.S. EPA twelve digit identilicalion number ol the fir~! lransporter identified in item S. I C. Slate Transporter's ID Number: Leave blank. ·
0. Transporter's Phone Number: 0Enter a telephOne number including area code where an aulhorized agent of the lirsl transporter can be reached in the event'ol •
··'.i •. · an en:,ergency, inc;luding nights, weekends. and holidays. . . . · . · : · ·, · . · · · , ·
T.. Transporter 2 Company Name: II applicable, enter the c'Ompilny name Oi !he seCOri'd"tra.i"S:"Porier who wm"tra'nsp0r1 the waste. II more than 2 transporters wlli ·
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in lhe order they will be transoor:irig the was.
8 .. U.S. EPA ID Numbed! applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. Stale Transporter's ID Number: Leave blank.
F •. Transporter's Phone Num~er: Enter a·tetephone number including a·rca· code w_here an authori~ed age~t ofih~ s~C'ond.transporter can.be reacr.e~ in ti
event ol an emergency including nights, weekends. and holidays. · ·
9. Oesignaled Facilily Name and Site Address: Enter the company name and site address of the trealment, storage, or disposal lacility desii;nated to rece_ive the
waste listed on this manilesl The address must be·the sile address. which· may differ lrom the mailing address-:·' . .
, )0.: U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage~ or disposal lacility identilied in item 9. I
G:. Slale Facility's ID Number: Leave blank. · · • · • · ' · ·
H;. Facility's Phone Number: Enter a telephone number Including area code where an authorized agent of the facility can be reached in the'event ol an
emergency including nights, weekends, and holidays.
11: U.S: DOT Descriptions: Enter proper shipping name. hazard class and ID Number{UN/NA) for each waste as ide.ntilied in 49 CFR 171 • 177.11 aCCi:icn.aJ spal
· ·is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. • ~ ,-, ~-_ . ~ . . r
12.. Containers {no. and type): Enler number or containers for each waste and the appropriate abbreviation from Table i" (be.low) lor the rype ol con1a1ners. ·
TABLE I • '
OM= Metal drums, barrels. kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons, cases. roll ctts i--~1
OW a Wooden drums, barrels, kegs TC = Tank cars CW = Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or p!as11c bags
13 .. Total Quantity: Enter to!al quantity ol waste describe"d on each line, relative 10 the units used In item 14, . . I
14. Unit (weight/volume): Enler the appropriate abbreviations from Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liQuid only)
I. Waste Number: Enler hazardous waste numbers.as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subpar-:s C ar:d 01
"~identify the hazardous waste on each line.
J. Addilional Oucriplions tor Materials Listed Above: In the spaces provided. enter the authorization.number (lrom the S.C. OHEC Authoriza!ion Reciuest For.
ror each waste stream Jis!P.d in section 11 above. Nole: Belore any hazardous waste can be accepted for treatment. storage or disposal in South Carr:,lina.1he
generator must obtain prior authorization from the treatmenl, storage or disposal facility. .. i •_
K. Handling Codes for Wastes Lisled Above: Leave blank. ·
1 S. Special Handling Instructions and Addillonal lnformalion: Generalors may use !his space to indicale special lransportation, treatment. storage or d1spo
inlormalion or Bill or Lading Information. For international shipments, generators musl enter in this space !he point or departure (ciry and s:a1eJ tor those
sl"lipments deslined !or treatment. slorage, or disposal oulside the jurisdiction of the United Slates. · . . ... 1 16. Generalor Cer1inCalion: The generator must AEAO,·SIGN {BY.HANO IN_INK), and DATE lhecertificalion statement. II a mode other than l"lighway is used;: .·
word ""highway" should be lined out and lhe appropriate mode {rail, woler. or air) inserted In the space below. If another mode in addition lo tl",e highway mode
used. enter the appropriate additional mode {e.g.,.and, rail) in the space below. .
TRANSPORTER SECTION . . , . · . , . ~ , '
11: Transporter 1 Acknowledgement: Ente/ttle na~'e·o, the person actepling !he ~asle on behalf ol ihe lirs_t lransporter:~That person rr.u'st ~cknowledl
acceptance of the waste described on lhe manifest by signing (BY HAND IN INK) and entering the DATE of receipt. •
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalr of the second lransporter. That person mus;
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE of receipt
FACILITY SECTION' ' ' . I
19. Discrepancy Indication Space: The authorized representative of the designated racility's owner or operator mus! note in this space any discrepancy betwe
ll"le waste described on the manifest and !he wasle ;_ictUalty received at the facility. Owners and operators ol facili!ies wh~ cannot resolve sii;;nilicant
discrepancies within 15 d.Jys receiving the wnsle must submit lo lhe Department a letler with a copy ol the manifest describing the.discrepancy ar.d a::emotst
reconcile il The 1reatment s1orage, or disposal lacillty must.enter the ac!uat weight ol waste in pounds in !he spaces provided ii the amount varies any from 1
specified by !he generator in item 13 or ii the generntor uses a unil of mcas11re olher lhan pounds, , .
20. Facility Owner or Operator Certillcation: Prinl or type th~ nameol the person accepling-lhe waste on behalf of the owner or operator of !he I.Jc1l1ty. That person
must acknowledge acceptanc·e or the waste described on the manilest by SIGNING {BY HANO IN INKf and entering !he DATE or receipt
111' ASSISTANCE IS NEEOEO 1N COMPLETION OF THIS MANIFEST, CONTACT THE TRE.ATMENT, STORAGE, OR DlSPOSAL FACILITY 0&$1Cfu,TEO 1
n@Cf!!V!! THE \','ASTE OR THE S.C. OHEC MANIFEST SECTION AT {803) 734-5200 WEEl{".!AYS FROM 8:00 am TO ~:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haurdous Wa,:e Mgt.
2600 Bull Street. Columbia, SC 2'9201
Phone: (803) 7:l-<-5200
Emergency&. Holidays: {603)734-5424
I LEASE PRINT or TYPE (Form desioned for use on elite r12-oltehl fvnewrilerl
UNIFORM HAZARDOUS I'· Gonora!o,'sU.S.EPAIONo.
Form Ai oroved. 0MB No. 2050-00J9 E,ipires 9.30.a,a
ManLfoa1 I 2. Page 1 Information in lho shaded MOU is n01
I, 4. O~O~Q~1Si0n I ol 1 required by Federal law, but is by State ra ...
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WASTE MANIFEST N, c, o, 0, q, 7, 6· O, 1• 1,
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
4. Generalor's Phone I 919 \ 9 34 9 711
5. Transporter t Company Name
Willms Truckino Co. Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and.Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
NC 27577
6. U.S. EPA ID Number
S • C, D• 01 7• 1r 7• n, Q, ?, Cl '
8. U.S. EPA ID Number 'c;n:..--::-.:..'❖:,,~·"'"·'··~-'··., -.-·.,;t;>>·' i .-,_;_ , ... .-, .. : ,·::: ;-,· : ... ~·,._
, • , , , • , 1 , 1 1 'F;\'.:f""'•'·• •'••·•:•,·5·1:..:;.'".:.;.,,\.:·'·'
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 3, 7, ~ 9, B
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14.Ur,it l'WU!liNl.nbw"-"·
No. Type WVV~ ,.. . . . ·,\·.','"., ·_,:/:.(:~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71470
1 e. GENERA TOR'S CERTIFICATION: I herebydoc1Dro lhel the co"tonl9 ol lhl:, con•lgnment are lullyend eccuretely described aboY• by proper ahlppl"g nam·• and are cla ... lled,
packed. marl<od, and 111:beled,a"d are In all respects In proper condition for transport by highway according to applfcabla lnternallonal and natlonal governmen1 re,c;uletlol'la aNI
u,e laws of the State of Soultl Caroline.
111 am a large quantity generator, I certify thal I haYe a program In place lo reduce thaYolume and 10,dcltyol wastegoneralod 1othe degree I have determined to be economteally
prec1,cable •"d that I hava selected tho practicable method ol 1realmant.; storage, or dlsposal currently avallabla to mo which mlnlml:ta1 tho pr a Mn! anC'l lul\.lre 11'\rul l0 hum&ri
healtn and the enYitonmcnl OR. if I am o small quonlitygonorator, I hoYo modo o good faith effort lo minimize my waste goneretlon and select the boll wa1:a mana;ement matnod
mat is availabla 10 me and tho1 I con allord.
IL...,+--Pr.J,~:..t7ed.l.!..~.ilT;.,,'!p,led _-'_:.t:N_• _m_•_:~::,.:,_.l,. /1...!;Jl..:!.~4.·..:...cl.------J_s_ig_n_•'_"'_•_. _.!.,.£..:;/,"'9 -~:i.,;_..:;.:::..; --'.__;:;;;/1::..::::::::a: Laa.. _____ ..1.M::onJ.lh~..:D:la"'y~:..yJ...,1-,l r r,, "1.,,.,.. I ?\O , , l~•· -:::::Z L.8~ ,cJ,[?;7,7,/r,7
T 17. Transoo'rt.e'r 1 Al:Knowlc<fgemcnl of Receipt ol Malctials U RI----'-----'-~'--'--'---'----'----~---------------------------------~
I ~ Printe<j/Typed Name · ~aturo i ~ %1!>.,.C,,, .-.. • .,. ... L. '-~-, .
o 18. Transparter 2 Acknowledgement of Receipt of Materials , "\. Rr-:-:'.,..:.C.~=-==========---.,,:--,-----'"=l--------------7-,---::,--;:--i
I ~i-+--Pn-·n-:eo_,_ry_p_ed_N_•m_, _______ c.... _____ _,l_s_ig_n_•'_"'_· _____________________ _._...,__._,_,._.,_-t
19. Discrepancy Indication Space
Mon:, Dat Ye.ar
, o,Q, ,2, ')r&,'l -
F
.
Monl.ll Day Year
i . I ' I ' .
' I I I I I I l'bs. ' I I I I I I l1to.
It •1---------------~ 20. Faciri~ Owner o, 01'eralor: Certificalion of receipl of hazardous materials covered by !his manifest excepl as noted In /lem 19.
1 Printed/Typed Name 1 Slgnalure
EPA Form 8700 22 (Rev. 9/86) ~revious Editions aro Obsololc, [DHEC 1988 (Rev. 10/86)1
bl I I I I I l'bs. d I I I I I I l'bs.
Monl.ll Dey Year
I . I . I .
·l•t. 1
IMPORTANT:
•r ,., . ;_• A.
STATE OF SOUTH CAROLINA INST~
1
~•~~•IONS Fo'R UNl~O~M HAZAROOUS WASTE MANIFEST ,, . J
TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL ·
·: GENERAL INFORMATION: Federal _Regulations require generators and trn~sporters of hazardous waste and owners or operators ol hazardous waste treatmel
. storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 {OHEC 1988 (REV 10/86)1 and, if necessary, the continuation sheet U.S. EPA For
· 8700-22A Rev.-9/86 (DHEC 1988A) foi both inter-state and intra-state lrnnsportation. Transporters who transport hazardous waste into the United States lro
·• another country are responsible !or completing the manilesL Federal and Slate regulations also require generators and transporters ol hazardous waste and •.
owners or operators ol hazardous waste treatmenl. storage. or disposal fac1h1tes to complete lhe rollow1ng mrormauon.
GENERATOR SECTION I
1 •. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the umcue live d,g,
· number assigned to this manifest by !he generator beginning with00001. lfyourcompany does not have a U.S. EPA Identification Number, please contact S.C.
DHEC at [phone] about obtaining an Identification number. • · I
_ 2.;. Page 1 of:. Enter the total number ol pages used to complete this manifest, i.e., the liist page EPA Form ~700-22 Rev. 9/86 (DHEC 1988 (REV 10186)] i:rus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A. Stat• Manifest Document Number: .. Leave blank. · ·
a: State Generator ldenliflcatlon_Number:· leave blank. J
3. Generator's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage the returned manifest rorms .
.c. Generator's Phone Number: .Enter a telephone number with area code where an authorized agent ol the generator can be reached in !he event ol
emergency including nights, weekends, and holidays .
.t .5. Transport 1 Company Name: Enter the company name of the first transport.er who will transport the waste. I 6.:, U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the fir~! lransporter idenlHied in item 5. .
c:· Slate Transporter's ID Number:, Leave blank: ·
, D. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of !he first transporter can be reached in the eveniol
·i~~-. an emergency,in~ludiiig nights, weekends, and holidays.,, ... ... ..-··-· -·-· . . '. · ·:, .. ·. •.
":;:,. T.. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 trans;,orters w ·
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transport'ers in the order they will be transpor:ing the was•
8 .. U.S. EPA 10 Number:lf applicable, enter the U.S. EPA twelve digit ID number ol the second transporter ident[fied in item 7.
LE.. Slate Transporter's ID Number: Leave blank. . . . .
1 F .. Transporter's Phone Number: Enter a telephone number including a'rea code v.:here an a~th~rized agent of1he secClnd transporter can be reached in ti
event of an emergency including nights, weekends, and holidays. ' •
9. Designaled Facilily Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be the slle address, which.may dUfer lrom the mailin·g•.iddress. · · .·
Ht U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number or the deSlgnaled treatment, stor~ge, or disposal facility iden1ilied in ite,:n 9. I
• G:. State Facility's ID Number: leave blank.
H;. Facility's Phone Number: Enter a telephone number Including area code where an authorized agent of the facility can be reached in the·even1 ol an
·emergency including nights,' weekends, and holidays.
1,: U.S: DOT Descriptions: Enter Qroper shipping name, hazard class and ID Number(UN/NA) for each waste as identified in 49 CFR 1 71 -1 ii. If aCCi.:ion.al spa'
is needed. use a U.S. EPA·Form 8700-22A Rev. 9/86 (DHEC'1988A) Continuation Sheet.··
1~. Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) lor the type ol CO_!"ta1~ers.
TABLE I .
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll oHs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons, cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
· TP = Tanks portable . CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantily: Enter total quantity of waste described on each 1ine, relative to the units used In Item 14. I
14. Unit {weight/volume): Enter the appropriate abbreviations from Table II (below) lor the unit al measure: •
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liQuid only)
I. Wasle Number: Entef hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subpar:s C ar:d 01
~ identity the hazardous wasle on each line. .
J. · Additional Dese,iplions for Malerials LI sled Above: In the spaces provided, enter the authorizollon.number (from the S.C. DHEC Authorization Aeciuest For
!or each waste stream listP.d in section 11 above. Nole: Be!ore any hazardous waste can be accepted fortreatmenl storage or disposal in South Carclina. the
generator must obtain prior authorization lrom the treatment, storage or disposal facility. < :· • I
K. Handling Codes for Wastes listed Above: Leave blank. •
15. Special Handling lnslruclions and Additional Information: Generators may use this space lo indicate special transportation. treatment. storage or dispos
.... inlormation or Bill ol Lading Information. For international shipments, generators must enter in·this space the point ol departure (city and s:a1e) tor tnos~
' shipments destined lor treatment, storage. or disposal outside the jurisdiction ol the Uniled States. · . •···
16. Generator Certillca'lion: The generator must READ,.SIGN (BY HAND IN INK), and DATE lhecertilicalion statement. Ir a mode other than highway is used, t
word Nhighway .. should be tined out and the appr'opriate mode (rail, water.or air) inserted in the space below. ti another mode in addition io the highway mode
used. enter the appropriate additional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION · · . ~
11: TranspoMer 1 Acknowledgement: Enter the name of the. perton accepting t_he waste on ~ehalf or ihe first transporte~. That person rr.ust ackn~w1edl
acceptance of the waste d~scribed on the manifest by signing (BY HAND IN INK) and entering !he DATE ol receipt. · · •.,
18 .. Transporter 2 Acknowledgemenl: Enter, if applicablC, the name ol the person ac~epting the waste on behalf ol the second transporter. That person mus:
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipL ..,_ ·
FACILITY SECTION I
19. Discrepancy lndic_ation Space: The authorized representalive al the designated lacility's owner or operator must note in this space·any discrepancy betwe
tht waste described on the ·manilesl ond !he waste actU.illy received at the lacilily, Owners and operators of facilities who cannot resolve s1;nilicant
e111e,,pa1'1cles w111'1il'I 15 daya recel..,lng the waate mual aubmlt to the Department a tellerwHh o copy or the monlfesl describing the discrepancy and a~em::,tsl
reconcile it The t,eetmenl storage, or disposal laclllty must e.nter the actuol weight ~f waste in pounds in the spaces provided if the amoun1 varies any trom tr-.
specilied by the generator in item 13 or if the generator us~s a unit ol measure other than pounds. . .
20. Facility Owner or Operator Certification: Print or type lh~ name al the person accepting.the waste on behalf ol the owner or operator or the lac1l1ry. That oerson ·
must ack.nowledge acceptanc'e ol lhe waste described on the manifest by SIGNING (BY HAND IN. INK) and entering the DATE ol receipt
i, ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DJSPOSAL FACILITY 0ESIG'1>TED 1
RECEIV': THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mi;t
2600 Bull Street. Columbia, SC 29201
Phone: (BOJJ 734-5200
Emergency & Holidays: [phone]
I !PL.EASE PRI;;:; TYPE (Form desioned for use on elite r12-citchl tvnewriler)
UNIFORM HAZARDOUS I'· Geno,ator'sU.S.EPAIONo.
Form Ai roved. 0MB No. 2050-0039 Expires 9.30.ea
M11nllea1 12. Page 1 Document No, l• 4, 0, 0, 0, 8, 1 °1 1
Information in the .shaded a,eas is n01
required by Federal law, but is by State law.
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WASTE MANIFEST N, c, n, O, q, 7, ,;, O, 1•• 7,
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
,. Generator', Phone f 919 l 9 34-9 711
NC 27577
5. Transpor1er 1 Company Name 6. U.S.EPAIDNumber CJ5taii,·t· .... _ .. ,.,, ..... IJIO·/:."~ ·<J-·: ... --.:.=.,,.(;_:_~ ···-,
Willms Truckino Co-Inc. • S• C• D• 0• 7• 3• 7• n, 9i ·21 'I . Diff' ... "&'Phone . ·,,·/7<;7"1111
8. U.S. EPA 10 Number ,.. ..-·1·10;!_:, ;_. :.:,.. :•.::--:_,-~-.?.,~,-..... :,
1-----------------------''-'-'.1-'.i'-''c_''-i_'.1-'-'--'-'c_'-'-'-'-rfi':'>~.,.,.r"'f'·••·•··••t,,;~~•i\::..-.•.··•·····••.<.•·.:"'·•··'··..-·.,·.,
9. Designated Facility Name and Site Address 10. U.S. EPA ID Number ~ ,G.{$ta't,i' F1 :mrv i ff') '')>i0; .. , ~:; -· .: : . ,~ :,_,_';: ··.,·~-'. <:~.-·: •:
7. Transporter 2 Company Name
GSX Services of SC, Inc. ,. . .. .'.::i:\:::.·,:;,:i.;.';,,pt'J·,;:_, :~~~:~o!, B~; ;~i 25 1 St C, D, 0, 7, 0, ~ 7, ' ~ !\ 'i~l)*~i!~[;1:ii(!':'io3/4}i2sb6';l\:,
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number}
GSX Work Order No.: 71471
12. Containers 13. Total Quantity tt Uni! L' w&Sta Nla'!:lber ···:"·
No. Type WtNr:J ;";-::=/·-i··: ··.·. <' =:.>~<j
1 S. GENERATOR"S CERTIFICATION: I hereby dect1111reth111 the conten1, ollhl:tcon1lgnment are lullyend accurately described abov• by proper 1hlpplng riam• and are c1,, .. 11.c,,
packed. m11r1ted, and labeled.end are in all ro,pecls fn proper condilion lor lranspor1 by highway according lo appllcabta lnlarnational and national governrne,it r99ulat10,i1 and
uia laws ol 1'1a St.ate ol South c.;aroli,io.
111 am a largo Quantity ge,iero.tor, t certiry \hat I havo a program ln placo to roducathavolumo and 1odcltyol wulagenoratod lo the degree I have dotarml,ied tot>. oconomie.a1ty
prachcab!e a,id that I have selected the practicable method ol lre.11.lment, storage, or dlsposal currenlly available to me which mlnlmizu the presant and lut\Jra U'HNI to P'lurnaf'I
heal!h and !he environment: OR, HI am a small quonlitygonorotor, I hove mode o good lailh effor1 lo minimize my waste generation and select the beat wuta management fT'l1'tr,od
ttlat is available 10 me and the! I con allord.
PrinK,Typed Name J {:rrnl0 I Signature j:( ,,.,,,,,,.,
< n 9-c,,.r-
Month Day Year
• o.,?,7..1,!r,7
, 7. Transport'e,·1 Ac.:.-;nowledgemenl of Receipt of Materials -V
P'..ff ?{~tlam'R 1// ... # I Sign'dluro//tJA-J (JJ
18. Transportet2 Acknowledge men! ol Receipt of Materials • 77
Printed/Typed Name I Signalure
. •Montti Day Year
I ' I , I '
19. Discrepancy Indication Space • I I I I I I l'b>. ,1 I I I I I Jito.
I ~ 1-.,-~-----~-------~ 20. Facility Owner or Operator: Cer1ilicalion of receipl ol hazardous malerials covered by lhis manilesl excepl as noled in Item 19.
b I I I I I I l'bs. d I I I I I I l'b>.
Ptinled/Typed Name I Signature I EPA Form 8700-22 {Rev. 9/86) P1evoouo EdHiono nro Obsolete [DHEC 1988 (Rev. 10/86)J
Mo111t1 Day Year
I ' I , I I
IMPORTANT:
·.,J.-.
STATE OF SOUTH CAROLINA INS+RUCTIONS FO.A UNIFORM HAZARDOUS WASTE MANIFEST . '"
1J
TYPE (on a i2.'pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL .
·: GENERAL INFORMATION: Federal .Aegulalions require gem~rators and transporters ol hazardous waste and owners or oper.ators of hazardous was:e treatmel
. storage, or disposal licilities 10 use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)1 and. ir necessary, the continuation sheet U.S. EPA Fo_r
· 8700•22A Rev: 9/86 (OHEC 1988A) loi bolh inter-slate and intra-state lr:-.nsportallon. Transpor1ers who transport hazardous was!e in!o the United States Ire
another country are responsiOlc !or completing the manilesl. Federal and Stale regulations also require generators and lranspor1ers ol hazardous waste and
owners or operators of hazardous waste treatmenl. storage. or drsposal fac1llties to complete the followIng mformat1on.
GENERATOR SECTION ' 1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter !he generator's U.S. EPA twelve digit idenllficat1on number and !he umcue hve digI
number assigned lo this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA lden!ilication Number. please con:act S.C.
OHEC at [phone] aboul obtaining an.ldentilication number. · I .. 2.:: Page 1 of:. Enterthelolal number of pages used 10 complete lhis manHesl, i.e., the liist page EPA Form ~700-22 Rev. 9/86jDHEC 1988 (REV 10/86)1 ~lus:
number of conlinuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
·-A.. SUie Manifest Oocumenl Number: .. Leave blank. · ·
~... B:'"' State Generalor ldentrflcatlon Number: Leave blank.-. · .
3. Generator's Name and Maillng Address: Enter the name and malllng address ol the generator who will manage the returned manifest lorms. ,
,,, ' •·· Genenlor's Phorle Number: Enter a telephone number with area code where an authorized agent of !he generator can be reached in the event ol
· emergency including riighls. weekends, and holidays.
5. Transport 1 Company Name: Enter !he company name ol the first transport"er who will lransport the waste. I
· 6.~ U.S. EPA 10 Number: Enter !he U.S. EPA twelve digit idenlificalion number of the first transporter identified in item 5. .
C. ,\ Slate Transporter's ID Number: Leave blank. · · ~ 0. Transporter's Phone Number: 'enter a te1eph0ne number including area code where an authorized agent of the lirsl transporter can be reached in the even fol
·n:. anen:,ergency,in~ludingnights,weekends,andholidays... ... . ... ..-•••·-• ·-·--· . . '.·•:' .. ·.·. . ·
T.. Transporter 2 Company Name: II applicable, enter the company name al the second transporter who will transpor1 the waste. II more than 2 transporters wl ·
be used. use a U.S. EPA Form 8700-22A Rev. 9/86.(DHEC 1988A) continuation sheet and fist the transporters in the order they will be transoor:ing the was
a .. U.S. EPA 10 Numbed! applicable. enter tho U.S. EPA twelve digit ID number of the second transporter identified in item 7,
·-E .. Slate Transporter's ID Number: Leave blank.
F. Transporter's Phone Number: Enter a telephone number 1ncludrng area code 'lf'.here an aUthonzed agent of the second transporter can be reached in ti
· -event al an emergency including mghls, weekends, and holidays. -
. 9.. Designated Facility Name and Site Address:· Enter the company name and site address ol the treatment, storage, or disposal lacility designated to receive the
waste listed on this manifest The address must be·the site address, which· may dllfer from the mailing address. · ·, ."
~1 ,10: U.S. EPA 10 Number: Enter the U.S. EPA twelve digit idenlilication number ol the designated treatment. storage. or disposal lacility identilied in i1em 9. I
"'•'" G:. State Facility's ID Number: Leave blank. · . · ·
H;. Faclllly'• Phone Number: Enter a telephone number Including area code where an authorized agent.or the racilily can be reached in thl!'eveht ol an
emergency includlng nights, weekends, and holidays.
11~ U.S. DOT Descriptions: Enler Rroper shipping name, hazard class and ID Number (UN/NA) for each waste as ident.ilied in 49 CFR 171-1 ii. II addi!io~al spal
· is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Conlinuation Sheet. •
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriale abbreviation lrom Table I {below) !or the type ol containe.rs.
TABLE I ,
·oM = Metal drums, barrels, kegs TT= Cargo tanks (tank lrucks) CM= Metal ~oxes, cartons. cases. roll qHs ,11
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF• Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP • Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: En!ei total quantity al waste described on each line, relative lo lhe unils used In item 14. 1·
14. Unit (weight/volume): Enter the appropriate abbreviations lrom Table II {below) for lhe unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons {liQuid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Sub pans C ar:d □,
~ identity the hazardous wasle on each line.
J. Additional Descriptions lor Malerlals Listed Above: In the spaces provided, enter theauthorizotion.number (from !he S.C. DHEC Authorization ReQuHt For
for each waste stream lislP.d in seclion 11 above. Nole: Before any hazardous waste can be accepted for treatment, storage or disposal in South Carclina. the
generator must oblain prior authorizatiori from the treatment, storage or disposal facility. . J
K. Handling Codes lor Wasles Usled Above: Leave blank. '
15. Special Handling lnslructions and·Addit/onal Information: Generators may use this space lo indicate special lransp6rtation. treatment. storage or dispo
.' . information or Bill ol Lading lnlormalion. For inlernational shipmenls. gcner3tors must enler in this space the point of departure (city and s:a1e) tor tnose
shipment, destmed lor treatmenl. storage. or disposal outside lhe 1ur1sd1ct1on ol the Unlled Stales.
16. Generalor Cert1ficalion: The generator must READ, SIGN (BY HANO IN INK), and DATE thecert1f1cat1on statement.Ha mode other than h1ghway1s used, ti
word Nh19hway" should be lined out and lhe appropriate mOde (rail. water.or air) inserted In the space below. II another mode 1n add1t1on to the highway rnode
used, enter the appropriate additional_mode (e.g.,.and_ rail) in the space below.
TRANSPORTER SECTION . , 11: Transporter 1 Acknowledgement: E~ter the nam~.of the.person, ac~_ep'ling !he waste on behalf or ihe first ~ransporter. That person rr:ust, a:cknowledl
acceptance al the waste described on the manifest by signing (BY HAND IN INK) and entering !he DATE of reCfipl. . . , ·.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name or the person accepting lhe waste on behalf ol lhe second transporter. That person mus:
acknowledge acceptance ol the waste described on the manilest by SIGNING (BY HAND IN INK) and entering the DATE or receipt
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in !his space any discrepancy betwe
· the waste described on \he manifest and tho waste act\Jally received at the facility. Owners and operalors of facilities who cannot resolve si;nilican1
dl1crepancin within 15 doya receh1lng !he waste musl submll to !he Oei,artment a letter with o copyol the monllestdescribing 1he discrepancy and a:-:emott
reconcile il The treatment. storage, ordlsposal laclllty must enter the actual weight ~!waste in pounds in the spaces provided ii the amount varies any !rom f
specilied by !he generator in item 13 or ii the generator uses a unit of meas11re olher than pounds. . .
20. Facility Owner or Operalor Certification: Print or type th~ ~ame ol lhe person accepting.the waste on behalf ol the owner or operator ol the lac1r11y. That :,er son ·
must acl(.nowledge acceptanc·e of the waste described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE ol receipt
"ASsrSTANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILITY OESIGNJr.TEO 1 AECE!VE THE \'\/ASTE OR THE 5.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS f.'ROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau or Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia. SC 29201
Phone: (803} 734-5200
Emergency & Holidays.: (803)734-5-424
LEASE PRll-<T or TYPE (Form desi ned for use on elite 12-ilch ewriler Form A roved, 0MB No. 2050-00J9 Ei:oires 9-30-ea
F
A
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No. Mf1nlfa11t Oocumanl No. 2. Page 1
o!
lnlormalion in lhe· shaded Men is nol
required by Federal law, but is by State law.
3. Generator's Name and Mailing Address
Channel Master
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone( 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
1400082
6. U.S. EPA ID Number
S C D 0 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
..
A.''sialeMiinifmt Oocumont -·. dL%fr1fY(/:>t)'\:.-,.,'.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity t( Uni! l 'Wasta tt..aber'~-
No. Type WVl/rJ ~:/:.\:,_:,: >,~;',' '.~>;_· ... ,<'::'?.
a.
b.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T 2 0 Y
-~--..... --~--•'-•''·~ -~ \ Li _._._.,___,I . ; I ~ir
t 5. Special Handling lnslructions and Additional lnrormation
GSX Work Order No.: .71472
1 6. GENERA TOR'S CERTI_FICATION: I harabydaclara that the conlenls ol thlseonslgnmont are fully end accurately described above by proper shipping name and are cla.-if19d.
packed, marked, and labeled, and are In all raspacta In proper condition !or transport by highway according to applicable lnternaUonal and national governmant r~1,1lat1on1 af\d
u,a laws ol the Stale ol South Carolina.
111 am a large quantity generator, I cortlfy that! have a program In place lo reducatha volume and toxlcltyofwaslaganaralod lo tho d~rea I have detarmJnod to t>e economically
prac11cabla and thal 1 have selected the practicable method ol trealment. storage. or dlapout currently avallable to me which mlnlmlz.81 tho pres.ant and lun..re tlirNI to hi.im.an
health and the environment OR, Ir! am a small quonUtygonorator, I hove mado a good laith effort lo mlnlmlr.e mywute generation and ,elect the belt wuta management m.tnod
Iha! is available 10 me and tho! I con allord.
Signature
1 a. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name Signature Mont:'!• Day Year
19. Discrepancy Indication Space
'I pbs. CT pt,,.
·~f.,.~---------~----~ ~ Facility Owner o, Operator; Certiflcallon of receipt ol ha.iardous malerlals covered by lhls manifest except a, noled In l1e·m t9.
bl pbs. d I pbs.
Prinled/Typed Neme Signature Montn Day YUi
EPA Ferm 8700-22 (Rev. 9/86) Pto\lieus Ed/liens nro Obsolote (OHEC 1988 (Rov. 10/86))
! • \ ·: 'I :"··• · . }. "
STATE OF SOUTH CAROLINA INST.RUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE {on a 12-pitch (elile) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require genP.rators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
storage, or disposal licilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)) and. if necessary, the continuation sheet U.S. EPA For
· 8700-22A Rev.-9/86 (OHEC 1988A) foi b·o1h inter-state and intra-slate 1rc1nsportallon. Transporters who transport hazardous w.iste into the United States lro
another country are responsiOle for completing the manilesl. Federal and State regulations also require generators and transporters of hazardous waste and
owners or operators ol hazardous waste treatment. storage. or disposal facilities to complete the following inrormation. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number. Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manifest by thegenera!orbeginning with 00001. Hyour company does not have a U.S. EPA Identification Number, please contact S.1 • .... OHEC at (B0J) 7:34-5200 about obtaining an Identification number. -. 2.:: Page 1 ol:. Enter the total number of pages used to complete this manifest, i.e., the first page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (P.EV 10/86)] i:lus t
number of continuation sheels EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any. r-·-· A.· siate Manifest Document Number: .. Leave blank. · ·
··· a:• Stale Generator ldenlttlcatlon Number: Leave blank. I
1 Generator's Name and Mailing Address: Enter !he name and mailing address ol the generator who will manage the returned manilest lorms.
•· Generator's PhoMe Number: Enter a telephone number with area code where an authorized agent ol the generalor can be reached in the event ol
emergency including nights. weekends, and holidays.
5. Transpor11 Company Name: Enter the company name ol the llr"st transporter who wilt transport the waste. I
6." U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
· C.1'· Slate Transporter's IO Number: Leave blank. · ·
0. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent of the lirsl lransporter can be reached in the even!O! ..
an eff1ergency including nights, weekends, and holidays... . . ' ; · ·. . '' . ;1'.
T.. Transporter 2 Co~pany Name: II applicable, enter the compa'~y name Oi the seC7)ri'd'1ral1S.POrter who wilftra'nspOrt the waste. If more than 2 !rans;::,oners ·
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they wilt be transpor:.ir.g the was
· e_ U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit 10 number al the second lransporter identified in item 7.
!., E;. Stale Transporter's ID Number: Leave blank. · · . · I
• F •. Transporter's Phone Num~er: Enler a lelephone number including a·rca code ~here an authorized agent of the second transporter can be reachea: int
;--event cl an emergency including nights, weekends, and holidays. · · · ~
9. Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal lacility designated to receive the
waste listed on this manifest The address must be·the site address, which may differ lrom the mailing addreSS. · · , I
· 11 111 U.S. EPA ID Number: Enter the U.S. EPA twelve dlgll ldenlilication number ol the designated treatment, storage, or disposal raci1ity identified in item 9.
• G:. Stale Facility's 10 Number: leave blank. • · ·
H;. Faclllty's Phone Number: Enter a telephone number Including area code where an authorized agent of lhe facility can be reached in the event or an
emergency including nights, weekends: and holidays. · .
11: U.S. DOT Descriptions: Enter proper shipping name. hazard class arid 10 Number (UN/NA) for each waste as identilied in 49 CFA 17.1 • t ii. II aC.Ci:icn.al spa.
is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers lor ea.ch waste and the appropriale abbreviation lrOm T.ible"i'(beloW) for the type ol Conta1nefs.
:, TABLE I '
OM = Metal drums, barrels, kegs TT = Cargo tanks (lank trucks) CM = Metal boxes. carton~. cases. roll cHs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
· OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
· TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic ~ags
13 •. Total Quantity: Enter total quantity ol waste describe"d on each line, relative to the units used in item 14.
14. Unit (weighl/volume): Enler !he appropriate abbreviations from Table II (below) for the unit ol measure: I
Table 11
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons {liquid only)
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpar'.s C ar.d 01
·· Identity the hazardous waste on each line.
J .. Additional Oescriplions lor Malerials Listed Above: In !he spaces pro"'.ided, enter the authorizotlon.number(lrom the S.C, OHEC Authorization AeQuestFor
tor each waste slream liSIP.d in seclion 11 above. Note: Berore any hazardous waste can be accepted lor treatmenl slorage or disposal in South Carclina. lhe
generator musl obtain prior authorization from the treatment, storage or disposal facility. . · I
K. Handling Codes for Wastes Listed Above: Leave blank.
15. Special Handling lnslructlons and Addillonal Information: Generators may use this space to indicate special transportation. treatment. storage or d1spo
information or Bill of Lading lnrormation. For international shipments. generators must enter in this space lhe poinl of departure (city and s:a1e) !or tnose
shipments destined lor treatment, storage. or disposal outside lhe jurisdiction or the Uniled States. '· I
16. Gene,alor Cer1iflcation: The generator musi REAO,.SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used. t
word Nhighway" should be lined out and the appropriate mode (rail. water.or air) inserted in the space below. If another mode in addition :o tl":e highway rnoc:
used. enter the appropriate additional mode (e.g.,_and_ rail) in the space below. ·
TRANSPORTER SECTION · ', · • ,
11: TransPorter 1 Acknowledgement: . Enter the name ol the-person ac~eptin'g the waste on b~hall ol ihe lir'st lransPorf'er. That Person rr.usi'·acknowledl
acceptance al the waste described on the manifest by signing (BY HANO IN INK) and entering !he DATE of receipt. • · ·
18. Transpor1er 2 Acknowledgement: Enter, if applicable, the name of the person accepting the waste on behalf of the second transporter. That person mus:
acknowledge acceptance of the waste described on the manifcsl by SIGNING (BY HAND IN INK) and entering the DATE of receipt. • • ·1·
FACILITY SECTION .
19. Discrepancy lndicatioii Space: The authorized representaliVe ol lhe designated·facilily's owner or operator must nofe '1n this space any discrepancy bet we
the wasle described on lhe manilost and the waste actUatly received at the facility. Owners and operators of facililies who cannot resolve si;nilicant
dl1erei:,ancies within 15 days receiving the wnsle must submit to the Oepartmenta leller with a copy ol the manifest describing the discrepancy and ar:em:itsl
reconcile il The ireatmenl, storage, or disposal lacll!ty must enter the actual weighl ~f waste in pounds in the spaces provided ii the amoun1 ... ar1es any !rem tt
specilied by the generator in item 13 or ii the generator us~s a uni! ol meas1.1re other thorn pounds. . .
20. Faclllty Owner or Operator Cerlillcallon: Print or lype th~ name of the person occepllng.1he waste on beholl of the owner or oper.:itor ol the l.:Jc1l,1y. Th;Jl person
must acknowledge acceplanc"e ol lhe waste described on the manilest by SIGNING (BY HANO IN INKf and entering the DATE ol receipt
I.II' A.$!=.ISTANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILJfY OESlCN:.TEO I
AECtWo THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 om TO 500 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haz.ardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
SE PRl'1T or TYPE ewriler Form A roved. 0MB No. 2050-0039 e:..o;r .. 9.30.ga
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generalor's U.S. EPA 10 No.
N C D O 7
M11nlfea1 2. Pago 1 Document No.· ol 1400083
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transponer 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sito Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7
10. U.S. EPA ID Number
S C D O 7 0
Information in the shaded a,reas is no1
required by Federal law, but is by State law.
DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity 14. Unil l w..--·
No. Type WtN':J :./ ;;-tt..
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling lnstrucbons and Addilional Information
GSX Work Order No.: 71473
1 D T
l; F j o·,r; 9c,';;.
.. ! >i'",
2 0 Y :JI f IO IO I 6 I~
:,~·i··· ., .....•. ~ .. :, ... ; -i-i
< I !:~~:·
1'5. GENERA TOR'S CERTIFICATION: I hereby declare thal the conlenls olthls consignment are fully and accu,ate1ydoscrlbod above by proper 1hlpping name and are cla, .. t,.ci.
packed. markod. and labeled. and are in all res peels In proper condilion tor transport by highway according to applicable lntornallonal and national governmanl r~ulat10n1 ar,(I
tno laws or the State of Souttl Garollno;
111 am a la,ge Quantity generotor, I cortiry that I havo a program In ptaco to reduce the volume and toxicity of waste generated to the do-gr-1 have determined to be oconomie.ally
pract1cab1e and \hat I have setecled \ho practicable method of treetmnnl :storage, or dl:spoaal currently avnl1eble 10 riia which minimizes tho prosenl •nd lurur• u,, .. , to huma:,
heal1h and the envi1onmcnt; OR. ir I am a small quanUtyoonornlor, I hovo mado a good loilh atfort to mlniml:z:a my wa:sl.o generation and :setacl tho ~•t ..... 11111 m•n•gemant metl"IOd
!hat is availal:lla ~o me and that I con orlord.
Prin!~./Typed Name 1 c _J_..
ii Op,, f' --0 01.J,·
Signature Month Day Yw
C1[? z 7 F-
17. Transporter/, At:l(nowledgemenl of Receipt ol Malerials
Mont"! Day /J;,' tad', .l, 7. . :J
Printed/Typed Name Signature Month Day Yw
'tf'
19. Discrepancy Indication Space • I jib!. C I llt,s.
b I pt,,. di pb!.
20. Facility Owner or Operator; Cer1ification or receipt o! hazardous materials covered by !his manifest excepl as nolod In /lam 19.
Printe,d/Typed Name Signature Month Day YW
?A Form 6700-22 (Rev. 9/B6) Previous Editions are Obsolote (OHEC 1988 {Rev. 10/86)]
, 'I ' . ~::,r.
STATE OF SOUTH CAROLINA INSTRUCTIONS Fc°R UNIFORM HAZARDOUS WASTE MANIFEST
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter} OR USE FIR~ POINT PEN· PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
·~ GENERAL INFORMATION: Federal .Regulations require generators and lrnnsporters of hazardous waste and owners or operators ol hazardous waste treatmel
, siorage. or disposal liciliIies lo use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and. if necessary, lha continuation sheet U.S. EPA For
· 8700-22A Rev.-9/86 (DHEC 1988A) ror both inter-slate and intra-state lr.insportatlon. Transporters who transport hazardous waste into !he United States Ira
another country are responsible ror completing the manilesl Federal and State regulations also require generators and transporters of hazardous waste and
owners or operators or hazardous waste treatmenl, storage. or disposal facilities to complete lhe ronowing information. I GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest Documenl Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manifest by the generalor beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:ac1 S.C.
OHEC at [phone] about obtaining an Identification number. I
': 2.:. Page 1 of:. Enter the total number of pages used to complete this manifest. i.e., the Hist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10186)1 ~lus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A. St.le Manifest Ooc;ument Number: .. Leave blank. · ·
a: State Gene,alor Identification Number: Leave blank. I
3.. Generator's Name and Mailing Addres,: Enter the name and mailing address of the generator who will manage the.returned manilest forms. 1
4. Generator's Phoiie Number: Enter a telephone number with area code wh~re an authorized agent of the generator can be reached in the even! ol
emergency including nights, weekends, and holidays.
·.S. · Transport 1 Company Name: Enter the company name ol the llrst transport·er who will transport the waste.
6.'.. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the first transporter identified in ilem S.
· C."' Stale Transporter's 10 Number: Leave blank. ·
0. Transporter's Phone Number: 0Enter a telephOne number Including area code where an authorized agent of the first transporter can be reached in the eveniol
an emergency in~luding nights, weekends. and holidays. ' . . ' · · , . · . ;1·
T.. Tran-Sporter 2 Company Name: II applicable, enter the c'Omp~~y name Oi the seCOl1iirans·port·er who will'tr3'n'sp0rt the waste. II more lhan 2 trans;,orters .
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in !he order they will be !ranspor:ing the was
8 •• U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number ol lhe second transporter identified in item 7.
E .. Stale Transporter's ID Number: Leave blank. t
F .. Transporter's Phone Number: Enter a telephone number including area code ~here an authorized agent ol the second transpor1er can be reacr.e~ int
event ol an emergency including nighls, weekends, and holidays. ·
9. Designated Facilily Name and Sile Address: Enter the company name .ind site address of the treatment, storage, or disposal lacility designated to receive the
waste listed on !his manifest The address must be·the site address, which may dilfer lrom the mailing address. . 1.
_10; U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number ol the designated treatment. storage. or disposal lac@y identilied in item 9.
G:. Stale Facility's ID Number: Leave blank.
H;. Faclllly's Phone Number: Enter a telephone number Including area code where an authorized agenl of the facility can be reached in the event or an
emergency including nights, weekends, and holidays.
11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 1 71 • 1 7i. !!_additional spal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. •
12.. Containers (no. and type): Enter number ol conlainers lor each waste and !he appropriale abbreviation lrom Table I {below) !or the type ol containers.
TABLE I
OM = Metal drums, barrels. kegs TT = Cargo Ianks (tank trucks) CM = Metal boxes. cartons. cases. roll ~Hs I
OW= Wooden drums.,barrels, kegs TC= Tank cars CW= Wooden boxes. canons. cases
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plas11c ~ags
13.'. Total Ouanlily: Enter total quantity ol waste described on each line, relative to the units used In item 14. I
14. Uni! {weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpar:s C ar.d DI
,uidentity the hazardous waste on each line.
J., Additional Descriptions for Materials Listed Above: In the spaces provided. enter the authorizntion.number(lrom the S.C. OHEC Authorization ReQuHt For
tor each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for lreatment, storage or disposal in South Carclina, Ihe
. generator must obtain prior aulhorization from the treatment, storage or disposal facility. I
K. Handling Codes for Wasles Listed Above: Leave blank.
15. Special Handling lnstrucllons and Additional lnlormalion: Generators may use this space to indicate special lranspor1ation, lrea1ment. storage or disp·os:
··-·~• lnlormation or Bill ol Lading Information. For international shipments, generators musl enter in this space 'the point or departure (city and s:ate) for Inose
\ shipments destined !or treatment, storage. or disposal outside the jurisdiction of the United Slates. ' · I
16. Generalor Certillcalion: The generalor must REAo,·srGN (BY HANO IN INK), and DATE !he certification statement II a mode other than highway is used. t
word "highway" should be lined out and the appropr'iate mode (rail. water .or air) inserted In !he space below. II another mode in addition to the highway mode
used, enter !he appropriate additional mode (e.g .•. and_ rail) in the space below. · .
TRANSPORTER SECTION --. . 11: Transporter 1 Acknowledgement: Enter the nam~ ol the person accepling the waste on behalf ol ihe first lransporter. That person rr:ust acknowledl
· acceptance ol the waste described on the manifest by signing {BY HAND IN INK) and entering the DATE ol receipt. ·
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name or the person accepting the waste on behalf of the second transporier. That person rr:us<
acknowledge acceptance ol lhe waste described on lhe manircst by SIGNING (BY HAND IN INK) and entering the DATE al receipl I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative or the designated facility's owner or operator must note in this space any discrepancy betwe
!he waste described on the mariirest and the waste actUally received at the· facility. Owners and operators ol facilities who can no I resolve sii;nilicant
discrepancies within 15 doy, receiving the waste mu,t submlt to the Departmenl a lener wilh a copy ol the manirest describing the discrepancy and ar:emptl
reconcile il The ire. atment. slorage, ordlsposol laclllty musl enlerthe actual weight ol waste in pounds in the spaces provided ii the amount varies any from r .
specilied by the generator iri item 13 or ii the generator us~s a unit ol meas11re olher than pounds. , .
20. Facility Owner or Operator Cerlllication: Print or type th~ nilme ol the person· acceptirig.the waste on beha/1 ol lhe owner or operator ol the lac1l1ty. That person
must acknowledge acceptance or the waste described on the manilest by SIGNING {BY HANO IN. INK). and entering the DATE ol receipt
,, ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OJSPOSAL FACILITY OESIG~J.=..Teo 1 ~EC!':':'! THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WE,;:'.KOAYS FROM 8:00 nm TO 5:00 pm.
I
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Street, Columbia, SC 29201
Phone: (800) 73'-5200
EmergenC)' & Holidays: (803)73-'-5-42,
LE.lSE PRINT or TYPE {Form desi ned for use on elite 12-itch ewriler Form A roved, 0MB No, 2050-0039 E.xgires 9.30.ga
T
A
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No. Manlfeet Document No. 2. Page 1
ol lnlorinetion in the shaded areas is no1
required by Federal law, but is by State la ...
3. Generator's Name and Mailing Address
Channel Master
N C n 0
P. 0. Box 1416, Smithfield, NC 27577
,. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
140008!,
6. U.S. EPA ID Number
S C D 0 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D 0 7 0 3 7
A. Sta1e Manifeot Ooctimon! Nutnb«.
/)ih<it=t=/.:-··--
11. U.S. DOT Description (incfuding Propef' Shippfng Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity
a.
b.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
No. Type
1 D T 2 0 Y
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71474
18. GENERATOR'S CERTI_FICATION: I hereby declare the! lhe corilents olthls corislgnmentare fully erid eccuretelydescrlbed above by proper 1hlpplt10 r1am• arid ar• ctaa .. tl..::1.
packed, markttd, and La baled, and are in all respecls in proper condllion tor 1rar1sport by highway according to appllc:.eble lritarnallorial arid rietlonal govarrimarit r-.gulalioria ar,,d
U'\e 1a..,s ol lhl $tale ol Soulh (;arollria.
II I am a large c::iuantity gerierotor, r certify that I havo e program In place to reduce the votume arid toxlcltyol waale ganeraled to the deor-I have delarmlnttd to be eeonomoean-,
prachcaote arid lhat I have selected the practicable method of treatment. storage, or dlspoaal currently avollabla to ma which minimizes the present and lun.ira U'lrNt to human
heal!h and !he environment; OR, ii I am o smn11 ciuantitygonoralor, I hove mado o good railh effort to minimize my waslo generation and select U'le be al wa11a mariagam•nt me~
that is avaiLaOle to me and tho.I I con allord.
Prin1f<.Typed Name L--Cood'6 Signature ~ ,✓. ' OP. /
17. Transponer .. 1/At;1mowl ement ol Aecei t of Materials
Ii Prinled/Typed /),J;/!f (/U (.,Y
0 18. Transporter 2 cknowledgement of Rec A T Prinled/Typed Name Signature
I E
A
19. Discrepancy Indication Space
F
.Montn Oay Year
• I Jibs. C I Jit:s.
I !t-:,,...,,-.,.,......,,---=----=--,,.......,...-::: 20. Facilily Owner or Operator; Certilicallon of receipt ol hazardous materials covered by !his manliest except as noted In llem 19.
Printed/Typed Name Signature
IEPA Fo,m 6700-22 (Rev. 9/86) Previous Editions nro Obso:oto (OHEC 1988 (Rev. 10/86)1
bJ Ji"'-d I pi,,.
Month Day Year
STATE OF SOUTH CAROLINA INSTRUCTIONS FO.R UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-p;lch (elHe) typewrHer] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal _Regulations require genarators and transporters of hazardous waste and owners or operators ol hazardous waste 1reatme•1
. storage. or disposal ficili1ies to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC t988 (REV 10/86)] and, ii necessary, lh& continuation sheel U.S. EPA For
· 8700-22A Rev.-9/86 (DHEC 1988A) foi b0oth inter-stale and intra-state tr:'lnsportatlon. Transporters who transport hazardous waste into the United States Ira
another country are responsible !or completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operators of hazardous waste treatment, storage, or disposal facilities to complete the following information.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number -Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
: ' number assigned to this manirest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number. please con:act S.C.
1. ~ .· ........ OHEC at [phone] about obtaining an ldenliliCation number. . · I
; : 2;.", Page 1 of:. Enter the total number of pages used lo complete this manHest, Le .. the'lirst page EPA Form ~700-22 Rev. 9/86 (DHEC 1988 (REV 10186)] t:lus:
i . number or continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any.
:n7'. ~:-·state Manifest Document Number., .Leave blank. · ·
1,,•. -· e:·~ State Generator ldenliflcallon Number: Leave blank. · ; J
· 3. Generator's Name and Mailing Address: Enter the name and maillng address ol the generator who will manage !he returned manifest rorms.
•· ·• Generator's Phorle Numbe,: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the even! of
emergency including nights. weekends, and holidays.
5 •. · Transpor11 Company Name: Enter the company name ol lhe lirst transport.er who will transport the waste. I
·• 6.,.; U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of !he fir~t lranspor1er idenliried in item 5. · c:· Slate Transporter's ID Number:, Leave blank: · ·
O. Transpor1er's Phone Number: Enler a telephone number including area code where an authorized agent of the first transporter can be reached in the e"ent of •
an emergency inc;:luding nights, weekends, and holidays.. . . . ' · ·. ·, , ' . ;1·
"r.: Transporter 2 Co~pany Name: If applicable, enler !he cOmp~~y name Oi the seC~n-dtra~·sporter who wilr"tra"n"spcirt the wasle. 11 more than 2 trans;:,orters .
. be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:lng the was
8 •. U.S. EPA 10 Number:lf applicable, enter the U.S. EPA twelve digit 10 number of lhe second transporter identified in item 7 .
.,_ E .. Stale Transporter's ID Number: Leave blank. t
F •. Transporter's Phone Number: Enter a telephone number including a·rea code 'h_'.here an authorized agent al the second transporter can be react-.ed int
,.., event ol an emergency including nights, weekends. and holidays.
9. Oesignale_d Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal lacility designated to recei"e the
waste listed on this manifest The address mus! be·the site address, which· may dlller from the mailing address. . I
, , · ! .10.: U.S. EPA ID Number: Enter !he. U.S. EPA twelve digit identification number or the designated treatment, storage, or disposal lacility identified in item 9.
~_; , G:. Slate Facility's ID Number: Leave blank. · ·
H;. Faclllly's Phone Number: Enter a telephone number Including area code where an authorized agenl ol the facility can be reached in the event ol an
emergency including nights, weekends. and holidays. . ·
11: U.S: DOT Descriptions: Enter Rropershipping name, hazard class and ID Number(UN/NA) lor each waste as identHied in 49 CFR 171-1 i~.11 aCCi:icn.al spal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers lor each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I
OM= Metal drums, barrels. kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll cHs I
OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases .
OF = Fiberboard or plastic drums. barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plas11c bags
13 .. Total Quantity: Enter total quantity ol waste describ8d on each line, relative to the units used in item 14. ~.
t4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit ol measure:
' Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous wasle numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpar::s C ar.d DI
·-identify the hazardous wasle on each line.
J. Additional Descriptions lor Materials LI sled Above: In the spaces provided, enter !he authorization.number (from the S.C. OHEC Authorization AeQuesl For
for each waste stream lislP.d in seclion 11 above. Note: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carc-lina. the
generator must oblain prior authorization from the treatment, storage or disposal lacitity. · · J
K; Handling Codes for Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Additional lnlormalion: Generators may use this space to indicate special transportation. treatment. storage or dis po
information or Bill ol Lading lnformalio,:i. For international shipmen\s, generalors must enter in this space the ·point of departure (ci1y anC state) !or tnose
Shipments destined for treatment, storage, or disposal outside the jurisdiction ol the United States. · · I
16. Generator Cer1ification: The generator.must REAO,.SIGN (BY HAND IN INK), and DATE the certification statement.11 a mode other than highway is used. I
word .. highway" should be lined oul and the appropriate mode (rail, water.or air) inserted In the space below. II another mode in addition 10 tr,e highway r.iode
used, enter the appropriate addition"al mode (e.g.,,and_ rail) in the space below.
TRANSPORTER SECTION . . · 11: Transpor1er 1 Acknowledgement: Enter the name of the person accep"ting the waste on behall ol ihe first transporter. That person rr:ust acknowledl
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt
18. Transpor1er 2 Acknowledgement: Enter, if applicable, the name ol the person accepting the waste on behalf al the second transporter. That perscn mus:
acknowledge acceptance ol the waste described on the manifest.by SIGNING (BY HAND IN INK) and entering the DATE ol receipt 1 FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative of !he designated lacility's owner or operator must note in this space any discrepancy bet we
tne waste described on !he manilesl and lhe wasle actually received at the facility. Owners and operators of facililies who cannot resol"e si;nilicant
' dlsarop1nc1e1 within 19 day■ receiving !he waalo mual aubmll lo the Cei,a,lmenla letterwllh a copy or the manlletl describing tl"IO dlscro~aricv ind 1r.1mo11 I
rocoricile it The trealment, storage, or dlsposol laclllty must enler the aclual weight [!1 waste in pounds In the spaces pro~lided ii the amount varies anv !rom rr.
· specified by !he generator in item 13 or ii the generator us~s a uni! ol mcns1.1re other than pounds. , . ·
20. Facility Owner or Operator Cerlilicalion: Print or type th~ name ol the person accepling.1he waste on behalf ol the owner or operator ol lhe lac1ltry. Thar person ·
must acl<.now1edge acceptanc·e ol lhe waste described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE at receipt
I~ ASSIS.TANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE T. REA TM ENT, STORAGE, OR OJSPOSAL FACILITY OESIC::eJHEO Tl
AECE!V~ THE \'.'ASTE OR THE 5.C, OHEC MANIFEST SECTION AT (803) 734•5200 WEEKDAYS FROM 0:00 nm TO 5:00 pm.
I
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haz.a.rdous Wa.ste Mi;t
2600 Bull Stre-et. Columbia, SC 29201
Phone: (BOO) 734-5200
Emergency & Holidays: (803)734-542,
(Form desi ned lor use on elile 12-itch ewriler Form A roved. 0MB No. 2050-00J9 E.ipires 9.30.ga
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Genorator'.s U.S. EPA ID NO.
3. Generator's Name and Mailing Address
Channel Master
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
•· Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc,
Route, l Box 255
Pinewood, SC 29125
7 0 l
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
2. Page 1 ol Information in tho shaded IWHS is not
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class. and ID Number) 12. Containers 13. Total Quantity 1( Uni!
No. Type 'M/Vr/.
L'Wasta-'-i =tj~·,)-'~
L
b.
C.
d.
Hazardous Wast_e, Solid, nos ORM-E
NA 9189 I D T
j/~: :'~.,,i;:~I~:~ill!ll,!il~li!:l!:1i~'i11l!!!llrillt!~!ll~lllil1~ii!!:ll1l!ll!1l~1\l'!il!lrlf i
LIE..ili.J-J0121717141-!ld1O121Hi'f!fo!:fa;;Jc,Lt..J-J I I I I 1-1 I I I u:1:
bLt..J-1 1-1 1~i~\~ii~0l'idLt..J:-l 1,111 1-1_, l~f
15. Special Handling Instructions arid Addilional lnlormation
CSX Work Order No.: 71475
-n_,
. .. ··· _:·.11..1 -'--''---'--.J ,.:;
,e. GENERATOR'S CERTIFICATION: I hereby declare lhat tho conlonls olthls conalgnmentare lully and accurately described above by proper 1hlpping naM• and are c1aa .. t1a<1,
packed, marked. and 1a·beled, and are in all rospocl.s in proper condition for lransport by highway according to 11pp1lcabl11 lnternatlonat and national government r~ulat.1on1 ar,,d
U'III laws ol the State ol South Garolino.
111 am a large ciuanllty generator, I certify !hat I havo II program In placa to reduce tho volume and toxicity of waste generated to tho dGgr-I have delarmlnod to be oconomically
prachcaole and \hat I have selected the praclicabte method of lrealmont. storage, or dlsposal currently evallab1e lo mo which minimizes tho present and lurur• u,,_, \0 hu,...:,
health and the environment; OR, ii I am a smoll quantity genorolor, I hnv11 mado a good reith effort to minimize my wa:,te generation and ,elect th& bell wute managemant .,...11'\od
that is availaOle to me end that I con nll01d.
Signature Year
Printed/Typed Name Signa!ur ~ontfl Day Year
, 9. Discrepancy Indication Space
a I jibs. c 1 · I jibs.
bl I'"' d I I I'"'-
20. Facility Owner or Operator; Certilicatlon ol recefpl or hazardous materials covered by !his manifesl excepl as noted In Item 19.
Printed/Typed Name Signature Month Day Yaar
EPA Form 8700-22 (Rev. 9/86) Previous Editions oro Obsolote {OHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS Fo'R UNIFORM HAZARDOUS WASTE MANIFEST 1··a,
IMPORTANT: TYPE [on a 12-pitch (eHte) typewriter] OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
.-•·:·. GENERAL INFORMATION: Federal .Regulations require generators and lra~spo~ers ol hazardous was le and owners or operators ol hazardous waste t;eatmel
... s1orage, or dispOsal licifitiCs to use !he U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, if necessary, th& continuation she_et U.S. EPA For
· 8700-22A Rev:9/86 (OHEC 1988A) foi bo1h inlcr-state and intra-state trnnsporlatfon. Transporters who transport hazardous waste into t_he United States lro
another country are responsible !or completing the manifest Federal and State regulations also require generators and transponers ol hazardous waste and
owners or operators of hazardous waste treatment. storage, or disposal facilities to complete lhe rollowing inlormalion. I GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manilest Document Number; Enter the generator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manifest by the generator beginning with 00001. lfyour company does not have a U.S. EPA Identification Number. please contact S.C.
-~ OHEC al [phone] about obtaining an Identification number. · · I
_ 2;.' Page 1 of:. Enter the total number of pages used to complete lhis manirest, i.e., the lirsl page EPA Form ~700-22 Rev. 9/86 (OHEC 1988 (P.EV 10186)) plus t ·
t.:-:"". A.'
a:·
3.
number of continualion sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any.
slate Manifest Document Number. . Leave blank. · · · ;
State Generator ldenliftcallon Number: Leave blank. J
Generalor's Name and Mailing Address: Enter the name and mailing address of the generator who w11t manage the returned manifest lorms
~-. Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol
emergency including nights, weekends. and holidays.
5. Transport 1 Company Name: Enter the company name ol lhe lirst transport'er who will transport the waste.
6.'.t. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5. I C.' stale Transporter's ID Number: Leave blank. • · ·
0. Transporter's Phone Number: 0Enter a telephOne number Including area code where an authorized agent of the lirsl transporter can be reached in the eveniol
-'./,··, 1 an e"'.4ergency.in~luding nights, weekends, and holidays.. . . . · · · ·, . · . . :1·. ~·· 'r.'. · Transporter 2 Company Name: ti applicable, enter !he cOmp~nY name Oi the seCOri'dt,ansporter who will0tra'n'spOrt lhe waste. II more than 2 lrans;:>orters
.. • , be used, use a U.S. EPA Form 8700:22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be !ransoo~ing !he was
8 .. U.S. EPA 10 Number:lf applicable. enter the U.S. EPA twelve digit JO number of the second transporter identilied in item 7.
E .. Slate Transporter's 10 Number: Leave blank. · 1·
F .. Transporter's Phone Num~er: Enter a telephone number including a·rca code 'h'.here an authorized agent ol lhe second transporter can be reacr:e~ in
event or an emergency including nights, weekends, and l:lolidays. . , ·
9 •. ' Designaled Facility Name and Sile Address: Enlerthe company name and site address ol the treatment, storage, or disposal lacili!y designated :o receive the
· waste listed on this manHest The address must be the site address, which· may differ lrom the mailing address. , :,, _,a; U.S. EPA 10 Number; Enter the U.S. EPA twelve digit Identification number ol the designated treatment, storage, or disposal facility identilied in item 9. I
.,-j G:.-Slale Facility's 10 Number: Leave blank. ·
.._, H;: Facility's Phone Number: Enter a telephone number Including area code where an authorized agent of the facility can be re.iche'd in the event ot an
·• emergency including nights, weekends, and holidays. · .: .
. 11~ U.S: DOT Descriplions: Enter proper shipping name, hazard c13ss and ID Number (UN/NA) for each w.isteas identified in 49 CFR 171: 1 ii. H."aCCiiicnar s;,a··
: ••is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
·. 12.. Containers (no. and type): Enter number of containers for each ..:.iaste and the appropriate abbreviation lrom Table I (below) ror the typ! of contain'ers.. .· ;..
TABLE I .
OM~ Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons, cases. roll oMs
. ''\,, "'' OW a Wooden drums, barrels, kegs TC= Tank car's CW= Wooden boxes. cartons. cases
. , , OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cas!s
-•¥ • TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or p!as11c bags
13 .. Total Ouanlily: Enter total quantity al waste describfd on each line, relative to the units used in item 14.
t4. Unit (weight/volume): Enter !he appropriate abbreviations lrom Table II (below) for the unit of measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid only)
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Wasle Management Regulation R.61-79.261 Subparts C ar.d DI
·' -·~identify the hazardous,wasle on each line.
J. :_ Additional Description, lor Material, LI sled Above: In the spaces provided. enter the authorization.number (from the S.C. DHEC Authorization Rec;ues! For
for each waste stream lislP.d in section 11 above. Nole: Before any hazardous waste can be accepted for treatment storage or disposal in South_Carclina. lhe
generator must obtain prior authorization lrom the treatment, storage or disposal lacility. . • I
K. Handling Codes lor Wastes Listed Above: Leave blank. •
15. Special Handling Instructions and Additional Information: Generators may use this space to indicate special lransportation, lreatment storage or dis po
· ·-.• information or Bill al Lading Information. For international shipments, generators musl enter in this spaCe··thl? point al departure (ciry and s:aie) !or tnose
'shipments destined !or treatment, storage,.or disposal outside the jurisdiction or lhe United States. · , < ·
16 .. Generator Certification: The generator must READ,.SIGN (BY HAND IN_ INK), and DATE the certification statement: Ir a mode cithert.~ha,n highway is used.I
word .. highway" should be lined out and the appropriate mode (rail, water.or air) inserted In !he space below. II another mode in addition to tl"',e highway mod
used. enter the appropriate additional mode (e.g .. _and_ rail) in the space below.
TRANSPORTER SECTION .
. -' n: Transporter 1 Acknowledgement: E.nter the name ol lhe person accepling lhe waste on behall or ihe first transporter. Thal person rr:ust acknowledl
acceptance of \he waste described on the manHest by signing (BY·HANO IN INK) and entering the DATE ol receipt. ·
18 .. Transporter 2 Acknowledgement: Enter, if applicable, !he name of the person accepting !he waste on behalf ol the second transporter. That person mus:
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE ol receipt ·
FACILITY SECTION • I
19. Discrepancy lndicalion Space: ·The authorized represenlative of !he designated facility·s owner or operator must note in this space·any discrepancy betwe
the waste described on lhe manilesl and lhe waslo actUally received at the facility. Owners and operators of lacililies who cannot resolve signilicant
dl1crepencie1 w11hln 1, days receiving t~o waelo muel 1ubmll lo 1he Oepar1menl a loller wilh a copy of lho manilesl describing the discrepancy and ar.emcul
reconcile it The 1rea1ment, slorage, or disposal lacltlty mus I enter the actual weight qr waste In pounds In the spaces provide~ if lhe amount vanes ~ny lrom 1
specified by the generator in ilem 13 or ii the generator us~s a unil ol measlJre other than pounds. . .
20. Facility Owner or Operator Cerlillcation: Print or type th~ name al the person accepting.the waste on beholl ol the owner or operator ol the lac1l1ty. That person ·
must acimowledge acceptanc·e of the waste described on the manifest by SIGNING (BY HANO IN. INK}° and entering the DATE of receipL
r, ASSISTANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT, STORAGE. OR OJSPOSAL FACILITY DESIGIIATEO 1
F=l:ECH,'I': THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WE~KOAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bure.au of Solid &. Haz.ardou.s Waste Mgt.
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
ewriler
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
N C D 0
3. Generator's Name and Mailing Address
Channel Master
_P. 0. Box 1416,
C. Generator's Phone 919
5. Transporter 1 Company Name
Smith field,
934-97li
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
l
6. U.S. EPA ID Number
S C D O 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class. and ID Number)
a. ·Hazardous
NA 9189
Waste, Solid,-nos ORM-E
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71574
Emergency & Holidays: (803)734-5-424
Form A
2. Page 1
of
roved. 0MB No. 2050-0039 E.x 'res 9-30-U
Information in the shaded areas is not
required by Federal law, but is by State law.
·a.;--:-~=~••>· , .. •;,, -=·-~-.,,.,.,.,,"'·""1 .. ,,'.·-·<.,,·,;", ...
j~;:;:~\Ld'.~'./'./U.)~---::~-\~ :,;::>:'.'::::. : .. •/: :: ·_: ~::~ -£.=, ;\~~:~~t:~:;;:\f~?J~=
c?s,.ie ,
o:tr ..
12. Containers 13. Total Quantity u. Uni! rwutatMmrw=·f-
No. Type 'MNd (;/\:',(:-.',~!;:' fj-.·:~tf
1, D_ T
11. GENERATOR'S CERTIFICATION: I hereby declare that lheconlents olthls cons!vnmenl ere fully and accuratelyde1crlbod above by proper ahipping name al'ld are cia...,fled.
packed, marked, and la.beled,and are in all rupact11 In proper condition forlransportbyhlghway according toappUcabla lnlernallonal and national government r~ulationa and
U'le lavwa ot !he S1.ata of Soult! c.;a,ollna,
111 am a largo Quantity generator, I certify that I have a program In place to reduce the volume and loxlc:ltyolwHtegoneraled lo thedegrN I have datarmlned to be .conom'calty
precticable and th al I have selected lhe pracUcabte melhod ol lreetment. 1torage, or dl1poaal currantty avaUab1e to me which minimizes tho preaonl end tuture U'ltNI \0 num.n
heallf"I and the environment: OR, 111 am a smol1 quanlitygenoralor.l have made a good failh etlortto minimize my wuta generallon and ulect the beat wuta managemenl method
trial is avai1a01e 10 me and that I con allord.
Printed/Typed Name L. Loa..,fs Signature Month Yw
17. Transporter l AtKnowledgement of Receipl of Materials
Printed/Typed Name #~ Monlt'I y..,
PnnledlTyped Name Signature Monlh Day Yoar
19. Discrepancy Indication Space
• I pbs. CI libs.
bl pbs. d I libs.
20. Facility Owner or Operator; Certificallon of receipt of hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature M0<11h Day y..,
PA Form 8700-22 (Rev. 9/86) Previous Edition• are Obsolete [OHEC 1988 (Rev. 10/S6))
'":,;
. ?·· ' ' •
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN· f'RESS DOWN HARO ALL COPIES MµST ~E LEGIBLE!
GENERAL INFORMATION: Federal Regulations require gen1m1tors and transporters of hazardous waste and owners or operators or hazardous was:e trea:m1· ·
s10rage. or disposal licilities to use !he U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, ii necess.if)', Iha continuation she·e1 u:s. EPA Fa
8700-22A Rev:9186 (DHEC 1988A) for b0olh inter-stale and intra-slate transportation. Transporters who transport hazardous waste into the United S:ates Ir
another country are responsiDlc !or completing the manliest Federal and Stale regulations also require generators 'and transporters or haz3rdous w.i.s!e arlc'
owners or operators ol hazardous waste treatment, slorage. or disposal lacililies lo co.mplete the ,loftowing information. .• .. I
GENERATOR SECTION
1. Generalor's U.S. EPA ID Number-Manilest Document Number: Enter lhe generator's U.S. EPA twelve digit idenlirication number and :he unicue t1ve d1;11
number assigned to this manifest by the generator beginning with 00001.11 your company docs not have a U.S. EPA Identification Number. please con:act S.C.
OHEC at [phone] about obtaining an ldenlilicalion number. · · I
· 2; Page 1 of: Enter the total number of pages used to complete this manirest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (P.~V 101.86)].~lus. 1
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any. ,--:
A. Stale Manilest Document Number. .Leave blank.
e:
1
••
Slate Generator ldenliflcallon Number: Leave blank. I
Generalor's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifes: forms, : -r 1
Gener11or'1 Phor\e Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in :ne even: cl
emergency including nights, weekends, and holidays, ·
5. Transport 1 Company Name: Enter the company name of lhe first transporter who will transport the.waste.
6. U.S. EPA 10 Number: Enter lhe U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. 'Slate Transporter's 10 Number: Leave blank.
O. Transporter's Phone Number: 0Enter a te1eph0ne number including area code where an authorized agent ol the first transporter can be reache-:! in the even1 of
an emergency in_cluding nights. weekends, and holidays. . . __ _ . · ·" .', . · .-~ .• ,
rr8n~porter 2' c~~pany Name: II applicable, enter the cOmp~~y rlame'Oi the sec-;,;d1,aM·porte,'~i,o will.tra'n'sp0r1 the waste. II more thari 2 lraris;::,orters' .
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and Hsi the transporters in the order they will be transoor.ing !he wa
U.S. EPA ID Number:ll applicable, enter the U.S. EPA twelve digil ID number ol the second transporter idenlilied in ilem 7. 8 ..
E .. State Transpor1er's ID Number: Leave blank. · ·
F .. Transporter's Phone N~mber: E~ter a telephone number i_ncluding area code where an 'auth~~ii;d~a·geni'Ofth'e seCOnd-transporter can be reacr,e-: in I
9.
10.
G:
event ol an emergency 1nclud1ng nights, weekends. and holidays. · · ,.. · • · • .,. " .,. -1
Designated Facility Name and Sile Address: Enter the company name and site address ol the lrealment, storage, or disposal facility desii;;naled :o receive li",e
waste listed on this manHest The address must be the site address, which may ditfer from the_.marnr1f(a'ddi'e.Ss:-.. -· ,~ -~ ~ 1• • ·• <;
U.S. EPA ID Number: Enter the U.S. EPA twetve digit identirication number ol the designated treatment, sto-r,i{fe: or disposal lacilit-i iden:1fied in item 9 .•
State Facility's ID Number: Leave blank. ..,
H;. Facility's Phone Number: Ent~i a telephone number including area code where an authorized agent of the' facility can be reached in ::-.e event ol an
·emergency including nights, weekends. and holidaYs. -.
~.$; DOT Descriplions: Enler proper shipping name, hazard class and IO_Num.ber (UN/NA) !or each waste as identilied in 49 CFR l 71 • l ii. II aCCi:icnal so'
1s needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. .,., " ,,..1 __ , •• , .. ., . -• ,~., ,r., ,... ,..
12.. Containers (no. and type): Enter. number ol containers !or each waste and the appropriate abbreviatl9n lrom Ta~le I (below) lor the fype ol c_ontarners.
. TABLE I -
OM = Metal drums. barrels, kegs TT:::: Cargo tanks (tank trucks) -:-.. ,. ,.CM =,Metal boxes, canons. cases, roll ct1s· ::-, ....
OW= Wooden drums, barrels, kegs TC= Tank cars . CW= Wooden boxes. cartons. cases .
OF• Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF II Fiber or plastic bo·xes. car.ens. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plas::c Oags
13 .. Total Quantity: Enter total quantity ol waste described on each line, relative to the unils used in.item 14 ... ..,_..,_,, ,--. , ..... -r, -~,, .... _ ~ .1 I
TJ. Unit {weight/volume): Enter the appropriate abbreviations lrom Table II (below) for the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liouid cnlyJ
I. Wasle Number: Enler hazafdous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Su::::,ar:s C ar:C I
identity the hazardous waste on each line.
J. Additional Descriptions lar Malerials Listed Above: In 1he spaces provided, enter the authorization number (rrom the S.C.-OHEC·Au!horizat1on ReQuest Fo ,
!or each waste stream list1-1d in section 11 above. Note: Before any hazardous waste can be accepted for treatment storage or disposal in Soutn Care/in a. tne
generator must obtain prior authorization lrorTI the treatment, storage or disposal facility. -· · ··-· •· " -·· :-. 1-·-·,· ·1
K.. Handling Codes lor Wasles listed Above: Leave blank. · · . o:· ,, ·
15. Special Handling Instructions and Additional lnlormalion: Generators may use this space lo indicate special lransportation, !reatment. stOrage or dis;:Jo I
inlorma1ion or Bill ol Lading Information, For international shipmenls. gcneralors must enter in this space the point of departure (city anc s:ale) !or :r:ose
shipments destined !or treatment, storage, or disposal outside the jurisdiction ol the United Slates .. : · ·.. .. -· ~ e: ,., , ., I
i6. Genenlor Certillcalion: The generator must REAO,'SIGN (BY HANO IN INK), and DATE the certification statemenl. II a mode other than highway is usec.
word "'highway" sh,;,utd be lined out and the approprit!tc mode (rail, water .or air) inserted in lhc space below. II another ~ode in addition :o tl",e hignway 010c
used, enter the appropriate additional mode (e.g.;.and rail) in the space below.
TRANSPORTER SECTION . . . . ,., .,, ,,, :,:. ,, """I
11: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste ~n behall 61 the first transporter. That person rr.us: ackno ... 1e
acceptance ol the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE ol receipt. -· , , ,. , ·,·.~ :· · , .. ,
18. Transporter 2 Acknowledgemenl: Enter. ii applicable, the name ol the person accePting the waste on behall ol the second transporter. Tha: ;:erscr: r:·a.:5:
acknowledge accept.Jnce ol the waste described on the manilest by SIGNING (BY HANO IN INK} and entering·the DATE of receipt , . ~· -"1.
FACILITY SECTION. . . . .
19. Discrepancy Indication Space: The authorized represenlative or the designated facility's owner or operator must nole in this•space any discrepancy ~e1..;. .
the waste described on the manilcsl and lhe wastO actually received at the facility. Owners and operators of facilities who cannct resolve s1g:iitica~:
d11cre.i:i_ar,cies w,1hin. 1 ! days receiving the woste muSt submfl 10 the Oepartmenl a lencrwilh a copy ol lhe manllest describing the discreoancy ar.c: a~tr.,::I
reconcile iL The trealment. storage, or dlsposol locHlly must enter !he aCtuol weight ~I waste in pounds in lhe spaces provided ii the amount var res any ir:::;m :
soecif1~d by lhe generator in ilom 1.'.l or ii the oene,ntor usos a unit ol mcns11ro other th.in pounds. . ,.
20. F1cllily Owner or Operator Cerlllleatlan: Print or type the n.ime ol the person occcpting the wash! on b'eholl ol lhe owner or oper;:,tor or the l,.1col,1y. T t1,.11 .,.,.,~On
must acknowledge acceptance ol the waste described on lhe manifest by SIGNING (BY HANO IN INK)' and entering lhe CATE or receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FAClUrY OESIG~~A.iEO I
AEC!'"IE THE WASTE On THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
C ,,
I South Carolina Department of Health
arid Environmental Control
Buraau of Solid & Hu.ardous Waste M;t
2600 Bull Str~t. Columbia.. SC 29201
Phone: [phone]
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name 8nd Mailing Address
Channel Master
ewrlter
1. Generator's U.S. EPA ID No.
N C D O 7 0
P. 0. Box 1416, Smithfield, NC 27577
4. Generatofs Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
1
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Cfass. and ID Number)
Hazardous Waste, Solid,-nos ORM-E
NA 9189
15. Special Handling lnstrucijons and Addlllonal Information
GSX Work Order No.: 71575
Form A
2. Page 1
of
Emergency & Holidays: (803)134-5'24
roved. 0MB No. 2050-0039 E.r ·res 9.30.ga
Information in the shaded areas is not
reciulred by Federal law, but is by Stale law.
l1i:lti=:~,-=t;::_}_r~:~~~;\.~~Ji·t·
il&~,0tt~i1t;:i~t;;;I};Jm/~2;~~:\t~NJ;;ij·
12. Containers 13. Total Ouantily tt Unit L'w.-~•-+
No. Type 'MNcl '\(::>:;·.<;;::: i'.>",!;:1
t,. D.T 2 0 Y
18. GENERATOR'S CERTIFICATION: I herebydecl•r• lhatlhe conlonts olthle conelgnmenterefully end eccuretolyde1crlbed ebove by proper 1hlpping name end are cta, .. ned.
pecked, marked, and labeled, and ere In all ,e,pec111 in proper condition for transport by highway according to applicable lntornallonal and notional govarl'lmen1 re,gulat1on1 and
Vie 1 ..... Ol lhe SUIIO ol Soult! Carolina.
111 am a largo Quantity generator, I certify that I have a prOQram In ptaco to reduce the volume and toxicity of waste generated lo the dogree I have determined lo tM economically
prac1icable and that I have selected lho praclicable method of treatment. storage, or dlspoaal currently available to me which minim I let the present and future U'lrMI to l'luman
healll'I and tl'le environment: OR, 111 am a smon quantitygeneralor,I hove mado a good failh enortto mlnimlie my wa,ta genera lion end ,elect the be11 wute management .,,.thodl
rnal i, availatile 10 me and 11'181 I con allord.
Printed/Typed Name "fZ_.o
' 17. Transporter l At.:1mowledgement ol Receipt of Materials
Prinled/Typed Name '
Printed/Typed Name
19. Discrepancy Indication Space
Signature
Signature
20. Facility Owner or Operator; Certilicallon of.receipt ol halardou, maier/al, covered by this manilosl excepl as notod In Item 19.
Prinltd/Typtd Nam, Slgnalure
PA Ferm 8700·22 (Rev. 9/86) Previous Edition, are Obsolete fOHEC 1988 (Rev. 10/86)1
• I
bl
Month Day Year
cl ~ 2-
Month Oar Year
pbs. C I libs.
pbs. d I jibs.
Monlh Doy YN/
IMPORTANT:.
GENERAL INFORMATION: Federal Regulations require generators and trnnsporters ol hazardous waste and owners or operators ol hazardous was:e treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if neC:ess8iy","the contin·uation she·e1 U.S. EPA FO
8700-22A Aev:9186 (DHEC 1988A) loi both inter-slate and intra-stale transportation. Transporter_s who lrarlsPaDhaZ'ardous waste into the Unite_d Sta!es Ir .,,
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters o! hazardous ..-.·as:e a:--.c·
o~ners or operators al hazardous waste treatment, storage, or disposal laci!ities to complete the !allowing information.
GENERATOR SECTION I
1' Generalor's U.S. EPA 10 Number• Manifest Document Number: Enter the generalor's U.S. EPA twelve digit idenlilicafion number and :he urncue live dii;1t
number assigned 10 !his manilesl by the generator beginning wilh 00001.11 yourconipany does not have a U.S. ERA ldentilication Number. please;con,:act S.,C;
OHEC at (803) 734•5200 about obtaining an ldenlilication number. . .,.. --·· -, ,, .•
2; Page 1 of: Enter the total number of pages used to complete this manitest, i.e .• the flist page EPA Form 8700-22 Rev. 9/86[DHEC 1988 (P.EV 10186)} i:lus:
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any.
A. Stale Manilesl Document Number: .Leave blank. ,, ,. • •· · ··• · ·ri,...,I
e: Stale Generator Identification Number: Leave blank. ;i :, 11
1 Ceneutor's Name and Mailing Address: Enter the name and (!'lailing address of the generator who will manage the returned maniles: !arms.
A. Gener1tor's Phoiie Number: Enter a telephone number with area code where an authorized agent.of the generator can be reached in :ne event o( . "
emergency including nights, weekends, and holidays. · "" •r . ,;: 1 •
5, Transport 1 Company Name: Enter the company name of lhe first transporter who will transport the waste. I
6. _U.S. EPA ID Num~er: Enter t~e U.S. EPA twelve digil identiricalion number ol the first transporter identified in item 5.
C. Slate Transporters 10 Number .• Leave blank: •. •· _, ·:-...•. '-•·--"'· _ •· . .-.._,, --·. ,•< ~ . ~ -.c..,.,
0. Transpor1er's Phone Number: Enter a telephone number including area code where an authorized agent of the lirsl transporter can be reache::! in me event ol
an emergency_ir:i_~luding·nights, weekends, and holidays.__ ..... . ... ··-·••--· . -···· · · .. · · .. ·-_ · · -, : I
Trarlspor1er 2° Company Name: II 3pplicable, enter the company name ·01 the second transpo·rter who wili'transp6i-t the waste. II more thari 2 traiis:io·r12~s
be used. use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:1r:g :ne wa
8 .. U.S. EPA 10 Number:I1 applicable, enter the U.S. EPA twelve digit ID number al the second transporter identified in ilem 7.
E .. SLiile Transporter's ID Number: Leave blank. • _ ·
F •. Transporter's Phone N~mber_: E~ter a telephone number i_nclllding area code whe;~ ~~,~~th.or;:;fa~~~,'~!'th~ ~~~b~dl~·nspor.er can,!:e reacr.ec in ti
event of an emergency including nights, weekends; and hohdays. : .. , · . ; -·· ~ - -· • 1 ·-:c, :; ,. ~-b•
Designated Facility Name and Site Address: Enter the company name and site address of the treatment, Storage, or disposal facility designate-: :c receive 1:-,e . •·t.-~•-•---'-'•r·-•-...,•• ••'·•••-, ,••,·• ,... waste listed on this manirest The address must be the site address, which may dilfer lrom the mailing address. • ~
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the desig~ated tre~tment. stor3ge, Or disposal facility i~en:i!ie:=}n 1:~r:, 9 .•
9,
Slate Facility's 10 Number: Leave blank. · '
H;. Faeilily's Phone Number: Enter a telephone number including area code where an authorized agent of ·the facility can be reached in :t·."e event ol an
emergency including nights, weekends, and ho1ida)'s.
U.S: COT Oe,crlplians: Enter proper shipping name, hazar_d class and ID Number(UN/NA) for each waste as identified in 49 CFR 171-1 ii. II aCci:icr.al sol
10.
G:.
11:
is needed, use a U.S. EPA Form 870~;22.~ Rev. 9~~6 (O~EC 1988A) Continuation Sheet. .,. .. "',·•n•• ,,..~,.,.1,--.,,-..., nv-· -.,., "'"' __ J, ..
12.. Containers (no. and type): Enter number or containers !or each waste and lhe appropriale abbreviation from Table I {below) lor 1he typ~ or c~ntainers, TABLE I .. . • ,l ' "·''.' ' . .._, . . . · ' .,•. ;. ··
OM= Metal drums, barrels, kegs TT= Cargo tanks (t_ank trucks)u • __ .<;;M_ =,.~,el_a! ~oxes,.ca.rtOflS .. ca_ses. r911 _ctfs .•
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard o·r plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or p!as::c :ai;s
13 .. Total Quantity: Enter total quantity of waste describe"d on each line, relative to lhe units used.in item 14. I
14. Unit (weighl/volume): Enter the appropriate abbreviations rrom Table II (below) ror the unit of measure: ·
Table ll
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallor:s (liQuid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Sut::iar:s C ar.c I
identity the hazardous waste on each line. .
J. Additional Descriptions lor Materials Listed Above: In the spaces p·rovided, enter the a~thorization number(from the S.C.-DHEC AuthonzaI1on Request F.o , .
for each waste stream listr.d in section 1 ~ above. N-ote: Before any hazardous waste can be accepted for treatmenl storage or disposal in South Carc-lina. tne
generator must obtain prior aUthorization lrom the treatment, storage or disposal lacility. -.~ ·" •-~-::·-· ... ,. •:-, t-., ·.···r. 1··" , ,.
K. Handling Codes tar Wasies Lisled Above: Leave blank. · . . . . • • • -r ,,, ,.;. .
15. Special Handling Instructions and Addilional Information: Generators may use this space lo indicate special transportation. treatment. storage or dis;)o
information or Bill of Lading· lnlormation. For intcrnotional Shipments, generators mus! enter in this space !he poinf or departure (city anc s:a:e) tor :nose
shipments destined !or treatment, storage, or disposB:I outside !he jurisdiction of the United Slates. · -" · :.--•• • . ·« _.,., • .• .. _,,.. .,,
16. Gen en tor Cer1illcation:· The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. ti a mode otner !han hignwiiy is Usec .•
word "highway" should be lined out and lhe appropriate mode (rail, water.or air) inserted in the space below. Ir ano!hcr mode in additior: to tr.e nign·Nay r:ri,oc
used, enter the appropriate additional mode (e.g.,,and rail) in the space below.
TRANSPORTER SECTION • . ' · · ··· •• ·
11: TransPoner 1 Acknawledgement;,·.Enter.(he name1of the.person a.ccepting,the waste on beha/1.ol lhe first transporter. That person rr:us: ackn-'";.._iel
acceptance ol the waSte described on the manifest by signing (BY HAND IN INK) and entering the DATE 01\eceipl: . , ·---~ ~ '.. .. ,.·. ·•·c, .... , -.f
18. Transpor1er 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf of the second transporter. Tha! ~erscr. mL..:s:
acknowledge acceptance ol the waste described on !he manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt. · -c ;,1 , •• ,,,..,.,
. FACILITY SECTION . I
19. Discrepancy lndicalion Space: The authorized represent<llive ol the designale'.d facility's owner or operator m~st note in this sPace any Ciscreo·ancy b.§1-;;.
u,e waste described on the manifest and the waste actUqlly received al the lacility. Owners and operators ol facililies who cannct resolve si;:,1!ica:-.:
discrepancies within 15 days receiving the waste musl submit to the Oepnrtmenta letter wilh a copy of.lhe manifest describing the discrepani:y ar.c:: a:':em:::I
reconcile iL The treatmenl. storage, or dlsposol Jaclllly musl enlerlhe actual weight ~I waste in pounds in lhe spaces provided ii the amount varies any !r:;r., t :
specified by lhe generalar in itom 1J or ii tho oonorator usos o unit ol monsuro other than pound.s. . .
20. F aclllly Owner a, Operalor Cerllllcatlon: Print or type the name oftho parson accoplino the was tu on,behnll of the own_cr or aper.itor ot thtt t.lc1t.1·1. Tt,.l! pi:r~on
must acknowledge acceptance ol lhe waste described on the manilesl by SIGNING (BY HAND IN INKfand entering the DATE or receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIG,.HED I
REC,"JE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8;00 am TO 5:00 pm.
· rn'")
;,r ,.., i' 1~,
I South Carolina Department of Health
,. and Environmental Control
Bureau of Solid & Ha.z.ardous Waste M;t
2600 Bull Street, Columbia. SC 29201
Phone: [phone]
SE PRINT or. TYPE
UNIFORM HAZARDOUS
WASTE MANIFEST N C D 0
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
t. Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transparter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC t9125
NC 27577
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. OOT Description (including Proper Shipping Name. Hazard Class, and ID Number}
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71576
Form A
2. Page 1
ol
Emergency & Holidays: (603)734-5'24
roved. 0MB No. 2050-0039 E.xDire.s 9-30-e.8
lnlormation in the shaded areas is not
required by Federat law, but is by State law.
:~:tl;:~tt~t1;0i~i:i;:'i)::::::;·; ·i:'~::{:(:~,;:r:~~~tt.-~;t~)-:{ ~,
:ffil~l~l~~m:~~g~Jb~/-4'.g-~~~tf~jJj
12. Containers 13. TotalOuantity 1~.Unil l'WalltMnl>lr'':'~
No. Type Wt.Nr:J. \~\==·::;<:•.,.~;/.-t:i;j.;·l~tt
LDT 2 0 Y
..........
L...1......1......L--.J' ¼'. ,~;
-==~·:·:::~. tJ' L. -'--'--'-...JI ~
P'.~ I -1-:1
1e. GEMERATOR·s CERTIFICATION: I hereby declare thet the contents of this con1lgnmenl ere rullyand accuratelydoscrlbod abov• by proper ahlpplng name and are claaa,ft.cl.
packed. marked, and t8beled,and are In all respects in proper condition !or transport byhlghwey according to appllcable lnternallonal and naUonal government r~u1auon1 and
U'le taw1 ol lhe Stale ol South Caroline. ·
If I am a large quantity generator, I cortily thal I havo a program In placo to reduce the volumoand 10_11.lclty ofwa1tegoneralod to the deg,_ I hava delermln.cl lo be ecOf'lomlc.ally
pracucable and that I have ■elected !ho practtcablo method ol treetmont. storage, or dlspoaal currently available to mo which minimize■ tho preMnt and luture ~'UNI 10 l'n,,1man
health and the environment: OR, 1r1 am a small quantitygonoralor, I have mado o good faith atrortto minimize my waste gonoralion and sa1oct tho bell was le management mee1"1od
trial is availaDlo 10 me and that I can allord.
Printed/Typed Name
Printed/Typed Name
19. Discrepancy Indication Space
• I pto.
bl Jlbo.
20. Facility Owner or Operalor: CertHicallon of receipl ol hazardous malerials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature
PA Form 8700-22 (Rev. 9/86) F'revious_Edllions nre Obsolole [OHEC 1988 {Rev. 10/86)1
Monlh
0 Ii'
Monlh
Month
"
C I
d I
Month
Day Year
1~
pto.
Day y..,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST 'I
IMPORTANT: TYPE [on a 12-pltch (elite) typewriter] OR USE FlAM POINT PEN· PRESS DOWN HARD~ · ALL·COPIES MUST BE LEGIBLE!
. ' ' . ,., . . '
GENERAL INFORMATION: Federal Regulations require genP.ratorsand transporters of hazardous waste and owne~S or operators al ha~ardous_ w_a~te tr-~~tm!?1·
storage. or disposal licilities to use lhf: y.s. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)Land, ii ne_c~.~sary,_the co_ntinuation she_e_t l:J~~-E~_A FC?.
8700-22A Re'l.-9186 (DHEC 1988A) !or both inter-state and intr.i-slatc lrnnsportation. Transporters who lransport hazardous waste inI0 the United S:a:es Ir
anoIher country are responsible for completing the manifest Federal and Stale regulations also require generators.and transporters of hazardO':;!S .-.-~~:e __ a~g
owners or operators of hazardous waste treatment. storage, or disposal facilities to complete the following inlormation. ~ __ · •
GENERATOR SECTION
t. Generator's U.S. EPA ID Number• Manilesl Documenl Number: Enter the generator's U.S. EPA lwelve digi_t identirication number and :he unicue five dit;i!
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:ac: S.C.
OHEC al {803) 734-5200 about obtaining an identification number. I
2.: Page 1 of: Enter the total number of pages used lo complete this manilesl, i.e., the fifst page EPA Form 8700-22 R~v. 9/66 {OHEC 1988 (P,EV, ~/ 86)1 ~lw_s:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any. · __ ,,.,_ ~-· .-:~-· · · · • ·! ., .... ,., '"'" !' · c,;.,. . .,
A. State Manifest Documenl Number. .Leave blank. ...... · ... '1 :--' :.,~
e: State Generator ldentiflcallon Number: Leave blank. · I
3. Generator's Name and Mailing Address: Enter lhe name and mailing address of !he generator who will manage the returned manifes! forms. ·
"· Generator's Phoiie Number: Enter a telephone number with area code where an authorized agenl·ol the generator·can be reached in tl"le event 011
emergency including nights, weekends, and holidays. · r r , :~ '·'""lC')~
5. Transport t Company Name: Enter the company name of the lirst lransporter who will transport the waste. I
6. -U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the first transporter identilied in·item 5. · ·"" ~ .J
C. "Slate Transporter's ID Number:. Leave blank: "': ·
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reache'= in 1r.e event of
an e"'.lergency_ including nights, weekends. and holidays. . . ' · ' · · · I
. T.. Trinsporter 2° Co~pany Name:. II applicable, enter the c·o~p~~y name Oi the se~Ori"d"ir.il1s"POrter who wm·1,ansPOi-t the waste. If more thari 2 trans~orters
be used. use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheel and list the transporters in the order they will be :rans~or.1r:g :he wa
8 .. U.S. EPA ID Number:!! applicable. enter the U.S. EPA lwelve digit ID number of !he second lransporter identified in ilem 7.
E.. Slate Transpor1er's ID Number: Leave blank. I
F --Transporter's Phone Number: Enter a tele"phone number including area code whe~e aA1 a"Uth0ri~e1rag~er:10(1h'e sE!C"oi{"ct°"tr·ansporter can be reacr:ed in !
event ol an emergency including nights, weekends, and holidays. • , .., ,. -: ,
9. Designated Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal racirity designatec :c receive 1ne
waste listed on !his manifest The address mus! be the site address. which may differ from the mai1ing"'a"dd.re.Ss~ ... ·--· -'"' --·• "' · ·-; ~ · I
10. U.S. EPA ID Number: Enter the U.S. EPA twe_lve ~igit identilication number ol the designated treatm·ent. storage: (Jr disposal facilit-/iCen:1fie:::: ,.in 1:ern 9.
G: Slale Facility's ID Number: Leave blank. • . · ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent oi the facility can be reached in :ne event al an
emergency including nights, weekends. and holida)'s. .
11: u.s: DOT Descriptions: Enler proper shipping na. me, hazard class and 10 Number (UN/NA) ror each wasle as identified in 49 CFR 171-171.11 acci:icr.al s~t
is needed. use a U.S. EPA Form 8700·22A Re~. 9./86 (_DHEC 1988A) Continuation Sheet. , ~ ~·-' . .... . , ,,~ ,.. __
12.. Containers {no. and type): Enter number ol containers !or each waste and the appropriale abbr9vialion lrom Table I (belo~)_lor ,;t1e !'/Pe ol cP:::in1a1ne_rs
TABLE I
OM= Metal drums. barrels, keQs TT= Cargo tanks (tank tr_ucks) -·-.,CM =_Meta_l boxes. cartons. cases. rel! cHs· .•
OW= Wooden drums, barrels, kegs TC= Tank cars · · • ·cw= w0oden boxes. cartons. ca.ses .
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic bo;,,;es. car.ens. c"ase~
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic Oags
13 .. Total Ouantily: En!er total quantity ol waste desCribC:d on each line, relative to !he units used~~" item_ 14. I
1.a. Unit (weight/volume): Enter lhe appropriate abbreviations lrom Table II {below} !or the unit al mc.:isure: .
Table II
P = Pounds L = Liters K = Kilograms T = Tons M :: Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallor:s (liquid cnty)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Su:::,ar:s C ar.c I
identity the hazardous wasle on each line. ·
J. Addilional Descriptions lor Materials Listed Above: In the spaces provided. enter the authorization number (lrom lhe S.C. DHEC AuIt1orizat1on Request F o. ,
for each waste stream lislP.d in seclion 11 above. Nole: Be lore any hazardous waste can be accepted !or treatment._ storage or disposal in Sou1t1 Carc-lina. 1ne
generator must obtain prior authorization lrom the treatment. storage or disposal facility. -• -. • , · -.--: ..•
K. Handling Codes lor Wastes Listed Above: Leave blank. . H ,
15. Special Handling lnslructlons and Addillonal lnformalion: Generators may use this space lo indicate special transporlation. treatment. storage or dis po I
information or Bill ol Lading lnlormation. For international shipmenls, generators mus! enter in lhis space the point al departure (city and s:ate) !or tnose
shipmenu destined tor treatment. storage. or disposal outside the jurisdiction ol the United Stales. · _ _ _
16. Generator Certillcalion: The generator must REAO,"SIGN (BY HANO IN INK), and DATE thecertilicaIion statement. II a mode other man higt1way is ~sec .•
word '"highway" shoutd be lined out and lhe appropriate mode {rail. water.or air) inserted in the space below. U another mode in additior, :o lr.e t1ignway r:ioc
used. enter the appropriate addilional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalf of the lirst transporter. That person rr:ust ackn:i·.-.lel
acceptance ol lhe waste.described on the manilcst by signing {BY liAND IN INK) and enlering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf ol the second transporter. Thai ~erscr: r.-:~s:
acknowledge acceptance al the waste described on !he manilest by SIGNING (BY HAND IN INK) and entering the DATE al receipt. . .
FACILITY SECTION . . I
, 9. Discrepancy 1ndicalion Space: The authorized represcnlative al the designated facility's owner or operator must note in this space any discrepancy ~et·,...
the waste described on the manifest and the waste actUally received at the facility. Owners and operators ol lacililies who cannct rescl-.·e s,g:-.ilica:-,:
discrepancies within 15 dnys receiving the wast~ musl submit 10 the Dflpartmenl a lefter with b copy ol the manifest describing the discreoanc:y ar:d a:-:e".'c:I
reconc,te it. The I,eatment, sIorage. or dlsposol laclllty mus! enter the actual weight ~I wasle in pounds in the spaces provided ii \he amounl ·,arIes .any !r:;m: ,
specified by lhe gener.ilor in itom 13 or ii ,no generator uses a unit ol monsure other than pounds. .
20. F•clllty Owner or Operator Certification: Print or type the name ol tho parson .iccopling lhe was lo on behnll or the owner or operotor ot 1he f.Jcil,1y. T t,.Jt Pt:>r~on
mus! acknowledge acceptance ol the wasle described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE ol receipt
IF .ASSISTANCE IS NEEOEO 1N COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGrureo I
RECr1'/E THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT {803) 734•5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haz.ardous Wasle Mgt
2600 Bull Streti~ Columbia, SC 292'01
Phone: [phone]
I
l~E PAINT or TYPE (F0rm desi0ned for use on elite f12•Dilchl tvnewriler)
UNIFORM HAZARDOUS ,,. Generalor'sU.S.EPAIONo.
WASTE MANIFEST N,C,o,n.0,7,< n,,.
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor'sPhonel 919 I 934-9711
Emergency & Holiday~ (803)734-5"24
Form A "roved. 0MB No. 2050-0039 Exe>res 9-30-38
Information in lht shaded a<HS is nol
required by Federal law, but is by State law.
f~~~=;=~:~-~::.::ii:~~:fh~t~~;~-:\
it;~~~~f )~~~lS'~:~='::::~:~\2~;;_:;~~j;;rttr;:~:·
5. Transporter 1 Company Name 6. U.S. EPA ID Number 'CSStlfi{···,:•'·"·'·'·"'.,. .. ,_, ·,c.to:N->;··· ·•'l >: ·. ;,:.,,' );,·Ufy~·•.,
f-7-_..:T~'"'.i"'n;"'~"":"".s""r-2 ... ~0.,.rm.,,up"'~"'~"'~-'-:"':'-e-'C"'o'-',.'-'I"'nccc,,_,_. ______ _j~L,.Sa.~L;"-.'~L~ll:Ll!,.!~L'N.L:;Lbe~1!Lr'·...1'Li'°';i...;°'ZL7,!L2L.Clo.iµ·~(:.;~;l,!\!1"~''·····.· .. ,~IJ::;:n.:/;7~7.~,:::~ ,,
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood. SC 29125
1· I I I I I I I I I I I "FXf•'"'• , . ..,,, .. ,._11·m.:~:.;../,;•-:~·.,,.-·,,,.:.:,,--~.,'.-.:'"·.\~,~-~:<':'\>···
11. U.S. COT Description (including Proper Shipping Name, Hazard Clas,, and ID Numb6r} 12. Containers 13. Total Quantity 14. Unit l'Waslll PMnber\·'i·
No. Type 'M.Nd >\<::';-•?;-:' :;/)~~~~l
L Hazardous Waste, Solid, nos ORM-E ~pr-;-o,T",·9,i
~ l-...!N~A~9:'._;1~8:'.;9:_ _______________________ i-·i.: ·"~·~•I::, f:D'..:_-~,T~..l'LJ'LJ'~2:..•L'.:o'...!.-...!y~~'::!;1 l::f:::i::D::l::0::'::6::l'..;.?:J.
l D. ' ' ' ' ' ' • ;,]:" : • :1·
R C.
l
T
R
R T
' ' ' ' ' ' '
d.
I. 0 I . ' ' '
15. Special Handling Instructions and Additional lnfor'mation
GSX Work Order No.: 71577
18. GENERATOR'S CERTIFICATION: I herebydoclaro lhat the contents ollhl, conalgnmontare lullyand accurately do,erlbod ■boY0 by p'rop,er 1hlpplng name and are cla ... fled.
packed. marked. and laheled, and are In 1111,rospects in propor condition for transport by highway according to appllcablo lntornallonol and national government r~ulationa al'\d
u,e laws ot 1h11 Stale ol Soulh Carolina.
II I am a largo qu■nllty generator. I certify that I have a program ln placo to reduce the volume and to,dcltyol wa,togoneratod lo the dOQrH I have determined 10 be e<:Of"lomic.11:,
prac11cable and Iha! I have selected the practtcable method of lreatmant, storage, or dlspoaal currently avallab1e to me which mlnlmli.os the prea.onl and lutur ■ U'HNI to human
health and the environmcn~ OR, If! am o small QuanUtygeneralor, I have niado a good lalth effor1 lo mlnlmli.e mywasla generation and Hlect the beat wHII manag■m■nl methOd
trlal is availatila 10 me efnd Iha! I can allord.
Printed/Typed Name 1Z~f1.R;,-/_, G,cJ;s I Signalure
~//A -;;;z c,t,~+, Month Day y..,
' (!, 'ii' I :;;, • ,JO, C. -
17. Transporter 1 Ac,mowledgemenl of Receipt ol Materials V
Prin/,).,Typ~ / .. me Ltft?c,5 ISlgnatur~_,,/_,... ./ L .JJo
Montn Oay Year
, 'fie/_ ~-A ,o" ,::J.J>rf',;
18. Transponer 2 Acknowledgement ol Receipl of Materials ,/ -✓,,
Printed/Typed Name I Signature Month Day Year
I . ' J • J •
19. Discrepancy Indication Space
• I 11t.. C I llb,.
b I pt,,. d I !lbs.
c .
v 20. Facility Owner or Operator; Cer1ificaflon ol receipt ol hazardous molerlals covered by this manilesl except as noted In flam 19.
Month Dey Yw Prinltd/Typed Name J Signature l,.. Form 8700-22 (Rev. 9/86) Previous Edl!lons are Obsolete (OHEC 1988 (Rev. 10/86)l
J , I , I •
.,
STATE OF s°OUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST '·1
IMPORTANT: TYPE [on a 12-pitch (elite) typewriterJ OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE! ',.. . '.~/.,:. ,.,,
GENERAL INFORMATION: Federal Regulations require generators and lrnnsporters ol hazardous waste and owners or operators of hazardous was:e trea:mel
storage. or disposal licililies lo use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and, ii necessary, thEt continuation sheet U.S. EPA Fo
8700-22A Rev.-9186 {DHEC 1988A) lof both inter-slate and inlra-slale trnnsportation. Transporters who transport hazardous waste into the United S:a:es Ir
another country are responsible !or completing the manilesl Federal and State regulations also require generators and transporters of hazardous .-.·as?e ar:c:
owners or operators ol hazardous waste treatment. storage, or disposal facilities to complete the lo!lowing inlorma!ion. ·
GENERATOR SECTION •• Generator's U.S. EPA 10 Number. Manllesl Document Number: Enter the generalor's U.S. EPA twelve digit identification number and the unicue five digit 1.
2:
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:ac: S.C.
OHEC at [phone] about obtaining an Identification number. I
Page 1 of: Enter the total number of pages used to complete this manifest, i.e .• the fiist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 {P.EV, 0t86JJ ~lus:
number or continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. . . • .~i
A. State Manifest Document Number. .Leave blank. · ·
e: Slate Generator ldenliflcatlon Number: Leave blank. · · , · I
3. Generator's Name and Maillng Address: Enter the name and mailing address of the generator who wilt manage the returned maniles: forms.
•· Gener■lor't Phorle Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in :ne event cf
emergency including nights, weekends, and holidays. · · · · · · · · ·~ ,:,r . ., · -.~ ·
5. Transport 1 Company Name: Enter the company name of the lirsl transporter who will transport the waste. ""1•
6. U.S. EPA ID Number: Enler lhe U.S. EPA twelve digit idenlilicalion number.ol_ the lirst transporter iden!ilied jn il~l)l.5. . ••
C. 'Slate Transporter's ID Number: Leave blank. .... '
0. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent of the first transporter can be reache-:: in the' even1 ol
an emergency inc;luding nights, weekends, and holidays. . . . · · · ·. I
Trai,~porter 2·C~mpany Name: II 3p°plicable, enter the c·Omp~~y name ·o; the seC""c;~'dt,ans'J)Orter who will.transp6rt the waste. II more than 2 lrans;:ioners
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheel and list the transporters in the order they will be transoor.1r.g :ne wa
U.S. EPA 10 Number:lf applicable, enter !he U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
SI.ale Transporter's ID Number: Lcavc·tirank. · · · . · •
F.. Transporter's Phan~ Number: Enter a tcle'phone· number including area c~de whe~e an aUth0ri~4d ~agCri't'Ofth'e s·eco·nc!'ira•n'spor:er can te reacr:e'; in t
8 ..
E ..
event ol an emergency including nights, weekends. and holidays. . ..-... 1 1 ,., .... ··,... , ,, ,· ·
Designated Facilily Name and Site Address: Enter the company name and site address ol the lrealment. storage, or disposal facility Cesignatec :c receive u·,e
waste listed on this manifest The address must be the site address, which may differ f(Om"the'mailing·addi-efs: ·~ ~ · ... ,. · ·,
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identilication number ol the designated·tre~t~ent. st~rag~. ~r rdispos~I lacilit"/ iCen:1!ie: .in 1:em 9 .•
9.
State Facility's 10 Number: Leave blank. -· · ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in tr,e event ot an
emergency including nights, weekends, 'and holida')'s. " ·· -~
10.
G:
U.S: COT Oescriplions: Enter proper shipping name, ha.zard class and 10 Number (UN/NA) for each waste as identilied in 49 CFR 171-l ii. II aCCi:icnal soal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation $heel. , ,..~ 1,.,_.,oa,,,_ ci,n .... ~in ,,,,..:11,-,,-r•,~Nl"'i '"' r ,,.. , •.
12.. Containers (no. and type): Enter number"Orc'"onlainers !or each waste and the appropri8te abbre_viatlorl from Table I (below) !or !he typ'.? ol contain.ers. '"" TABLE I , • ~-.. , . . e
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank lr~c~s) .. c-_ .<;M, =,,~,!;!tal b.oxes,.ca,0ons. cases. rcll'ctts . .-:• ... :I
OW 11;1 Wooden drums, barrels, kegs TC= Tank cars CW·= Wooden boxes. cartons. cases·:·\
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car:cns. c'as!:!s
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or p!as::c tags
13 .. Total Quantity: Enter total quantity of waste describ8d on each line, relative to the units useq,in, i,t~.':' 1~.
i.:. Unit (weight/volume): Enter the appropriate abbrcvia!ions from Table II (below) for the ·unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid cnly)
I. Waste Number: Enter haza'rdous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61·79.261 Su::;,ar:s C ar.d]
identity the hazardous waste on each line.
J. Additional Oescriplions lor Materials Li sled Above: In the spaces provided. enter the authorization number (from !he S.C. OHEC Au1honza11on ReQ1.Je~t. F,o,. •:
!or each waste slream lislf!d in section 11 above. Nole: Before any hazardous waste can be accepted !or treatment, storage or disposal in South Carclina. trie
generator must obtain prior authorization lrom the treatment, storage or disposal facility. .. ·1
K. Handling Codes !or Wastes Listed Above: Leave blank. • --. -• ·
15. Special Handling lnstrucllons and Addillonal lnformalion: Generators may use this space to indicate special transpor1ation. treatment, storage or dis:,a
information or Bill ol Lading Information. For international shipments, generators must enter in this space lhe poinl of depar1ure (cit'/ anc s:a:e) !or :nose
shipments.destined !or treatment,.storage, or dispos~I outside lhe jurisdiction ol the United Slates. "· ~ r ~ :.. ' •'•""., __ , . , . ,,,,,,.._ ,.,,:,.1 ,__ .··~ ._ .. , • ., ••
16. Generator Cer1illcalion: The generator must REAO, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than hignway is useo.
word "highway" should be lined out and !he appropriate mode (rail, waler.or air) inserted in the space below. II another mode in addition to 11",e ni;nway r.ioc: .
used, enter the appropriate additional mode (e.g.,.and rail) in the space below. · · ' ·
TRANSPORTER SECTION . . •· " •··" ... • -C ••• ·-I 1i: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalf ol the first transporter. That per·s~n ~us! ·ackn':,-...-1e
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt., -,... . ,1-... ••11 ,.,
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name or the person accepting the waste on behalf ol the second transporter. Thai· perScr. r.1•.Js:
acknowledge acceptance ol the waste described on !he manilest by SIGNING (BY HANO IN INK) and entering-the-DATE ol receipt. ~r. ,., ~,1~
FACILlrt SECTION . I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator mu St note in this·space any discrepancy b~t· ...
the waste described on the manifest and the waste actUally received at the facility. Owners and operators ol facilities who cannci resol·•e s1;:,dica.~.:
dl1c.repan.cies within 15 doys receiving lhe woste mus! submil to the O~pnrtment n teller with a copy of lhe monlfesl describing'1he discreoa'nc··f-ar:d a:-;ern;:::I
reconc1te •L n,e 1rea1ment. storage, or dlsposnl laclllty muslenler the acluorwefghl 91 waste in pounds in lhe spaces provided ii 1he amount ·,ar1es any :r:m:
soecilied by lhe generolor in item 13 or ii the oenerntor usos a-unit ol mcnsi.,re other lhon pounds. .
20. F ~cillly Owner or Operalor Certlllcallon: Print or lype !he nome ol lhc person accepting the waslo on behntl ol lhe owner or oper.ilor or tne lacildy. T r1.:i1 ;,~rson
must aclc.nowledge acceptance ol lhe wast~ described on the manifest by SIGNING (BY HANO IN INk}°and entering the DATE of receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT. STORAGE, OR OISPOSAL FACILITY DESIGelATED I
AECf:11.'E THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
· · and Environmental Control
Bureau of Solid & Huardous Waste Mgt.
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5"24
I LEASE PRINT or TYPE {Form desioned for use on elite 112-nilchl "·-ewriler)
UNIFORM HAZARDOUS 11, Generalor'sU.S.EPAIDNo.
Form A r,roved. 0MB No. 2050-0039 E.lt)ires 9-30-a&
Manlfo11t 'nl 2. Page 1 • Documonl No, ol
1
Information in the shaded ateas is nol
required by Federal law, but is by State law.
I
I
I
I
I
I
I
I
I
T
A
I ..
N s p
0 A
T
I E A
F
WASTE MANIFEST N-C· D· O· q; 7, '-· o, 4, 7, I• , .. n, n, "· a,
7. Transporter 2 Company Name 8. U.S. EPA ID Number
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, I Box 255
Pinewood. SC 29125
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 3, 7, '
11. U.S. DOT Description (including Proper Shipping Name. Hazard Class, and ID Number}
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71578
12. Containers 13. Total Quantity 14. Unit l1W&:illtMnbef~-
No. Type WtNrJ \~(;+~<:-,:'.;-;,::,_;::'._i~<\~
' ' ' I I I I
' ' ' ' '
10. G!:MERATOR'S CERTIFICATION: I herebydoc1arethal the content• of this conslgnmont■re.fullyand ■ccuratetyde,crlbod ■bov• by proper •hipping name and are ct■-t19d. packed, marked, and 1abeled, and are In ell re,pect• In proper condlllon tor tran,port by highway according to appllc..ble ln1orna11onot and notional governme,u ,e,,g..,1at1on, aflCI,
U,e laws ot !he State or South Caroline.
111 am• large quanllty generalor, I certify that I have a PfO'.lram In piece lo reduce the volume and loxlcltycifwaste generated lo Iha deg,_ I have delarmln.-d lo be ■cOl"IOfflic.lly
prac1icable and thal I have 3e1ected the practicable method of trealment. storage, or dlspoaal currently available to me which mlnlmltea the preMnt and lutura tl'UMI to human
health and the environment: OR, HI am a smolt quontitygeneralor, I have mado a good teilh el'fortto minimize my waste generation and solacl tho be•I wall a management ,,...thod
trial is available to me and that I con ollord. · --·•
Printed/Typed Name L, Cv c,.,{-S: I Signature Month Cay Yw
1 C. l?, 1'.f;",f'-.7
17. Transporter 1 Ae;~nowledgemenl of Receipt of Materials U'
Printed/T~
1
Name fY) .
ff' K . CJ£P /...5QIV
·I .Sign31u.re
1 a. Transporter 2 Acknowledgement of Receipt of Materials I
Prinled/Typed Name I Signalure Cay Year 1
I , I ,
19. Discrepancy Indication Space
• I !lbs. C I libs.
I ~f.,,,,...,,-,.,...,,..--..,,.--....,,-,,,.....,..-~ 20. Facility Owner or Operator, Certilicalion of receipt ol hazardous malerials covered by lhis manifesl except as noled In Item 19.
b I !lbs. d I I l'bs.
Prin1e<:1/Typed Name . I Slgnalur.• · I JaPA Form 8700-22 (Rev. 9186) Previous Editions ere Obsolelo (OHEC 1988 (Rev. 10/86)1
Monlh Day y..,
I ' I ' I '
,,, ' .. ~ ' ,,~•, r-!\I ~ • •
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR U~IF~RM HAZARDOUS WASTE MANIFEST' . . . . ,: ~ ,, 1·
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST.BE LEGIB1'
GENERAL INFORMATION: Federal Regulations require genP.rators and trunsporters of hazardous waste and own·ers or operators of ~azardous was:e 1rea:m1· ·
storage. or disposal licilities 10 use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and. H necessary, the con1inuation sheet U.S. EPA Fo
8700-22A Rev: 9186 (DHEC 1988A) tor both inter-stale and intra-stale transportation. Transporters who transPOrt hazarao_us ·waste into !he Uniled Stites Ir
another country are responsible !or completing the manilesL Federal and
0
S!~te regulations also require ger,crators and_ transporters 01 hazardous waste anc
owners or operators ol hazardous waste treatment. storage, or disposal facilities to co.mplete the lollo.wing i~.for~_at.io.· ~-~. :. -~_'. ~~-~-~-:., ~
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest Oocumenl Number:· Enter the generator's U.S. EPA twelve digit identification number and the un1cue five d1g11
number assigned lo this manifest by the generator beginning with 00001. Hyour company does not have a U.S. EPA Identification Number. please con:act S.C.
OHEC al [phone] about obtaining an Identification number, , I
2; Page 1 of: Ent.er th~ total number of pages used to complete this manilesl, i.e.,_the first page EPA Form 8700-22 Rev. 9t86fDHEC 1988 (REV 10186)] ~lus
number ol contInuatIon sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) 1f any. -....... -./' 11.,.,--, ,.,.. ~, • ,·.,.~,-· ,· .-., 1·--· ~. ~ -: -:,.-~1
, k State Manifest Oocumenl Number. .Leave blank. 1 • t,'..:
e: Slate Generator Identification Number: Leave blank. · . I
1 Generator's Name and Mailing Address: Enter lhe name and mailing address ol the generator who will manage the returned maniles: lorms.
,. Generalor's Phoiie Number: Enter a telephone number with area code where an authorized agent ol.the,generator.can.be reached in,:r.e even: ct, ,
emergency including nights, weekends, and holidays. · · · -·"' 1~.:-~~~,;
5. Transport 1 Company Name: Enter the company name or lhe first transporter who will lrc1nsport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identHication number al the first transporter-identified in.item.5. _,. ... , ... ;. . •. i
C. 'Slate Transporter's ID Number:. Leave blank: ,
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the lirst transporter can be reached in the event ol
.an en:,ergency. ir:i<;luding nights, weekends. and holidays... . .... ... ..-.•.. _.. . -·.. . · · • i · · I
· T.. Trinsporter 2' Company Name: II 3pplicable, enter the company name ·01 the second transpClrter who wili'transPcii-t the waste. 11 more thari ?,t__r_a!:ls;iorter~( !
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be Iransoor.1r.g !he wa .
8 .. U.S. EPA ID Number:lt applicable, enter the U.S. EPA twelve digit ID number of the second transporter idenlilied in item 7.
E .. Slate Transporter's ID Number: 'Leave blank. · , ·
F .. Transporter's Phone Number: ·eflleli't~i'eph·o'n1FnJn1ber'i'ncluding area code wh'e-:re ~n4a~th~'rii~'ci"'il9~~fO'fihE! S1tcOrfcI',~anspor1er can be reacr.ed in I
event ol an emergency including nights, weekends. and holidays. -·-· · .,, . • .: · ·
9. Oesignaled Facility Name and Sile Address: Enter t~e company name and site address ol the treatment, storage, or disposal facility desi;na1e-::: :c ro:ceive u·,e
waste listed on this manifest The addre"ss~ITlust be !he SitC"addreSs, which may dilfer rrorfi th8~rn'.ii1irig"'iicfdt·e·ss:~,. -,...,,....,.,..,.,~ ... " · -~ · · ,--•' "-· · -·--
10. U.S. EPA 10 Number: Enter the U.S. EPA·twetveTdigilideri'tilication number ol tht: desighated·frea:tirferit. stcir"age·..-or disposal facility iden:1!ied-in item 9 .•
G: SlateFacility'slDNumber: Leavebtank: · '"'t·""~,nc· '-.•c,<, 1 .• ~,or,c·~l\•"0,·""~---· t> ·,r, •,;;s-,c1•" · "; •
H;. Facilily's Phone Number: Enter a telephon·e· number including area code where ·an autho"riied' ag'e"rit'of the ra·cility can be reached in :~.e event o! an
emergency including nights, weekends. and holida)'s.' -· ·
, ,: U.S: DOT Descriptions: Enter proper shipping name,_ hazard class and ID Number (UN/NA).lor each waste as identi.lied.in 49 CFA 171 • 1 ii. II aCdi:icnal s;,I
is needed. use a U.S. EPA Form 8700-~2A_Rev_. ~(86 (OHEC 1988A) Continuation Sheet. . -~: ,,..,,,.,. -,,-,, ,-10::~· "~-,.,,.. ......... _ ..,, ., ,,..
12.. Conlafnus (no. and type): Enter nufDbe.r ol C<?_ntai,llers !or each waste and the appropri~t~ a.t?,~f~'tl?.Jif?':' fr_orri~i:~~l~_I (belo~).tor tt:e ,!'1Pe ol,c_pntain_ers.
TABLE I . . . .
OM= Metal drums, barrels, kegs TT= Cargo tanks (lank trucks) -=-~-_ ~M =:=. ~elal boxes, ~anons. cases. roll cHs· I
OW= Wooden drums, barrels, kegs TC= Tank cars •' · ~ CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
TP .. Tanks portable CY= Cylinders BA= Burlap. cloth, paper or p!as::c :iags
i3 .. Total Quantity: Enter tot?I quantity al waste descr_ibe'q_on each line, relative to the.unit~.u.se~.i~.ilf::~.J:i,.,...,0 ;...".r'"' ,..,? rpi•.-n~r. .,,,,.,.1p~ ::,,.... I
· t4. Unit (weight/volume): Enter the appropriate :ibbreviations !ram Table II (below) for the unit~! measure: .., ,._,, :,' ·"'!
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (!iQuid only)
I. Waste Number: Enter hazardous waste numbers as specilied in ?outh Carolina Hazardous Waste Management Regulation R.61 • 79.261 Su::-ar.s C ar.d I
identity the hazardous wasle on each line. ·
J. Additional Descriptions lor Materials Listed Above: In the spaces provided, enter the authorizalion number (lrom the S.C. DHEC Authorization Request F.o J
for each waste stream listed in section 11 above. Noie: Be!ore any hazardous waste can be accepted tor treatment. storage or disp0Sa1 in South Carc.lina. tne
generator musl obtain prior authorization !ram the treatment, storage or disposal facility. . .. ... •--. ----· • --,, -·~ ---. .... --·. r·• ....
K. Handling Codes lor Wastes Listed Above: Leave blank. . _ .. •. · .. . · ,r 1 • .. ~
15. Special Handling lnstrucllons and Additional Information: Generators may use this space lo indicate special transportation, treatment. storage or disp I
information or Bill ol Lading Information. For international shipments, generators must enter in this space !he point of departure (ciry anc s:ate) !or :nos~
shipments destined !or treatment. storage. or' disposal outside the jurisdiction al the Uniled· States .. ·: '..~ · :" ........ ' •... -•• ,~ ~
16. G•neralor Certillcalion: The generator must AEA0,·sIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is usec .•
word "highway'" should be lined out and the appropriate mode (rail, waler, or air) inserted in the space below. If another mode in addi!ior. to tr.e hignway moc:
used, enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION , .. , . . •
11: Tr.anspor1er t Acknowledgement: Enter the.name oi the person acCepting the waste on behall·ol the,lirst trans~orter. That person· must ackno .... iel
acceptance al the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE or receipt. _ ,
18. Transporter 2 Acknowledgement: Enter, ii applicable, lhe name of the person accepting the waste on behall or the second transporter. That perscr. r.,•,.:s:
acknowledge acceptance ol lhe wnste described on the mnnifesl by SIGNING (BY HAND IN INK) and entering the DATE or receipt _,, -,,.,-.
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized represenlative al the designated facility's owner or operator must note in this space any discrepancy :-:1· ...
the waste described on !he manirest and Iha waste actUally received at the facility, Owners and operators of facilities who cannct resolve s1g~1licac",:
dlscre.pancies w1lhin 15 days receiving the waste must submit to the Or.partmenl a letter wilh a copy of the manifest describing the discrepancy ar,d a:-:er:i::I
rtconc•I• ii. Tht 1reatm•n~ storago, ordlspoaol lacUlty mus! onter tho actuolweight ~I wosle in pounds in !he spaces provided ii the amount varies ~ny i,:r:i: :
1p•cif1ed by lhe generalor in ilom 1.'.J or ii the generator usos a unil or menstJre olhcr lhan pounds. .
20. Faclllly Owner or Operalor Cerl/1/callan: Print or type tho name ol tho porson acccpling lhc w.:islo on behnll ol lho owner or operator al the l.:ac,1,ry. T t1.Jf ,:,~r~on
musl acknowledge acceptance ol lhe waste described on the manilesl by SIGNING (BY HAND IN INKfand entering lhe DATE ot receipt
IF .ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAG.E, OR DISPOSAL FACIUTY DE$1GfJATED I
AECc''!E THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 nm TO 5:00 pm.
7:•i.;
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Huardous Waste Mgt.
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
LEASE PRINT or TYPE {Form desi ned for Use on ellle 12-itch ewrlter
UNIFORM HAZARDOUS. 1. Generator's U.S. EPA ID No.
WASTE MANIFEST
l Generator's Name and Mailing Address
Channel Master
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
,. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
6. U.S. EPA ID Number
S C D O 7
8. U.S. EPA ID Number
· M11nlleat
Document No. 0 0 0 9 1
Form A
2. Page 1
of
Emergency & Holidays.: (803)7l4-5-'24
roved. 0MB No. 2050-0009 Ex ·r~ 9.30.ga
Information in ·the shaded MHS is not
required by Federal law. but is by Stale law.
~~~g;tM~t#~-~~;:: ;j~:J;{-j(k~'.)·:
:iiil~t~fa:jfi,;:::::\::,;:;-~; -,~·,.:-,:i:,;:_/··•-·; ..
'Ctlsti~-, ~-··.· •··""'"·~. & D:·J~<;··,
6ht" ·■'Phone:,.;.,,
. ·~.T i10·\.;:k·--. --.-~.~;:-: ,...,, .. :-:-;·,;,:~--~.;: ::·, :_;_,_..._
'FN.f_ .. ,.,,~,--...c:., .. ,, ·s, ... ,-.,-... ,. ,z;+~1\.--:,~=--~--=·.:.•--~ :::-:-:"'"'""i.,.+.-'l',:'f:-: :.~ '"i
9. Designated Facility Name and Site Address
CSX Services of SC, ~nc.
Route, 1 Box 255
Pinewood SC 29125
to. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Nam~. Hazard Class, and ID NumbtJr)
L
t.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormalion
CSX Work Order No.: 71579
12. Containers 13. Total Quantity 14. Uni1 .. l'Waita tMabir~
No. Type Wt.Nd. :·•?:~f-:;:--t;\'-:4}.;)~
1 D T 2 0 Y
••• •••••A-.A---••• :.~ g_ ... , ......,_._.._.,1 ~~~
~}' r}J
, e. G!NEAATOR'S CERTIFICATION: I harabydacl■ ra lhattha contant1 olthl1 conslgnrnentarelullyand accuratelyda1crlbed above by proper ■hipping nam• •"dare ciu .. n..:s.
paclr.ed, marked. and labele~. and are In au respecta In proparcondillon for transport by highway according to app11cabla International and national govammanl ra,oulatlon1 al'ld
tne'laws of !he Stale ol South Carollna.
111 am a large Quan1ity generator, I certify lhal I have a prOQram In place to reduce the volume and toxicity of waste generated' lo Iha d&gree I have de1armlnad' 10 be economically
practicable and Iha! I have sa1ecled Iha practicable method ol trealment. storage, or dlspoaal currently avallable to ma which mlnlmli.oa the proMnl and lut1.1ro lfUNI 10 human
heallh and Iha environment OR. HI am a small quonlltyganarotor, I have mado a good laith eNor1 to minimize my waste ganeratJon and select the b<!l11 wa11a managemenl method
tl'lal is availat>la 10 me and Iha! I can allord. ' ~-....,
Printed/Typed Name l, Day Year
l 7. Transporter 1 Ac;"'nowledgement of Receipt of Materials
Printed J ed ~lam;
f (l "V
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name Signature Monttl Day Year
19. Discrepancy Indication Space
• I pb!. C I libs.
b I Jlln. d I pb!.
20, Facility Owner er Operate,: Certlllcallcn of receipt or hazardous malarlals covered by this manifest except as notod In Item 19,
Prinled/Typed Name Signature Month Dey Yur
PA Form 8700-22 {Rev. 9/86) Previous Editions oro Obsote1e (DHEC 1988 (Rev, 10/68)1
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
IMPORTANT: TYPE (on a 12-pltch (elite) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARO· ALL COPIES MUST.BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require genP.ratorsand transporters of hazardous wasleand owners oropera\ors al hazardous wasie treatml
storage. or disposal ficilities to use lhe U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, ir n~cessa,Y: the co.l1ti~uation Sheet U:s. EPA F'O
B700-22A Aev:9186 (DHEC 1988A) toi both inter-state a.nd intra-state transportation, Transporters who lransport hazardous waste into the United S:a:es Ir
another country are responsible tor completing the manifest Federal and S!ale regulations also require generators and transporters al hazardous .... as:e a:-,c
owners or operators ol hazardous waste treatment. storage. Or disposal facilities to complete the following information.
GENERATOR SECTION . I
1. Generator's U.S. EPA ID Number-Manilest Documenl Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue live dii;1t
number assigned 10 this manilesl by the generator beginning with 00001. Hyour company does not have a-U.S.-EPA Identification Number. please con.:act S.C,
OHEC al [phone] about obtaining an identilication number. ·-·• •,. ~ I
2: Page 1 of: Enter the total number of pages used to complete this manilesl, i.e., the liist page EPA Form 8700-22 Rev. 9/86 jDHEC 1988 (P.EV 10186)].~lus
number ol continuation sheets EPA Form 8700-22 Rev. 9186A (DHEC 1988A) if any.
A. Slate Manifest Documenl Number. .Leave blank. ---·-··-' -,~ .,,. ,--1• ·:i :n·'-'":• .. ,::::.al
B: State Generator ldenliflcallon Number: Leave blank.· " :-I
3. Generator's Nam~ and Mailing Address: Enter lhe name and mailing address of the generator who will manage the returned maniles: forms.
,. Generalor's Phone Number: Enter. a telephone number with area code where an authorized agenl ol the generator can be reached in·:ne even: of an
emergency including nights, weekends, and holidays. · · n s. Transport 1 Company Name: Ente'r the company name of the first transporter who will transport the waste. I
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve dlgil Identification number ol the lirsl transporter identified In item 5. _ .•
C. 'Slale Transporter's 10 Number: Leave blank. •·t •· .
O. Transporter's Phone Number: 0Enter a teleph0ne number including area code where an authorized agenl ol the lirsl transporter can be reacnec in the event ol
an en:iergency_iocluding nights, weekends, and holidays... ..... . ... ·•----• . -····,. . ·. · · .. · -.. -,. . --,, · T..' Traff sporter 2° Company Name: II 3pplicable, enter the company name ol the second lransportE!,· who will trarlsp6i1 the waste.Jf more thari 2 trans:,o·r:ers
be used, use a U.S. EPA Form 8700-22A Aev. 9/86 (DHEC 1988A) continuation sheel and list the transporters in the order they will be 1ransoo~1r:g :ne wa
8 .. U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit ID number of !he second transporter identified in ilem 7.
E.. St.ale Transporter's ID Number: Leave blank. ' I
F .. Transporter's Phone Number: Enter a telephone number including area code where an allth·or1ze-d·ageni'ClftFle Se'COl"ld·ir'ansponer can-:e reacr:e'; in
event of an emergency including nights, weekends, and holidays. r •· ·,,-• · · • ,.
9. Designated Facilily Name and Site Address: Enter the company name and site address ol the treatment, storage, or disposal lacility desii,;:natec :c receive tr-,e
waste listed on this manifest. The address must be the site address. which may di lier rrom the'" ma"ilin9'" acidresS. .. · · ~ ·" -• I
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated trealm~n-t. ~tora98. O'r dispos?! racility iCen:i!ie:i in item 9.
G: Slate Facility's ID Number: Le·ave blank. . . . .
H;. Facility·s Phone Number: Enter a telephone number including area code where an authorized agenl of the facility can be reached in :r-.e ever,! ol an
emergency including nights, weekends. and holida)'s. · 1·
11: U.S: COT Oescrlplicns: Enter proper shipping name, hazard class and ID Number (UN/NA) tor each waste as idenlilied in 49 CFR 171-1 ii. II ac:c::r:icnal so
is needed. use a U.S. ~PA Form 8700-22A ~ev. 9/86 (DHEC 1988A) Continuation Sheet. . . . ~ . ,. , ~·, ~ _ •.• ,
12... Containers (no. and type): Enter number or conlainers lor each waste and the appropriate abbreviation from Table I (below) lor me t-;De of containers. TABLE I • . ' ' .
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank.trucks) CM,.= Metal boxes. cartons. cases. rcll cHs • I
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car:ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or Dlast1c :a,;;s
· 13 .. Tolal Ouanlity: Enter total quantity ol waste describe"d on each line, relative to lhe units used in ~tern. 14.
14. Uni! (weight/volume): Enter lhc approprintc nbbrevintions lrom Table II {below) ror the unil of mensurc:
Table II
P = Pounds L = Lilers K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (!iauid cnly)
I. ~asl_e Number: Enter hazardous was_te numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Su:::iar:s C ar,d I
1dent1ty the hazardous waste on each line. ·
J. Additional Oescriplions tor Materials Listed Above: In the spaces provided, enterlhe authorization number(lrom the S.C:OHEC·Authonza:ion Rec::uest Form)
for each waste stream listed in section~ 1 above. Ncle: Belore any hazardous waste can be accepted for treatment. storage or disposal in Soutn Ca retina. ine
generator must obtain prior authorization from !he treatment, storage or disposal facility. • · · · · ·1
K. Handling ~odes for Wastes Listed Above: Leave blank. . .
15. Special Handling Instructions and Addillonal Information: Generators may use this space to indicate special lransportation. lreatment. storage or dis::io t
information or Bill of Lading Information. For international shipmE!nts. generators must enter in this space the poirit ol departure (city and s:ate) tor tnost
shipmenl3 destined lor treatment, storage, or disposal outside the jurisdiction of the United Stales. · • . ~ -,., • • I
16. Generator Certillcalion: The generator must READ,.SIGN (BY HANO IN INK), and DATE lhecertificalion statement. If a mode other than highway is usec.
word .. highway .. should be lined out and the appropriate mode (rail, water.or air) inserted in !he space below. II another mode in additior, :o tr.e hi<;nway r:iod
used, enter the appropriate additional mode {e.g.,_and rail) in the space below.
TRANSPORTER SECTION · .
11: Transporter 1 Acknowledge,;,ent: Enter the name of the person accepting the waste on behalr ol the·firsrtransporter. That person rr.us! ackno ... iel
acceptance ol the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transpor1er 2 Acknowledgcmenl: Enter, ii applicable. the name of the person accepting lhe waste on behall or the second transporter. Tha: ;:erscr. r....:s:
acknowledge acceptance or the waste described on lhe manilcst by SIGNING (DY HANO IN INK) and entering the DATE ol receipt. I
FACILITY SECTION .
t9. Discrepancy Indication Space: The oulhS'rized representative or the designated facility's owner or operator must note in !his space any discrepancy ~et·,., _
the waste described on the manilest and the waste actUally received al the facility. Owners and operators ol facilities who cannct resolve s1;:,1!ica:-.:
dlsc,eDancies w11nin 15 d.ays receiving the waste must submit to the Department a letter with a copy ol the manifest describing the discrepancy ar.d a:-:em;:;:I
reconcile iL The treatment. storage. or dlsposol loclllly must enler the acluol wolghl ~I waste In pounds in lhe space:s provided ii the amount varies ~ny !r:;m :
specified by the generator in ilom 13 or ii the generalor usos a unit ol mcns1Jre other than pounds. .
20. F•cillly Owner or Operator Cerllllcallon: Print or type the n;:ime of tho person accepting lhe wnsto on behalf ol the owner or ODer.'.ltor ol the l.::ic1ld•f. Tt1.::if pt:rson
mull acknowledge acceptnnc'e or the we1110 described on the manlleat by SIGNING (BY HANO IN INK)'and onterlng the CATE ot receipt.
IF ASSISTANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OS:SIGNA.TED I
AECf"/E THE WASTE OR THE S.C. OHEC M<'NIFEST SECTION AT (803) 734•5200 WEEKOAYS FAOM B:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Ha.z.ardou.s Wa.ste Mgt.
2600 Bull Str~t. Columbia. SC 29201
Phone: (8-0J) 734-5200
Emergency & Holidays: (803)734-~24
I LEASE PRINT or TYPE (Form desioned for use on elile r12-oitchl tvnewriler\ Form A•
UNIFORM HAZARDOUS 11, Generator'sU.S.EPAIDNo. Manues, 12, Pagel
WASTE MANIFEST ' N,C,D,0,0 · 7, h, O· b, 7, 1· /,.'itco:"ci71
g~
02I of 1
roved. 0MB No. 2050-0039 E.rpires 9-30-1!8
Information in the .shaded ateas is not
required by Federal law, but is by State law.
I
I
I
I
I
I
I
I
I
I
I
I
I
I
G
E
N
E
R
A
T
0
R
T
R
A
N s p
0
R
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield,
4. Generator's Phone! 919 I 934-9711
5. Transporter 1 Company Name
Willms TruckinP Co-Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
NC 27577
6. U.S. EPA ID Number
S• C• D• O• 7• >, 7, n. g,· ?l q
8. U.S. EPA ID Number
I o I o o o o I O o · o I
10. U.S. EPA ID Number
6.\. 'aPhon<i','•:-nn,/.7"7"',1''1--.
-~.?~:r,·~·,··""·''·' ··"" 81>~!.:/-:.,.v. -'. . .. ,A;,.;;/,~ :='•.:.:.: ...
l l. U.S. DOT Description (incfu(Jing Proper Shipping Name, Hazard Class, and ID Number) _12. Containers 13. Total Quantity 14.Unil l'WUIINldber--·:·~·
No. Type Wr.N~ '.)':°·,;•.>,>.\·:' =-~}..,<?:{
a.
b.
C.
d.
Hazardous Waste, .Solid, nos ORM-E
NA 9189 ,· 11 D ,T I O 12 00 Y
I I I I I I I
I I ' "I I I I
I I I I I I I
15. Special Handling Instructions and Addilional lnlormaUon
GSX Work Order No.: 71580
, 15. GENERA TOR"S CERTI_FICATION: I horobydoclorettlaltho contents olttil• consignment are fully and eccuratolyde1crlbed 1bov• by prop,sr 1hlpplng name el'ld ere cl••.,f'led.
packed. marked, and labeled, and are In all respects In proper condlllon for transport by highway according to appUcable lntarnallonal and national gov.,nmel'lt r99utallol'I• af\d
U'le Ja..,, of the Staie ol Soulh Carollna.
If I am a large quantity ganeralor, I cortity ltioll t,avo a program In place lo reduce Iha volume and toxicity of waste goneraled lo Iha d&gr-I have doter mined lo b'9 economlc;:ally
practicable and thal I have selected tho prac:tic:abla malhod of treatment, stou1ga, or dlspoaal currenl1y available to ma which minimizes tha pras,ent and lurura UUMI to hu~n
health and ttla environment OR, UI am o small quonlitygonorator, I h11vo mado a good faith enort to minimize my wuta generation and ,alacl the t>o1t wuta managamanl m.thod
lhal is availat>lo to ma and lhol I con ollotd. • · -'
Printed/Typed Name !Signature /.J ...-./ /'· _J 'l / ----_o-'---' C _,:,)--z:t _;c:;_
Month Day Year
1 fJ /?.? P,J'-;7
17. Transparter 1 Ac.:,mowledaement ol Receipt ol Materials {/ /
Prin~_J>Typed Name/ 'tJ / -F-. u I • ..,. ,,.cs 7-;
Month Day Year
,&,JJ,c ;rit ~
1 8. Transporter 2 Acknowledgemeri\ ol Receipt ol Materials
Ii Printed/Typed Name I Signature Month Day Year
1'·, I , I ,
19. Discrepancy lndicalion Space
F • I l1bs-< I libs. I t 1------------b LI ..1...J._J,_J....,L_Jl'b,. d LI ..L..J._J,_J....,L_Jlibs.
~ 20. Facility Owner or Opt!ralor; Certilicalion or receipt ol hazardous malerials covered by lhis manilesl e1Ccept as noted In Item 19.
1 Printed/Typed Name I Slgnalure
EPA Form 8700-22 (Rev. 9/86) Previous Editions ore Obsolete IDHEC 1988 (Rev. 10/86))
Mooth Doy YNI
I , I , I ,
-
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
IMPORTANT: TYPE (on a 12•pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIB.LE!
GENERAL INFORMATION: Federal Regulations require generators and !rnnsporters of hazardous waste and owners or operators of hazardous waste treatmel
s10rage. or disposal licililies 10 use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 {REV 10/86)1 and, ii necessary, th& continuation Sheet U.S. EPA Fo
8700-22A Rev:9/86 (OHEC 1988A) loi both inter-slate and inlra-state tr.insporlation. Trnnspor1ers who transport hazardous waste into the Uni!ed States It
another country are responsible ror completing the maniresl Federal and State regulations also require generators and transporters of hazardous .-.·as:e ar:c
owners or operators ol hazardous waste treatment. storage, or disposal facilities lo complete the following information. I GENERATOR SECTION
1.
2:
A.
B:
3.
'·
5.
6.
C.
0.
T..
8 .. e: ..
F ..
9.
10.
G:
H;.
11~
12..
Generator's U.S. EPA ID Number. Manllesl Document Number: Enter lhe generalor's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manifest by the generator beginning with 00001. llyour company does not have a U.S. EPA Identification Number. p_!ease con:ac: S.C.
OHEC at {803) 734-5200 about obtaining an ldentilication number. • . · I
Page 1 of: Enter the total number of pages used to complete this maniresl, i.e., the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P.EV 10t86JJ c/\.:s'
number of conlinuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
Stale Manllest Document Number: .Leave blank. .
Stale Generator ldientiflc.itlon Number: Leave blank: · • I
Generator's Name and Mailing Address: Enter !he name and mailing address of the generator who will manage lhe returned maniles! forms.
Generator's Phorle Number: Enter a telephone number with area code where an authorized agent ol the generalor can be reach,ed in :ne event ol _
emergency including nights, weekends. and holidays. ·
Transport 1 Company Name: Enter the company name of the lirst transporter who will transport the waste. I
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first lransporter identified in item 5.
'Stale Transporter's 10 Number: Leave blank. . ,, ..
Transporler's Phone Number: 0Enter a telephOne number including area code where an authorized agenl al the first transporter can be reache'~ in tr.e· e,..er\1 of
an emergency inc;luding nights, weekends. and holidays. . . · · . . ·. · · · -. I
·Tra'n~porter 2° C~mpany Name: II 3pplicable, enter the C
0
0mpa"rly name 'Oi the sec-;;·~·d'ircills'PClrter who will lra'n'spOrl. the waste. II more thari 2 trans;,orters
be used. use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be fransoor.ir.g the ,...,a
U.S. EPA ID Number:I1 applicable. enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7.
St.ale Transporter's ID Number: Leave blank. I
Transporter's Phone Number: Enter a telepho"n'e'numbe'r including area code whe~e an;.aUth~~i~~<')~g~~tOfth~ ;ecc;nd"1r'anspor1er can be reacr.ed in
event al an emergency including nights, weekends, and holidays. . -, · · · -· · · ·' -" ,.... '
Oesignaled Facility Name and Site Addres!: E_~ter the -~o~mpany name and site address o( !l).t1/~;l)~;~!_._~t,2,r.~.9-~_..,o~?ispo~?~!~<::il~y_ d:.s~ign,a1e~ ;c re~e1ve tt·,e
waste listed on this manilesl The address must be the site address, whic_h may differ from the mailing addr_ess. . . I I
U.S. EPA 10 Number: Enter the U.s. EPA twelve digit identification number ol the designated tre.alment. ;to~ag-;, ~r disposal facility iden:1fie:: in item 9.
~late Facility's 10 Number: Leave blank. . · • ., . ., _ . _ .. ~ • .,. :
Facility's Phone Number: Enter a telephone number including area code where an authorized agenl of the facility can be reached in :r.e event of an
emergency including nights, weekends. and holidays. · .
U.S: DOT Oescr!Jtions: Enter proper shipping name, hazard class and ID Number (UN/NA) !or each waste as identilied in 49 CFR 171 • 1 ii. II acci:lcr,.al s;:,
is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 {OHEC 1988A) Continuation Sheet. ~ ,<·• ~ ,,11,,.,-.. •-,
Containers (no. and type): Enter number ol conlainers for each waste and the appropriate abbreviation lrom Table I (below) lor the ry;::e al c:intainers. TABLE I "J ~ /)l•• ,,,:, • " •• -.. - . • ' ~ ' I. ' • ';; .
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) .. CM= Metal boxes .. cartons. cases. rel! ctts' .. •J" .1',-p•~-,., .,.,;,,._,., .• u .,
OW a Wooden drums, barrels. kegs TC= Tank cars · CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plast:c ::iai;s
I
13 .. Total Ouantily: Enter total quantity of waste describe'd on each line, relative to the units used in item_ 14. _
14. Unil (weight/volume): Enter the appropriate abbrevi.itions from Table 11 (below) for the unit ol measure:
Table 11
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters .. Y·= Cubic Yards G = Gallons {liquid cnly)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste ManagementAegulalion A.61-79.261 Su:;;ar:s C ar.d I
identity the hazardous waste on each line.
J. Additional Descriptions tor Materials Listed Above: In the spaces provided. enter the authorization number (lrom !he S;C;OHEC·AuthorizahOn Rec:uest Form)
for each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted for trealment. storage or disposal in South Carc!ina. 1ne
generator must obtain prior authorization rrom the treatment, storage or disposal facility. .,,, · ...... ,.. •11 • ~-.... -.-; ... -• 1~ 1• ' ,.. 'r, · · ; •1
K. Handling Codes !or Wasles Lisled Above: Leave blank. · · r • ~~ ,, • -: • • , r : •
15. Special Handling Instructions and Addilional lnlormalion: Generators may use this space to indicate special·lransportation. treatment. siorage or dispo
information or Bill al Lading lnlormatio'n. For international shipmen!s, generators musl enter in this space the point al departure (city and s:ate) lor :nose
shipments destined lor treatment, storage, or diSposal outside the jurisdiction ol the United States:~.~ ... ~ ~·/;_r.T,. '""'~,. '" .,._. --· . -, ,s. Generator Certillcation: The generalor must READ, SIGN (BY HANO IN INK), and DATE lhe certificalion statement. If a mode other 1nan highway is useo.
word "'highway·· should be lined out and !he appropri.:!..!e mode{rail. w::iter,or air) inserted in the sp_ae:e,~e.ro~. ti another f!10de in additior. :o the hignway mac.
used. enter the appropriate additional mode {e.g.,,and rail) in the space below. __ ,. __ , .., • .,~,
TRANSPORTER SECTION I
17: Transporter 1 AcknowledgerTlent: Enter lhe name of the person accep!ing !he waste on behal! of the lirsl transporter. Th.~t perSon rr.us: a.ckno ... 1e,
acceptance ol the waste described on the manliest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter. ii applicable, !he name of the person accepting the waste on behalf ol the second transporter. Tha: ~erscr. ~~s:
acknowledge accept~nce or the waste described on the manilcst by SIGNING (DY HANO IN INK) and entering lhe DATE al receipt. . · 1••1
FACILITY SECTION .
19. Discrepancy Indication Space: The authorized representative or the designated facility's owner or Operator mu St note in this space any d1screp-ancy b,e1V. _
the waste described on lhe manifest and the waste actUatly received at lhe facility. Owners and operators. al_ (acilities who canncl resolve s1g.-,1!ica!"',!
dlscre.pancies within 15 days receiving the woslo mus I submit to lho Df'lportmenl a lellor with o copy ol the manlfo:sl 'describing the discrepancy and a:-:emc:I
reconcile iL The treelment. s1orege, or dlsposol loclllty must enter the actuolwelght (?I waste In pounds in !he spaces pro1Jided ii the amount -.,aries any tr:;r., i
specil,ed by the generator in itom 13 or ii lho generalor uses a unit ol n,cns1.1re other than pounds. . ·
20. F,cilily Owner or Operalor Cerlillcallon: Print or type the nameol tho person accepling lhe wasto on behnllol the owner or oper;11or ol !he i.1c1to1-,.. lfl.JI ;;i~r!>on
must acknowledge acceptanc'e or the waste described on lhe manifest by SIGNING (BY HANO IN INK)and entering the DATE al receipL
,, .&S5tSTANCE Is Neeoeo 1N COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FActuTY oEStGfJATED I
AEC!'".'E THE WASTE on THE s.c. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 nm TO 5:00 pm. ·.
I South Carolina Department of Health
and Environmental Control
LEASE PRIITT or TYPE (Form desi lied for use on elite 12-ilch ewriter
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
N C D O 7 0 1
Manlfee1
Oocumenl No.
0 0 0 9
1 Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
,. Generator's Phone 919
Smithfield,
934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
. 6 .. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7
Form A
2. Pago 1
ol
Bureau of Solid & Haurdous Waste Mgt.
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
Emergency & Holidays.: (803)73-C-~24
roved. 0MB No. 20.50-0039 E.xpires 9-30-&a
lnformalion in the shaded ateas is not required by Federal law, but is by Stale law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity !(Unit l'Watltbnberi'.i
No. Type 'M/Vr:J './f~/::~:·,t:~·-t :-;>J~~f, ..
b.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnrormatlon
GSX Work Order No. 71581
l• D T 2 0 y
,e. G£NERATOR·s CERTI_FICATION: I herebydecl11re lhel the content:, olthl:, con11fvnment11r11 fully end 11ccur11telyd111crlbecl above by proper 1hlpplng name arid ar• ct_•1a,fled.
packed. marked. and lebeled. and are In 1111 re,pecla In proper condlllon for transport by highway according to appUcablo lntarnatlonal and national government r99utat1on1 and
u,a la*• 01 Iha Sale of Soulh Cerollna. ·
111 am a 111,ge quanllty gonor11ilor. I cortily lhnl I hnvo II progrnm In placo to ,cduco tho volume and toxicity ol wa11e gonereled lo !he dogroe I have dalermln9d 10 be eco"o""W:ally
prec11cable 11nd 11,a1 I havo :,olocled 111n prnctlcablo mnthcxJ ol lronlmont. :,tor ago, or dlapoaal curronl1y avollable to mo which mlnlmlu1 tho preunt and luNr• lhrNI 10 hu'""n
heallh and 11,111 envilon11,o,,1: 011, lit n,n n ninnll r1un11Utygonornlor,I hnvo mndo e good fnllh etfo,t lo mlnlml111 my waatooono,allon and 1111ocl lhe b4!111 w111a managarnenl metl"IOd
tl"lal i1 avai1ar:,10 to me and lhnt I can 11110,d. ·
Printed/Typed Name 1Zc::-l.
17. Transponer 1 At.:Knowledgemenl of Receipt of Materials
Printed/Typed Name -Montn Day Yw
•·
19. Discrepancy Indication Space
• I l'bs. C I libs.
b I libs. d I Jibs.
20. Facility Owner or Operator; Certirica!lon of recelpl ol hazardous materials covered by !hi, manifesl excepl a, noled In llem 19.
Printed/Typed Name Signature Mon"1 Day y..,
PA Ferm 8700-22 (Rev. 9/86) Previous Edllions nre Obsolete {OHEC 1988 {Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST , , r • -,, , :,ii· ---• ,-,1 --,,.,o ~ I
lMPORTANT: TYPE (on a 12-pitch (eli!e) typewriter} OR USE FIRM POINT PEN -PRESS DOWN HARD· --·:, .• ,. '"'' ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder3I Regula!ions require genP.rators and trunsporters ol hazardous waste ~n.d o~~e~.S_oroperators cl hazardo~s wa;1e treatml
storage. or disposal ricilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)} and, H necessary, tha continuation sheet U.S. EPA F
8700-22A Rev.-9186 (OHEC 1988A) foi bo1h inter-stale and intra-state lrnnsportalion. Transporters who lransport hazardous waste into the United States I
another co_untry are responsible !or completing the manilesl Federal and State regulations also require generators and transporters ol hazardous ...,as:e a:-,o
owners or operators or hazardous waste treatment, slorage. or dispOsal facilities lo complete the following information. " . -I '· GENERATOR SECTION
1.
2;
Generator's U.S. EPA ID Number-Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the un1cue live d1i;11
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA ldentilication Number, please con:aci S.C.
OHEC at [phone] about obtaliling an Identification number. · I
Page 1 of: Enfer the total numberol pages used lo complete !his manilesl, i.e., !he Ii isl page EPA Form 8700'22 Rev. 9/86 {DHEC 1988 (P,EV 10/ 8611 .ius
number of conlinuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) H any. · • ·
A.. St.ale Manifest Document Number: .Leave blank.
B: Stale Generator Identification Number: · Leave blank. · •· I
3. Generator's Namo and Mailing Address: Enter the name and mailing address ol the generator who will·man·age·the·returned·manifest lorms. · '
4. Generator's Phor\e Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in !he even! o n
emergency including nights. weekends. and holidays. ·
5. Transport 1 Company Name: Enter the company name ol lhe first transporter who will transport the waste.--.. • -•.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit idenlification number of the first transporter identified in ilem 5.
C. 'Slate Transporter's ID Number: Leave blank.
O. Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent ol the first transporter can be reache~ In tne event ot
an en:,ergenCy. in_c;luding nights. weekends, and holidays... .... . . ... ··-··--. ---· _· -·· · ·:. · ·." ,., · · · · 1
· T.. Tra.nsporter 2' Company Name: II applicable, enter the company name ·of the second transp(lrte·r who will lran.spOrt the waste. II more than 2 tra_ns;iorters 11
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they wjU be 1ransoor.1r.g mew .
8 .. U.S. EPA ID Number:1I applicable. enter the U.S. EPA twelve digil ID number al the second lransporter identified in item 7.
E .. State Transporter's ID Number: Leave blank. · I
F.. Transporter's Phone Number: Enter a telephone number including area code where an authO(iZ'e°d ag~ni'Ofth'e second iransporler can be reac~ed in
e\'enl ol an emergency including nighls, weekends, and holidays. . •
9. Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal lacility designatec :c receive lhe
waste listed on this manifesL The address must be the site address, which may differ from·the marnng addres-S:'''' -· ~.. . ' : I
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatmE!nt, storage. or disposal facility iCen:i!ied in item 9.
G: Slate Facility's ID Number: Leave blank. . ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized 'agent ·of !he lacility can be reached in :r,e e ... ent of an
emergency including nights. weekends, and holida)'s. · · · ·
11: U.S: DOT Descriplions: Enter proper shipping name. hazard class and 10 Number (UN/NA) lorea~h waste as identilied in 49 CFR 171-1 ii. II ac::c::i:icnal sot
is needed. use a U.S. EPA Form 8700·22A Rev. 9186 (DHEC 1988A) Continuation Sheet. .-.i , , • • • • . -~ • •
12.. Containers (no. and type): Enter number ol conlainers lor each waste and the appropriate abbreviation lrom Table I (below) lor the rype ol i:on:ainers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM,=.Metal boxes, cartons. cases. rC'll c~s·
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic bo,:es. car.ens. cas~s I
TP = Tank.s portable CY= Cylinders BA= Burlap, cloth, paper or plas:1c bags
13 .. Total Quantity: Enter tolal quantity al waste described on each line, relative to lhe units used in i_l.~.m. 1~ ..... ,.
1.1. Unil (weighl/volume): Enter the approprialc abbrevintions !ram Table II {below) for lhe unit ol measure: I Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Was.le Management Regulation R.61 • 79.261 Sub~ar:s Car.a I
identily the hazardous wasle on each line. ·
J. Additional Descriptions for Materials Li sled Above: In lhe spaces provided, enter the authorization number (from the S.C. DHEC Authorization Request Form)
!or each wasle stream listP.d in section 11 above. Mote: Before any hazardous waste can be accepted !or treatment storage or disposal in Souih Carclina. the
generator must obtain prior authorization lrom the treatment, storage or disposal facility. · I
K. Handling Codes for Wastes Listed Above: Leave blank. .
tS. Special Handling Instructions and Additional lnlormalion: Generalors may use this space to indicate special transportation, treatment storage or diso I
information or Bill or Lading Information. For international shipments, generators must enter in this space the point or departure (city and s:a:e) !or triose
shipments destined lor treatment. storage, or disposal oulside the jurisdiction ol the United States. · J
16. Generator Certilicalion: The generator must READ,·sIGN (BY HANO IN INK), and DATE the certification statement. II a mode other Ihan hignway is used e
word "highway" should be lined out and !he appropri.1Ie mode (rail, water.or air) inserted in the space below. ti another mode in addilior. :o the hignway r:io s
used. enter the appropriate additional mode {e.g.,.and rail) in the space below.
TRANSPORTER SECTION· . •
11: Transporter 1 Acknowledge;.,ent: Enter !he na~e of the person aCcepti,:ig the waste on beha.11 or the_ first'tra~sporter. Thal person must aci..no ... iel•
acceptance ol the waste described on the manifest by signing {BY HAND IN 1NK) and entering the DATE al receipt · .. ·
18. Transporter 2 Acknowledgement:· Enter, ii applicable, the name or the person accepling the waste on behalf al the second transporter. That perscr: r:-:us:
acknowledge acceptance al the waste described ori lhc mnnilcst by SIGNING (BY HAND IN INK) and enter'ing·the DATE al receipt I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized rcpresentalive or the designated facility's owner or operator must note in lhi°s space any d1screoa'ncy :0':'!w .,
the waste described on the manifest and the waste actUally received at the facility. Owners and operators ol facilities who cannct resolve s1i;.,dica:-.:
ditereo_an_cies w1lhin 15 days recol\'lng tho waste must submit to lhe Or:partmenl a lefler wilt~ o copy al ~he manl.rest describ~~g the disi:repancy ar.c:: a:-:er:i:I '
reconcilo tl The lreatment storage, or dlsposol laclllty must enter the actual weight ~I waste m pounds m lhe spaces provide9' ii the amounl varies .any tr:,r:, :
spocilied by !he generalor in ilom 1 J or ii tho generalor usos a unit of mcas11re olhcr lhan pounds. . ·
20. Faclllty Owner or Operator Certlllcallon: Print or lypo tho nome ol lho person occeptino lho woslo on behalf ol lho owner or operator ol the lacilo1·,. That per?l.on I
mus! acknowledge acceptanc'e cl the waale described on the manilesl by SIGNING (BY HAND IN INK,. and entering the DATE ol receipt.. ~ 1
IF ASSISTANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESICWATEOI .
AECf"/E THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKOAYS FROM B:00 nm TO 5:00_pm.
. ~
I South Carolina Department of Health
'· and Environmental Control
Bureau ol Solid & Ha.urdoi.1s Waste Mgt.
2600 Bull Sttee~ Columbia., SC 29201
Phone: [phone]
Emergency & Hot;days: [phone]
I PL.£lSE PRINT or TYPE {Form desloried for use on elfle 112-cilchl "'-writer)
UNIFORM HAZARDOUS 11. Generator'sU.S.EPAIDNo.
Form A "'roved. 0MB No. 2050·0039 E.icires 9.30.ga
Manlreat 12. Page l Information in the shaded a,eas is n01
] i , •• 8~()u~()7'g~04 ol 1 required by Federal law. bu! is by State law.
I
I
I
I
WASTE MANIFEST N, c, n, o, 9, 7, ,;, o, 6, 7,
1 Generalor's Name and Mailing Address
Channel Master
P, 0. Box 1416, Smithfield,
,. Generator's Phone I 919 l 934-9711
NC 27577
A.1 ~-Miinifeitl Ooc1imont Hvtnb«.. '; Lt;;hh=trx;p ;, :,; ,.0,~·:, <)J:' :::.
5. Transporter 1 Company Name 6. U.S. EPA ID Number 'CJ:·~·ta:·,;.n,······ · 'l[):-c,:c .. '.'.: · •·'f,.·,·:-
1-
7
-. ~T~~•i"'n~"'Pl~
0
;!!!.,s;e.r _2 -=.~
0
..,rm~up.!a~..O~c!~c.!.:!1'':.._
0
~C,;o~, -L....I~nu:c~. ---------l~w.S2'~L;~_''LE~!.!~Ll.!.!iL'N.!.:~Lbe,.3!lr' .J7c.w,n.!Lo.a...?.g_<ll;a,_~-~~ i·~~:: :\:.~.:L~ ... ~ ~:::::,~ ::,
9. Designate-d Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box
Pinewood, SC
255
29125
• , , , , , • • • • • • ·r:yf .,., ... ,_.,, ... ,i·-·,··.'e' m..-...:.;.\+~,$~ .,., . .,_;:1··"··:.d·~.:.;~.c(";'::y..,.
10. U.S. EPA ID Number
, SI Ct D, o, 7, 0, 3. 7, '
11. U.S. OOT Description (including Proper Shlpp(ng Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity 1'-Unit L''W&Stll Nl.a'aber'=•;,
No. Type 'M/VrA .\:.i ,~·_yf~'t
I ~ a. Hazardous Waste, Solid, nos ORM-E ,;l'F jO'iI,·9·t~~
~ l-,,;N::A~~9.:1~8::9 _________________________ -I-.J'L . ..:'L'.l+D:...r,T:..j.._L'L '.l:. ,2.J'.:'.o-l-...'.Y_1-"-::,i!;:' f:::::' Q~•::D:•::6:!'.:.;:'i~·
li1-b-------------------------------~.J'J'~~·L~'LL'L'L'~-+t~;:=·•··=·=·=·~=·=·>=,,=•·~:;~'~
I R l-c._:, ________ _:__ ________ _:_ ____ _:_ _____ _j_....1....1....j---lLl-:,..LLL.L.J,..._..j_:
4:_:'
1
;:=•·•=· ·=•·=··=· :'.:::'..
11
~!!?•,i.::ci
I
I
I
I
I
T
R
I A
N s p
0 R
I T
E
R
I I I 't I I I "JJ., '~it<
d.
't I I I I ' '
15. Special Handling Instructions and Additional lnlormation
.GSX Work Order No.: 71582
1 IS. C EN ERA TO R'S C ER TI_FICATION: I horoby declare th al tho con1on1s of this conalgnrnent era fully end accurately described above by proper •hipping name and are cla-■,n.cl.
packed. marked. •nd labeled.and ■re In a11 respect• In proper condillon lor 1ran1por1 by highway according to appllc.ab1e lnternatlonal and national government reg1,1latlOl"II ~•"4_
ll'le law1 ol the SI.ate ol South Carolina.
111 am a targo Quan11ty gene,elor, I cer1ify that I havo II program In place to reducatho volume and 10xlcltyofw111tegeneraled to tho deg,_ I have determined to t>eo economk.11.IIJ'
practicable and 1hal I have selected the practicable melhod ol treatment, storage, or dlspoaal currenlly aveilable lo me which mlnlml1111 tho proMnt and future th,_, to human
haallh and Iha environment,; OR. ii I am a small Quantity generator, I hove mado a good laith olfor1 lo minimize my waste generation and sale ct the bell wall• management mecnod
1nat is available 10 me and \hot I con ollo,d. ·
Prin_ted/Typed Name fZr;;,.,' L,Cx,__-t I Signature ~
0
.A ~ ~·
Montt, Day Yw
lrJ,,P,?.P.,P.7
17. Transpor1er 1 Ac.amow1edgemiri"t of Receipt of Materials (/
Printed/Typed Name \Signa/2?, .L
Mont1'1 Day Year
JJ, }'\ -r r} I,,,._ /., )9n {: I--• · '-./✓ ~ ✓ _,,,. I ,t,-?_ ~-. , .
18. 1ransparte, 2 Acknowledgement of Receipt of Materials
?tinted/Typed Name I Signature Month Day Yw
t I , I , •
19. Discrepancy Indication Space
F
It...,._=------.,...--~--..,..-;::: 20. Facility Owner or Operator; Cer1ilication ol receipl ol hnzardous mnterials covered by lhis manifest oxcepl a, nolod In 11cm 19.
I I
b I
l'bs. C I ltbs.
libs. d I ltbs.
Prinled/Typed Name I Signature
IEPA Form 8700-22 (Rev. 9/86) Previous Editions ore Obsolete (DHEC 1988 (Rev. 10/86)1
Month Doy y..,
. I , I ' I '
•,'
STATE OF SOUTH CAROLINA )~ST.RUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and trnnsPorlers of hazardous waSt8 .irid oWn·ers .. o"r Operators al hazardo~s waste treatml
storage. or disposal licililies to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86Jj a.rid, i_l nec·es_Sary, th& continuation sheet U.S. EPA F
8700-22A Aev:9/86 (DHEC 1988A) !or' both inter-state and intra-stale transportation. Transporters who transport hazardous wasle into the United S:a:es Ir
another country are responsible !or compteling the manifesl Federal and Stnte regulations also require generators and transporters ol hazardous wasie ar:c
owners or operators of hazardous waste treatment, storage, or disposal racililies to complete the following information. I
GENERATOR SECTION
· 1. Generator's U.S. EPA ID Number -Manilesl Document Number: Enter the generator's U.S. E_P,~.!'-:-:~':~~-<;fi_gj!i~~~-ti,!ifation ru.mb~r.a.n.? th~ ~~~ue !i}e. q1_c;:t,
number assigned to this manifest by the generator beginning with 00001.11 your company does not haVe a_ U.§i..:.~YA )d_entification Number. pleas~ con:act S,C.
OHEC at {803) 734-5200 about obtaining.an ldentilication number.. _ I
2.: Page 1 of: Enter the total number ol pages used to complete this manirest, i.e., the liist page EPA Form 8700-22 Rel/. 9/86 [DHEC 1988 (P.EV 10186)] ~rus
number of continuation sheets EPA Form 8700-22 Rel/. 9/86A (DHEG 1988A) ii any. ,---:,r.:. s ~" ... ~,;,1•1,. .... .,",. A.,,.. . ,., -:::::·
A. Stale Manliest Document Number: .Leave blank. , . _. ___ , ..• _ -""" ·.:i ,
B: State Generator" ldentiflc'atlon Number: leave blank. · -· · l
1 Ge_nerator's Name and Mailing Address: Eriter the name and mailing address ol the generator wh_? will manage.the returned.maniles: forlT)S.1 ·
,. Generator's Phorie Number: Enter-a telephone number with area code where an authorized agent ol the generafor can be reached in :ne even: cl
emergency including nights, weekends. and holidays. ' -· -·
S. Transport 1 Company Name: Enter lhe company name of lhe first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identHication number ol the lirst transporter identilied in item 5.
C. 'Slate Transporter's 10 Number: Leave blank. -n ·_' _·r. ··-· ·--.,.,.
0. Transporter's Phone Number: Enter a teleph0ne number including area code where an authorlZed 8Qen'i ol u;e·IirSt transporter can be reached in the e ... ent o!
T.. ~~::::~ee~~r ~~:~~i~~ ~~g~~~-~~=~~~::b~;.~~~~~~:s~Omp~~y flame ·a; the seCO;dirans·p·o·rter who wiif1·,a·~·s~O~ l~e waste. II more thari 2 :r~ns;,orter~ •. I
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheel and list the transporters in the order they will be transoo~ir.g !he wa .
a .. U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. Slate T,ansporter's ID Number: Leave blank. I
F .. Transporter's Phone Number: En!er a telephone number including area code where an 'aUthOriZE!d"aQ'eri'i'Ofth"e sei::Ciiid transpor1er can tie reacr.e-: in .
9.
10.
G:
event ol an emergency including nights. weekends, and holidays. _ ·
Designated Facilily Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility desii;;natec :c receive 1:-,e
waste.listed on this manifest The address must be the site address, which may dilfer from the ·ma"iling addreSs'. ·---· ·~" ' ' · 1 U.S. EPA ID Number: Enter the U.S. EPA iwelve digit identification number ol the desig~ateci'tr'~a~mer:,i, sf9~age .. 9r disposal lacrlity ider,:ifie:: !n 11em 9.
Slate Facility's ID Number: leave blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in :r,e event ot an
12...
13 ..
14.
'·
J.
emergency including nights, weekends, and holida)'s. ·
~.s: DOT Oescriplions: Enter proper shipping name. hazard class and ID_Num_ber (UN/NA) I.or each waste as identilied in. 49 CFR 1 71-l ii. II ac:c:i:icr.al s~f
,s needed. use a U.S. EPA Form 8700-22A Rev. 9/86 {OHEC 1988A) ConI1nuat1on Sheet. . . ~ ··r" .,. -~11 ;~ ••• -. -.~ ,,,
Containers (no. and type): Enter number ol containers tor each waste and the appropriate abbr~vfatlo·~ lrOm:Table I (below) !or the rype or c_onta1ners
TABLE I -
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) .CM =;.Metal boxes. cartons. cases. roll ctts·
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. car1ons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plas::c :ac;s
Total Ouantily: Enter total quantity ol waste describe'd on each line. relative to the units used in. item 14.
Unit (weight/volume): Enter the appropriate abbreviations rrom Table II (below) for the unit ol measure:
Table II I
P = Pounds l = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
Waste Number: Enter hazardous waste numbers as specified in South Carnlina Hazardous Waste Management Regulation R.61-79.261 Sut:;,a~s C ar.d I
identity lhe hazardous wasle on each line.
Addilional Descriptions !or Materials Listed Above: In the 9paces provided, enter the authorization number (lrom the S.C. DHEC Aulhorization l=;equesl F o J
for each waste stream listt1d in section 11 above. Nole: Berore any hazardous waste can be accepted lortreatmenl storage or disposal in Soutn Carc-lina. tne
generator must obtain prior authorization lrom the treatment, storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: leave blank. ,
15. Special Handling lnstruclions and Additional Information: Generators may use this space lo indicate special transportation. treatment. storage or disp,.. I
information or Bill ol Lading Information. For international shipments, generators must enter in this space !he poinl or departure (ciry and s:a:e) !or :nose
shipments destined !or treatment, storage. or disposal outside the jurisdiction of the United Slates: · ~ ·' ,. · · • I
16. Generalor Certillcation: The generator must READ, SIGN {BV HAND IN INK), and DATE the certillcalion statement. II a mode other !han highway is usec.
word "highway" should be lined out and the appropri.?le mode{rail, water.or air) inserted in the space below. H another mode in addition :o tr.e nign'Nay r:io
used, enter the appropriate additional mode (e.g .•. and rail) in the space below.
TRANSPORTER SECTION . . .
11: T,ansporter 1 Acknowledgement: Eriler the name ol the pers~n acceptiiig lhe waste on behall of the first transporter. Thal person rr.us: a,kn:, ... 1ef
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE al receipt. ·
18. Transporter 2 Acknowledgement: Enter, ii applicable, lhe name of the person accepting the waste on behalf ol the second transporter. That perscr. mus:
acknowledge acceptance or the waste described on lhe manilest by SIGNING (DY HAND IN INK) and entering the DATE or receipL I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative ol the designated lacility's owner or operator·must note in this space any discrepancy b-eI ....
the waste described on the manifest and the waste actUally received al lhe facility. Owners and operators ol facilities who cannc! rescl..,e Si\;.iifica:-.:
dlsc,e.p.an.cies w1Ihin 15 days receiving the waste m~sl submit to the Departmenl a_le.tter wil~ a copy ol the manifest describing the discrepancy ar.d ar:er.i~•,
reconcile IL The lreatment. storage, or dlsposol lacll1ty mus I enler the actual welght ol waste in pounds in lhe spaces pro ... ided ii !he amount vanes any !r'.Jr., t
spec::il1ed by 1ne generator in ilom 13 or II lho oenerato, usos a unit or mons11re other than pounds.. .
20. Facility Owner or Operalor Cerlfllcallon: Prlnl or type the nameol lho person oc::copting lho waslo on behnll ol theownor or operator of 1he l.:1cilt1y. Thal ::,~,~on
must acknowledge acceptanc'e or tho wasle described on lho manHest by SIGNING (BY HAND IN INK)'and entering the DATE ol receipt. ·
IF ASSISTANCE IS NEEOEO 1N COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECf:"/E THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
I
I
I
I
I
South Carolina Department of Health
., and Environmental Control
LEASE PRUfT or TYPE (Fofm'desi
UNIFORM HAZARDOUS
WASTE MANIFEST
1 Generator's Name and Mailing Address
.Channel Master
ewriler
1. Generator's U.S. EPA ID No.
N C D O 7 0
Manlfosl Oocumenl No. 1400095
P, 0. Box 1416,
4. Generator's Phone 919
Smithfield,
934-9711
NC 27577
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transparter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of·SC, Inc.
Route, 1 Box 255
-Pinewood SC 29125
6. U.S. EPA ID Number
S C D 0 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
of
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Street, Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (SOJ)73-4-~24
roved. 0MB No. 2050-0039 E.ipires 9.30.ga
lnlormalion in the shaded areas is not
required by Federal law, but is by Stale law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity 14.Unil -l'.Wa!IIHl.nber":'f·
No. Type Wi.NrJ ~j{\,<;:-'.~;:,:_:.;f:i~\£~=t'
L Hazardous Was·te, Solid, nos ORM-E
NA 9189 1, Q T 2 0 Y
::i~TF ;1·01 .. rt··9~1~!
:j1f1Q1Q161~·
):f 1..I ....L-JC....L...'.J'j R:
"Jt!. .~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71583
, e. GENERATOR'S CERTIFICATION: I hereby declare that lhe contents olthls consignment are fully and accuratolyde•crlbed above byprop,er ■hipping name ■l'ld are c1a-,fled,
packed. marked, and labeled, and are In all respecta ln proper condition for lranspor1 by highway according to appUcable International and national governmanl ,■o..,tatloniif'd
uie laws of 1'1• Stale ol Soulh Carollna,
It I am a largo quantity generator. I certify that I have a program In place to reduce the volume and toxicity of waste generated 10 the dog,_ I have determined lo ba econofT'lically
pracucabla and thal l have se1ac1ed the practlcabla method of treatment. :,torage, or dlsposal currently avallable to ma which minimizes the pra..ont and h,,1a.,ra tl"ltMl lo,,..,.,..,..,,
P'laaltP'l and Iha am,i,onmcnl.: OR, Ill am a smotl quonlltyganeroto,, 1 have mad a a good lallh effort to minimize my waste gene,atlon and 1a1acl ttte ball wa1ta managernant meU"locl
that is ava;lablo 10 mo and thot I con artord.
11-,-1-,,..,P,-rin-1ed_,r_y_ped_N_•m_• __ ~_;~-"-r:;:.._.,.L;...;,' _..:G,=:i..,a:,:f;.r_J....s1_gn_•_tu,_• __ :...,.::;.:µa::i..--~,;;.._.l;_;,~~~1 ..:' =::·a::;;;; ___ ...JM.:;;.in::.~..a.:2..ioa~y..ia:.Y..Jear~
~ 17. Transporter 1 Ac.:,mowledgemenl of Receipt ol Materials
I ~ Pri~ted/Typed Na e/
s .31 . ' p ~~U.!;_:,_ _ _J:J1!.J.!.JJ!,;L--'--..ll::l.!.------~..;_.,~l.Le!..!........1'...D..:l..l..2..I.U-....,t.µ.. ___ J..!..il_:::.J..!;_ _ _l.l.!J~Le::U..U.J../.-l
o 18. Transporter 2 Acknowledgement ol Receipt of Materials .. i-;.::...:.:===:.:.:.:===:=:.;:.:.:..:::=~===--~~----------4------------------..J..-I T Printed/Typed Name ( .H~ _______ _._ ________ _........ ............ ~
19. Discrepancy Indication Space
F
Month Day
• I ptis. C I libs. ·~ •!----------------~ 20. Facility Ownar or Operator; Cer1illcatlon of receipt ol hazardous materials coverod by !his manilosl oxcopl as noted In Item 19. I Printed/Typed Nam, Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions nre Obsoloto [OHEC 1988 (Rev. 10/86))
b I pbo. d I libs.
Monllt Day y..,
Pr'~I' ;, .~· ·~ ~,,, ,,,-~.JQf:fl•~n..;:. ,i::.1•~r~.11 .:.i~•~.t.,?.~\JI; ., .. , lr)~ .• : • -{ t::u1:u·~· f'IJ !!l''."'ltl::i"!'.'-"11'.;•~•I<!''''·''"'''-; -·
.... ~,: ';'~ O't ,~::-:ft-._ 1,.: ;,.;:l\~f\(l.r>O!t'll''(1,\IW~-!,~'=e,fr0 (
--• ' • • -STATE OF SOUJH_CAROLINA INS;~UCTl~NS FOR UNIFORM HAZAR0DO_US,WAs','ii.'MANIFEST,,, ., ',, .. ,,s;,0°,a '"'·I·
IMPORTANT: TYPE (0f1 a 12tpHCh''(e1t1€) typ~w'r1ter(OR USE FIRM _POINT PEN. P~ES_~ !J9~N!HARci ooc~~'~r;,. 0,1 !~C11"~fA'u!"""c·oPIES'MUST1~E LECilBl!E!'
· -" · -~ · • · • •'·"''" ·;,c'!'•·,. --,ne ·.,_;;-;•q tt:l', ~, , ,;,y,..,. , ::--~ ! :_ : _ r .. !. 1,..t.11,:;;.,ol;J,:.:i'v;Q,py10Mhe<;"t1-.!r'l!P.s1 descr.~;~r,rthP. r.•-:::r,.:1a,~<.I :i:-; :e·-.-;:~ ::;
GENERAL INFORMATION: .. Federal Regulations require generators and transporters of haz.i{dou$>Wi86~ af)O q~Q-~{s..,or,oper~!o.rs,of t)azar.dous was.1e treatml:
storage. or disposal ficilities·to use lhe U:S.·EPA Form 8700-22.Rev:-9/86 (DHEC 1988·(REV 10/86)1,and, il.n·eces'sary;tha continuation sheet U'.S. EPA F
8700-22A ReV: 9186 (DHEC 1988A) toi·both inter~state•and'intra-slate transportation.-TranspOrters .whoilransport-tlazardous .waste into the Um1e9_ States, tr. _
another country cir"e resp01'1sitile fOrrCOITfpletiOg' 1he~ma"nilesl1 FCdera1 1a'nd,S!ale 'reQ'UtitiOn"S;!JJSb'fetfhif'8Yge11etatotsr8nd1 trarisj)Ohersrof hazarCous .-.·as:e ar:c:
O~ners or op'e~ators Or ha'.i3rd0Us .. ~aste-ueatrri-eht~ sl01,'.iQe:10r''ciispOSa17"1a'cilities·To ~co'fuP1eie~iiil?11(). 'riO~rng-1n,ormatro. n'. 01.sQ,:)$ ll.L f ,\ri: lTY [" F $I( ':·c;) .-'") • . ·' . :•-:•·. --••01~ ~-·~o~-'; :;. JC '4-":i:'~i•P'\"~ -:-i:i:-,•.t· '::•"!1~,..;..-.'T.-,:o;,n,..., rs·1
GENERATOR SECTION
,. Generator's U.S. EPA io Number·. ¥an_ilesl Document Numbe~: Enter lhe gen~ratqr:s q.s;:ePAJXi~~nd!9i~)~.~~iiAi~,<!fion. ~~mber and the un~\::ue,,tiv,e._di_gi~
number a•s·Si~fnCd tci this'initiiif8Si 6y'tti8'ge·ne•raitOr'beQinnin9 with 00001.11 your coriip3'n;/dO'EiSii8t fia"Vi?°J u:s! EPAi1aJntilicalion Number. please con:act S.C.
bHEC aX(8031'134~s2()6"18BOut"'obiairi1ng'an·1cfonlilicalion number. ' ' .. ... ·· I
2; Page , ol:1 "Eii1er'1riiiiotai"riumliiii'olj:,a"g'es·us·ea fo ccimjileie this"nianilesl, i.e., 1tii,'iiisip~geeP)i'l'\flfff'B1tWlWi'll!V:§/e51l:#iec i98B\P.-~V 10'186)fcius -'
numbi~~ o,~·on1inUa'tio'rtstieers~ePAr-F'Or"m187a6:2~Aev.-978GA fti1-H~ct19aaA) u'i:irl'y;}~T!~!faCCOotealfdt.tr~aHrrent:-storaoe or d1 :>l'(; :,ill r, ::;ou:'1., :;ltrt L. ::
~ Stale Ma·nileSt ·DoCUmenFNcinib'e'f:'•f":·i::eave•biaf1k!l.;•:J:-,tt»<plf, .1-'i'C"fl~•f"':• : f-~fa:::i/Hy,:w~t·l~rlWfu'.\t•ltl·!r~nr,i:,~,~ t:-ir. ' ,I ':IP..'· ' '"'l• '.,. ,._ !" • "-' W •
s: Stale~ Gl!n~;atOi 1deriuf!di11on NUfflbe/{' ,·l:eave bla'nk: ·-. • . ·.· '. -... "· H'1 1 i,q ·•,.-.•1mnsonrtr>r<; in 1:1e Qrc,~-.... .,,, 1' . ' ·-; .' --"I~ "( -=,--
3'.i Genl!fato'r's' NarTle'ral'u:1-Miiilirig.~ActdrCs"S: "''Ente·r iti8-·rlani8 and'in"3ilin-g addresS'ot'ttifl9'efie'iatOiW~i:>~Wf1Prffiit\~1Qif'\~~c-refu\:n'ed%'a'11!1E!Si 10F'rfi'sq• •::: 5·,, 1
4, Gentra10·,·.-Phoiie·Nufflb'ei: .. EritEl'i a~1e1e"Phi)r'l'e''riumb·er wllh iirea code where ·an·autnOH'ie'ci ogen1r:-onrifl'6e'n8'r'tJ.10i c'an:-b"e re"aCh'ed1 fn'i tt'i'e' even·i o, ";
"emetge·nc·y· irlcludiilg"nightS! w'eek'erid5?8ii(fh011ct8Ys:' . '•r :-_,:, .:· J· :."' J·t"'·:,~si~·J~~;T{f ;~·-\·\·';'..fl'ifl,; :..; • .;..; .. ··-~· .. -~ ,. · ~ ~
S: . TranSPort 1-comp·any Na~.e:· ~entcYtl'ie ~_omi:>a~Y ·name Or lhe -l_i_~·st' transporter Yl_h9 ,~1i)ra~-~PQ'1j)rye•~asi8 .. 1""!'l~r\t. 11 <' ..,..,c~~ ~t" -· ··-•,n i1;9!"'"'? ._,. "•;; ·•-,~
6. U.S. EPA11D'Nunitiei':\' Eiitef the·u.~~ EP.~~twE?tv((digit'idCritHicalion number of l~~1fif~t .. 1~·~~~P.Q6.~(i.Q.e,ry)!liitiJl.~l~fnj~;~,?t,.1l' J?C-1 1"'" '!J tr . .: ~-'?f ,: '7' '' t
~-~Slate_}~~~if~'!~r~~!D Nu_"]bCi:;,11l:'e~v~ bl~nk~ :\ ,_"f-.. . .-;-/''-.f :: . -··~:·· , .. '''. it ,:"r~·}]l:hif:,i;t~iijS;(:1_;.-✓, • •
oY~-Transpor11!r's'·Pho_ne Number: . !:r:i~~r a_ tel~p~.9_n4: number_ including area code whf:'r~.an a1:1l.~~!l;f:1.~.~g~r:i~. o,f_~t)~!1r_~lJfa¥f'!SPf!C{e_r,can be r~ac_he-:! 1n thE: ever.1 ol
.-• r: an erryei'g·ency, i0'c;IUdirig:n·igh1S;~w·eefE!n"dS,'3rid'tfolii::lays.::l;'! ,;. .. ~~t.·_;• " . __ •·~'.:. ~:'..:~.~-1:.:_:_c? ·tlchaHc.oF !he:lir,st,:1 .. r~nsoor1er. ·T>rrni pers-?n l!'ll s: a :.i ""1=r"--~
. T.. rrarlsp0r1er f com·p·an~Na~me·:·.c;i,113PPliC3ti1€,,.erlte'r th'e'COnij:ian'Y na·me ol the se·co~~ t~~H~:P?~~~~:~im_;!~~~¥fiO_~r.!~e ."."a~~e_J' ~ore t~ari 2_lr~_?s~o.~ers I'
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheel and list lhe lransporters·rn the order they will be transoor:1r.g the wa .
8 .. U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number of the secoild irar'IS"porte/' identilied'in iiem 7.
E. S~te Transpor1er·s ID Number: Leave blank. · I
F .. Transporter's Phone N~mber: ·{~ler•aitelepho·ni·nu·mbei'~hc15di~g area code wh~ea~atithb?i~elfl¾lfi~a~1li'e .. S~~-O'rl~lraTnspor1er can be reacr.ec in
. evenl,ol an emerg~,r1cy_ 1~.~l~?~IJQ,!)rg!),ts,,~~ee.~e_r,~~.-,<~n_d.:_h_olr~ays:: ,:: ,,,: c. :=.'~SS Dow;,"(fl.A-FlD 00~1 .. •:, \ cl 1J~. _;,·u. r ,:,,;, 1 ~s. ~ 1 i:=:T "' EC-1R _ ...
9. Designated Facility Name and Sile Address: -Enter the company name and site address ol ttie trea1ment:'stor3ge; oi disposaHacifily des1gna1eo to receive the
waste listed on this ma'ni1e·sl'Th-e 3ddress--mus11beithe1Site'a"ddi"CSs";'which may-c1urt?r'rrom:th8ir/ol3'1tin'lfa"dO?~r-F.;Of Or.'-'rn:.tor.'i.O! h-:i B[.C Ol:.~ U/rtS, !!a'.:-,'/"'.:.
10. U.S. EPA ID_ Num~er: : Enter t~e· u.~. EPA'~twel~e-digh ide'rlli!ic~t!O"n' number 0~ ih'e~d8SiQr\81ecltf'elafm~n·1: StOrage;-or CHSp'oS31'1ac_ility'iden·:ifie:fln item. ~-~1 G: Stale Facility's ID Number:· Leave· bla0K:'•fer•~•l1!'? f; nd mtrn-ici,e \~ii (l;l, 1 ;m15po'!'!:JS,WJlC'lr.et:·:m.:JT1➔•:n ::tr-d<'· '·' U/,lf.::?. 1(''.0 !:->?. 1:l•11teC :•:-,,
H;. F acm1Y·s Phone' Nllmtier:'1 Eii le'r~aL1e·1e·phori"!-e~nt~bEfr':jfLC1u-dihQ area code WhE!ie"i½~a~fh1>~fflRr''ft1@!Wtifl\ft'ifo ,acrniy,canib·e0reach-e·d ·i rnr.e ev eni,. of· an
emergency·including nights, ;;,/eeKends~,..Biid:hOlid3Ys)~. afCHs-J?~?} ~' _-, 1'm_~~"e~)~~11.?~~Yjfn)~~+;c,ri~~O~-~,-~-: . r ' -'[. • ' -_;
, 1'. U.S: DOT Descripli~ns: Enler proper shipping name, hazard class and ID Number (UN/NA) ror each waste as identilied in 49 CFR 171-1 ii. II aCd1:icr.al s::,t
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ,. ,,., . . . .
12.. Conlainers'(no. arid typ·e):"..r.1enier·nUm'H~l'"'oi·C:On'_iafl1e'/s"fOTeaCh Waste and the· apJ)r<>Pri~t~:itf'b~e~al_iOnC'f,'tlh'l\fa'Yl~':f(bei'o1wlfTo1°1h'e"'F}P1~"'o'(C'6nta1~·erf-".
• · . ··~1~• ""'1'ir i,: .• , ,· •~·,;o-!,2':rr;;(b"!t:i"~.11~--·..-• ; ~ TABLE I c-mD"<lm does not hii\/e ~.u:s. EP.A'ldentllic:ation t~uniber. ·:.I<:.,~ 0 e ::rtr:: S C
OM = Me.~ "drums, barrel~. keg"s',•:: ' ~ :-.,-... "'"'"'.1'.'1c.a·· . - ; •. · ... TT = Cargo tanks (tank true. ks)lintt.nUJ\61§:M,r;jMelal,hoxes.,.._cart. on~, cases.,rcll;c:ts· ~-. -1 , · -·; · -,·· ,., ... ,-,.-<lu:,.·J!~,...,.,,,f,:?,e-, •t .. ,...,.,., r.~':1;>s1;,,1mEPJ\·rurrno. ~-, Cl:~iJ9r0 F.!,:HP(:"t~!'l.P.f;:,;;\.'1•1/ f:'!u°' pw ~c'-Cw',?i°t:d.j,~.~~!P~~·.··b~~rr.~1.~.:,~~g.~,~ .. -~,~"0w.~1'1f~;v, Qr;~t. [•:Tf?\Tank caL~/~y: ~·::ir :~1~ asccoteo·/(J W.,'fl:.i'l'!_oo.~er,, bq~:-s,,.cartqns. ca}~S:·, :: :: .
I\.. : OF 1= Fi~~r~oard _or,,.1~.las)ic .. dru_rrys,. ~.~!.~~ls.,~;Jke~s-·" 1• • •m• . .,OT1 =,Dump truck J:.0i<Hy,)l!/·M·H\lhi.•·::... ... ,\"[,CF~,~. F_iber \or plastic boxes. car:cns. cases •
t. , TP ,= Tanks por1able •·::;-·~.--: ·, 1 • ..,~,,.-.. A°:1rik · CY= Cylinders ,., (, : · ,,,, tt,1n.,w118A.p1Burlap, cloth, paper or plast:c bags
i3 .. Tola! Quantity: ~nier.t?ta!•Ql!_a,:,tity:oL~as!:Aescrjbe'.~.,op_each.line,-retative to the.~r~,i;t~.4,l~~~v.u!~Ji~::,f'rlflH-5Wlrt~oeru\:n'Cci',.,,a',111d: 1::.-~;~· ·1·
T .s. Unit (weight /volume): .,.Enter tt\_e approprialc.abbrcvialions from Table 11 (belqw) for the unit qtrl}_~a_sµ_r~ictf-~tir:,",;r-;·;~'.10r C:-i ·b:i • .,,.. ,.,, ,, · ,--·; ,: . .-.: ,:; I ·
_ . .,,;•.!>r••·f'n;, · .. :,?-:: Tablell-:1 •,:...r.fJ-:u.er .. ·.-_;;.._.,._,;.~,~ ,, -.
P =Pounds-'· L = Liters ,.. K·=•Kifograms:::~:-,,, T =rTons · . 1• M.= Metric Tons·: .. ,.·N!=.:·CUbiciMeterss!,i'.1"Y ::·clJbic Yafds G = Gallon·s (liouid cnly)
1. Was le Number: ., Enter hazardous Waste number~ as specified ir:t South Carolina H~i~.rdo\.is:,vV~~!~'.f:-(~n.~trerh_ef!i.~€gqJati6ri'A:6·1 · 79.261 Su:::;.1ai-:s Car.d I
identitythehazardou·sWasteonei!Ch'lirleJ,_, _:--. · · · . • ~.· -iVi;••,· ,, ,,.,,' · •
J. Additional DesCriplion·s for Maletials Llsled·Above:-.1dn.lhe spaces provided, enter the auth_orization number 11,0m the S:C.di>HEO:Authoozatron:Request.F.o )
for each waste stream listed in seclion.11·abOve;'»ote:·v Be lore a·ny hazardous waste·can'b"e 'acc:e~i°~d fO'r trf3atr\10ML1slorag€! or'disposal in South'Carc-llna.'-tne
•,~ gene.rator, must,obtain prior1autho. ri~ation:from th .. e,treatm.ent. storage _or disposaiTaCit!ty.~f{;;o:iei:'H_t{'l.· \..'...~.,;~H~pdrtith'"' v,,a ste .. 11 "l'Cr~ th2!~ '? :rar, r~=-~$1
K. Handling _Co~es for.Wastes Lisled,A_bove::•, Leaveibla11k~ , g:, -~: -:: ~ 1~et zr: j lfa\· i,e'tr'ci;.-.,_,::; .Z::--•<:'·!'1 ti•~ or-:1~ · :t-iev ~"11 :,., Ir: ,, ~ :-~r-:1r :e: '"'~
tS. Special Handling lnstrucll_on, and AdditioF'lal lnlormalion: Generators may use !his space•IO indicate special:ti:anspor1ation. treatment. storage or disp t
information O_!" Bill of Lad)ng .~i;i!or~?_lio _ _n:1_F0r international shipments, generators must enler in lhis space the poinl ol depar1ure (city ar,c: s:a:e) !or tnose
shipmenl.5 destined lor trealmenl,:slpra~~-qr.disp9s~I outside the jurisdiction ol the United Sta_tes.,~0,l.J..'i.'l-'~,::.ti::--t10-~i,r ?c=;~~1'l._ ·~nw r r, ::"' r:: :''"' 1 .....
16. Generator Cenillcation: ,.The generator must READ, SIGN (BV HAND IN INK), and DATE lhecertili.cation statement. II a mode other !!')an hign.w~y is used.
Word "~ig h..-.:a y'; sho~td.b_e,1(~.e~ P~U\ ·~n'cf(h'~ iPPJ~ij~ri.ite m0d_e (r?JI. ~Ole~. or air) ir s~rt~~~_irjt~i ~lli'~i~~e~ . .,r.1,.~~l~FMrg.d~i~~?,~:~\t]~n i9(.1r1 ~ /~/~ f]w a~· [J;f~ ... -
used. e.ntef.the appn?pria!~ addi~onal m_o_de (e.g ... ~fldJail),in the space below; .. , J;,_~•,,:r,,,,_ /.:-d!>'lti!'~~;-...,f'l;..riP.~.f.~t~<: .. orv.. , r. · :,,5
' ~t~r! ~~p:Tr1Ee~. ~ ~~:~~:r~d g~m~ n t: E~~er.:~h~ ~:~1e
00I -,~~-·pers·~~ a~ceptin;/ t~e ~z~:;e~~~~!~~~t~l~t:::t~~~;~;;p~~>;t;~ ~,";!~~/s:;--;:~·.::~ ;c kr:~;: 1:1
. acceptance ol the waste described on the•manile~I by signing (BY HAND IN INK) and:eniering'a~&!D:AliE1ol1feceip_1;,,11it,, :--~fl o1~:, 0 :11•.:,·"rr 111· )~ ',,<n, -)t
18 .. Transpor1er 2 Acknowledgemenl:,,,~Enter:il-applicable, the name al the person acce'PtiritfihelW3sieiOn,-beh3rr:ol!the second transpOner. Tha:'perscr, mus:
acknowledge accep1ance:01 the wasle described on the manifest by SIGNING (BY .HAND 1N· 1NK} ·~nd enterinQ·the:DATE of"r'ei::eipt · 1 • J, .. ,-c ,.,_: !-~'I
FACILITY_ SECTION _ , · ':~-. ~. 1 ,:: : -o, tv;P';• ,-·1 1 ,,.,., !,c. ,. r , _ _ ,
19. Disc_repancy Indication Sp __ ace: ~ Th~ authori?~d-~'epresentative ol lhe designated_ l~~!~HfJ:C?~6~61,'gP~~~6~itf~?r~~r~'.i.n·1~i~'~~~c·e'any· d1scre,sa-ncy ?~1.,-;,
the waste described on the manilesl and the-wa·s1e·aclually received at the lacility. OWners 3nd oper81ors of ficilities who cannct resol .. ·e s1s,1irica~:
dlsc,epan_cies w. 1thin .15 dil. ys recelv.lng lh·e·w· .ast8 niust sub.mil IO:!~e:p. f,POrlment,~.-.~1.i!~f ~th~f<i~{'V,q,r,\~~~f~.~,~~~~f (6(bi~ft~'d~5cre'Pa1cY;ar;·c: a~l!~:::I reconcile 1t !tie treatf!'!_e,:'1,t_~torag~. or diSP!)SOl lac~\ty mus,t en1er t_h,e_a~luol welgh!.~twaste in pounds in the sp'aceS7p~rOVided H,th"e-.. aniOunt\1ilf1'es any !r~r.i:
specilied1by lhe ge~erntor1in i~om1ct :l.o,)l,_th~. oe.n,~!ntor usos a u!1_it~ol men sure 0Utc:r11/;lpr;i.ppufld~: , , .. \ I.I;= .=)=:t:er 0' ,. ,:;~:t:;; ~:·, r.2 • cc r-.:·;"'..5. :.
20. F aclllty Owner a, Operator Certlllcatlan: Print ~r.type the name of the person ncceplino tho wnste on b.e~~II ol:tt)e,o'l"'ri.er,or,operotor,ol the l,:ic1t,,t:,-. Tt1.:i1 person
must.acknowledge _!",_cc.~p_!an,~i.~,l.1_tl. ~ .. ,w..?J!~-~eJ~~!~e_d p_~ t~e ma. nilest by SIGNING !Bj\~,~~.9J~ll!j .. ~> .. ).n .. J.:enl~ .. !!r,o..:!~_e,.~~ !~ or_,rece.ipt:
. IF ASSISTANCE 1S ~~~QED_ I~ COMP.LETIO_~. OF .. !HIS MA}JIFEST,.CONTACT THE __ TRE~:r~EN,\\1$;r:<;)iM9E.~OR' DISPOSAL FACILITY OESIGtJ,l TEO I
REC!:".'E THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEK.DAYS FROf,.f8:001c1'fT{T() 5:'o·o l)m.· . , ' ' . , ... ,, . ,•
. ., .. :-,. . ;q·St b~~(.ve1S,,,s.,',l.'.,\r = S;·t,:,_ ";';;-1.:;s ...-, ::. ,,.,nr.~. ~1~ o··,1.,,
-~ .... -, ,~.... ~~-···--·~--· .... ~1·11~\~{)!,~~,r, .. Hii11'0('-!~·¥idtt1n:i~!;-!C'H~-~.F.•-7c.2::1 n,:.::ar .a'"'lr'.~::.i
I
~~i\ ,· t,j '
-~ ..,.:
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIONo.
WASTE MANIFEST N c D o 7 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transponer 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
6. U.S. EPA 10 Number
S C D O 7
Manifest
Document No. 0 0 0 9 6
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
ol
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Streel Columbia, SC 29201
Phone: (BOJ) 734-5200
Emergency & Holidays: (803)734-5-424
roved. 0MB No. 2050-0039 E.r ires 9-30-U
Information in the shaded a<eas is not
required by Federal law, but is by Stale law.
11. U.S. DOT Description (including Proper Shipping Name. Hazard Class, and ID Number} 12. Containers 13. Total Quantity 14. Unit L:W&StlNr..uberf·:-'·
Na. Type Wt/VrJ \f:,,;. ,; -,=::-: ':.!\.; fj
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
_GSX Work Order No.: 71584
I. D T 2 0 Y
1 e. GENERA TOR"$ CERTIFICATION: I harebydaclare that tho cor,tents ol this con1ignment are fully and accurately do1crlbed above by propor ahlpping "•m• and are cla.udled.
packed, mulled.and ••·be1ed,and are In e11 raspects in proper condition !or transpor1 by highway according to apptlcabta International and nat.lonal govarnmaf"lt r~utat1on1 aN:I
I.ha laws ol tha $late ol Soulh Carolina.
111 am a large ciuanhty generator, I cer1ify lh81 I hove a program In place lo reduce the volume and to1dcltyofw11.1tegenaralod to the deg roe I have dotarmh,.ct to be oconomically
prachCable and lhat I have selected Iha practicable method ol lrealment. storage, or dlspoul currently available lo ma which mlnlmiu,1 the pru.ent anCI future u,, .. 1 to humeri
heallh and !he environment OR, ii I am n smoll quantity generator, I hove made a good lailh ettort 10 mlnimlu mywute generation and ,ale ct the be al wu1a managamenl tT-.tr,od
thal is available 10 me and thot I eon 11110,d.
Printed/Typed Name }\O_CER L. COATS
17. Transpor1er 1 Ac;Knowledgemenl ol Receipt of Malerials
P~!ediJyped N
, •• l/'l,C(
18. Transporter 2 Acknowledgemenl of Receipt of Malerials
Printed/Typed Name
19. Discrepancy Indication Space
Signature
Signature
20. Facility Owner or Operator; Cer1ilicalion of receipt ol hazardous materials covered by this manilesl oxcepl as nolod In Item 19.
Printed/Typed Nam, Slgnalura
PA Form 8700·22 (Rev. 9/86) Previous Editions arc Obsolole (DHEC 1988 (Rev. 10/86))
• I
b I._.I...J....L.J....l
Day Year
Montn Day Year
jl I 8:7
Month Day Year
Jibs. C 1•·1 !lbs.
Jibs. d I I Jibs.
Month Day YOII
f
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-p;tch (elHe) typewrilerJ OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPI.ES MUST,,~E LE,GI_Bf-f,
· GENERAL INFORMATION: Federal Reg. ulations requiregenP.ralorsand lransporters of hazardous wasle and owners or operators or hazar~ous wciste treatml
storage, or disposal licihties to use !he U.S. EPA Form 8700·22 Rev. 9/86 [OHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA F
8700-22A Aev.-9186 (DHEC 1988A) toi bolh inter-stale and intra-state lransporlallon. Transporters who transport hazardous waste into the United States Ir
another country are responsible for compleling the manilesl Federal and State regulations also require generators and transporters of hazardous waste ano
owners or operators of hazardous waste treatment. storage, or disposal facilities lo co.mplele the following inlor~ation. , . I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manllest Document Number: Enter the generator's U.S. EPA twelve digit idenlilication number and the unicue frve drg1t
· number assigned to lhis manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. p!ease con:act S.C.
OHEC at {80:3) 7:34-5200 about obtall1ing an ldenlilication number. I
2; Page 1 of: Enlerthetotal number of pages used to complete this manlrest, I.~ .. the fiisl page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10186)] ~tus .
number or continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. • ., r-•• - •
A. St.ale Manifest Document Number: .Leave blank.
a: Stale Generator ldenliftcallon Number: Leave blank; I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage lhe returned manifest forms.
-'· Gener1t0r'1 Phorle Number: Enter a telephone number with area code where an authorized agent of ,the ,ge!'erator .car b_~ reac~ed .!~, t~.~ eve_r:i,1 ':,L ,
emergency including nights, weekends, and holidays. · 1, .,,J ,,;
5. Transport 1 Company Name: Enler the company name of the first transporter who will lransport the waste. I
6. U.S. EPA 10 Number: Enler !he U.S. EPA twelve digit iden!Hicalion number ol the first 1ransporter identHied i!".ilem 5. . .,. "
C. ·Sl.1le Transporter's 10 Number: Leave blank. 1
0. Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent of the lirsl transporter can be reached in the event of
. an en:iergency_i,:i!;luding nights, weekends, and holidays ... · , ..... . ... ·•-·-·-· . ____ ,... . . .. ·. ·. ·.:,. · ... ·. 1 • · r.:" Trai,sporter 2° Cofflpany Name: II 3p°pllcable, enler the company name.of the second transporter who will transport the waste. II more thari 2 tra_ns;,orters 1
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor.1ng the wa . ·a.: U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digil 10 number ol the second transporter identified in item 7. ·
E.-• Slate Transporter's ID Number: Leave blank. -I
F •. Transporter's Phone Number: Enter a telephone number including area code :-"'here an auth~ii~ed"a9'~~-,·~1,h-~ sec~·nd transporler can be reacr.ed in
event ol an emergency including nights, weekends, and holidays. . · ·
9. Designated Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal facility desiGna1ed to receive the
was le listed on this manifest The address mus I be the site address. which may dilfer from the mailing addrE!SS~ -• · • · ;
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatmenl,_storage, or disposar·racility iden:ified in item 9 .•
G:. Slale Facility's 10 Number: Leave blank. .
H;. F1cilily's Phone Number: Enter a telephone number including area code where an authorized agent ol the lacility can be reached in :he event ot an
emergency including nights. weekends. and holida)'s. ·
11~ U.S; COT Ducrlplicns: Enter proper shipping name, hazard class and ID Number(UN/NA) for each waste as identified in 49 CFR 171 •1 77. II acci:icnat sof
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. , ~ ", ,. •·· ~ .. .
12.. Containers (no. and type): Enter number ol conlainers lor each waste and !he appropriate abbreviation from Table I (below) /or 1he type ol containers.
TABLE I .
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) ,CM ~.Metal boxes, cartons. cases, roll _ctts·
OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cas~s I
... TP = Tanks portable CY= Cylinders BA= Burlap. cloth, paper or plastic bags
13 .. Total Quantity: Enter lotal quantity ol waste describ8d on each line, relative to the units used in item 1,4.
14. Unit (weighl/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II
P II Pounds L = Liters K = Kilogr,ams T = Tons M = Melric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid onty)
I. . Waste Number: Enier hazardous waste numbers as specified in South Carolina Hazardous Waste Managemen_t Regulation R.61 • 79.261 Subpa~s C ar.d I
identify the hazardous wasle on each line. ·
J. -Addilional Descriptions lor Malerials LI sled Above: In the spaces provided, enter the authorization number (from the S.C. OHEC Authorization Request Fo )
for each waste stream listP.d in section 11 above. Note: Be lore any hazardous waste can be accepted lor treatment. storage or disposal in South Carc-tina. tne
generator must obtain prior authorization from the treatment, storage or disposal facility. ~ --1
· K. Handlin9 Codes lor Wastes Listed Above: Leave blank. .
1 S. Special Handling lnstrucllons and Additional Information: Generalors niay use !his space lo indicate special lransportation, treatment storage or disp I
Information or Bill ol Lading Information. For international shipments, generators must enler in lhis space the point or departure (city and state) tor those
shipmenl3 destined lor treatment, storage, or disposal outside the jurisdiction of the United States. · • • • I
16. Generator Certification: The generator must READ,"SIGN (BY HANO IN INK), and DATE lhecertificatlon statement. ti a mode other than highway is used.
word Nhighway" should be lined Out and the appropriate mode (rail. water .or air) inserted in the space below. II another mode in addition 10 the hignway r:io
used, enter the appropriate additional mode (e.g .. _and_ rai_l) In the space below.
TRANSPORTER SECTION . 11: Transporter 1 Acknowledgement: Enter !he name ol the person accepting the waste on behatl of !he first transporter. Thal person rr:ust,acknowlet·
acceptance ol the waste described on the maniresl by signing {BY HANO IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgemenl: Enter, if applicable, lhe name of lhe person accepting the waste on behalf of lhe second transporter. That perscn r:ius:
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HANO IN INK) and entering !he DATE ol receipL
~ILITYSECTION . I
19. Discrepancy Indication Space: The authorized representative ol the designated lacilily's owner or operator must note in this space any discrepancy bf!w ,
!ht waste described on tho manifcsl and tho waste actu;illy received at the facilily. Owners and operators ol facilities who cannot resolve s1;n,licar,:
·-· dlscrepan_cies w11hin 15 days receiving the waste must submil lo the Dr.parlmenl a lellerwith a copy ol lhe manlrest describing 1he discrepanc'I and ar:er.io11
,econcde •l The treatment. storage, or dlsposol laclllly mus I enter !he actual weigh! ~I waste In pounds in !he spaces provided ir the amount varies any lrom r
1c,ecilied by the generator in ilom 13 or II lhe generator usos a unit of mensi.,re other than pounds. .
20. F•clllly Owner er Operalor Cerllllcallan: Print or type lhe name ol lhe person occepting the waste on behnll of the owner or oper.itor of the l.icllity. H1a1 person·
must acknowledge acceptanc·e of lhe waste described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE ol receipL
IF·ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNHED I
RECfc"JE THE WASTE OR THE S,C, DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm,
I South Carolina Department of Health Bureau of Solid & Haz.ardous Waste Mgt.
2600 Bull Streel Columbia, SC 29201
Phone: [phone] · '· and Environmental Control
LE.lSE PRINT or TYPE !Form desi ned for use on elite 12-llch ewriler
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
N C D 0
1 Generator's Name and Mailing Address
Channel Master
P.· 0. Box 1416,
4. Generator's Phone 919
5. Transporter 1 Company Name
Smith field,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood, SC 29125
NC 27577
6. U.S. EPA 10 Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. COT Description (including Proper Shipping Name, Hazard Class, and ID Number}
· Emergency & Holidays.: (803)73"-5'2•
Form A roved. 0MB No. 2050-0039 Expires 9-30-M
2. Page 1
of lnlormallon In the shaded a,eas is not
required by Federal law, but is by State law.
12. Containers 13. Total Quantity 1'. Unil .r.wasta Ht.inlbw';~·
No. Type wvv~ ·t··'··:·.:." ··;';,:· =-:i'_t~< .. :·t
I GE a. Hazardous W S lid ORM E '.lj1' jO,r/9,iJ. aste, o , nos -j £ ~ J-~N:..!A::._:9::l~B:,:9:_ _______________________ .J-Ltl+D~T+..L..L..J.'.2:...1'.:0+~Y_..:1,.:'.:.11~F=1=Q~1=Q~r=6~1'":.:.J·
I :T b. /~·~· .·: ..... ,-:-~.:v:;.~,]~
·d ;: :;:,; ' ,w oj_;__ __________________ .:,_ __ l-1-L-I-L.).-L..LL.l-l--~====:;.:;.j
I
I
I
I
I
I
R C.
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71585
, IS. Cl!NERATOR'S CERTIFICATION: I hereby declare thal !he content• Ollhl:, con•lgnmenl are fully end accuratelyde•crlbed above by prOP41r •hlppl~g name and are cta ... he,d,
packed, marked, and 1a·beled,and are in all ro,pecls In proper condition !or lran:,port by highway according lo appUcable lnlarnatlonal and naUonal governmen1 r90ulat1on1 af\d
v,e laws ol !he St.ate of South Cerollna.
111 am a large quantity generator, I cer1ify lhal I have a program In place lo reduceth0 volume and loxlcltyofwa:,tegeneraled to Iha dogroe I have determlne-d 10 ti. economk:ally
practica01e and lhat I hava selected lhe practicable melhod ol treatment. storage, or disposal currently available lo me which mlnlmh:111 the pru.enl and future tnrMt to human
heal1h and lhe environment: OR, II I am a smoU quontitygonorotor, I have made a good faith effort to minimize mywute generation end 1al111cl lhe bell wut• management "'9ttiod
lt'lal is avaifaOle 10 me and thal I con allord. · 1
I o 18. Transporter 2 Acknowledgement ol Receipt ol Materials Rl,;.:;._:;.:::;,::::;:::::,;:.:.;:::;:;::..::,::::a::;::;::::..:::..:::=!::.::;.;;.:==--~:----------------------------,--,-,--i
T Printed/Typed Name Signatur~ ·Month Day Year
Iµ~ ----------1--------............ ~"'--I
19. Discrepancy Indication Space
F
"
·~1---------------~ 20. Facility Owner or Operator; Certilication of receipl ol hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature
I EPA Porm 1700•22 tRov. 9186) Provlous Edition, oro Obsoloto (_OHEC 1988 (Rov. 10186)(
• I
bl
jibs. CI irt:s.
Jibs. d I , Jibs.
Monlll Day y-
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
IMPORTANT: TYPE ion a 12-pilch (eHle) typewriler] OR USE FIRM POINT PEN· PRESS DOWN .HARD'
GENERAL INFORMATION: Federal Regulations require generators and transporters ofhnzardoUSwaste and owners or operators of hazardous waste treatlt.
storage. or disposal ricilities to use the U.S. EPA Form 8700-22 Rev. 9te6 (OHEC 1988 (REV-10/86)13iid,'il neCE?sLsa·ry~ tha c·o•ritit'lu-ation~sheet U:S. EPA :n
8700-22A Rev.-9/86 (OHEC 1988A) tor both in!er:s,ate and inlra-slale transportation. Tronsporters Who frarlsPor1 lla'zardous waste into lhe United States m
another country are responsible for completing the manifesl Federal and State regulations also reQui~e-g;ne;~{o;s-an·d transporters ot hazardous .... as:e ar-,c
owners or operators of hazardous waste treatmenl. storage, or disposal facilities to complete the lollowin"g information. I
GENERATOR SECTION •. , ., .
1. Generator's U.S. EPA ID Number-Manilest Oocumenl Number: Enter the generator's U.S. EPA'°iWelve digit identification number and :he unicue live digit
number assigned to this manilest by the generalor beginning with 00001.11 your company do
1
~;;pp~J;i~~.~,~tJ,.,S,._~~~JcJ~[l.lilic_ati_<?,~ NyrnQ~r. ~.l~_H,,_e, co,:i,:act S.~1
OHEC al [phone] about obtaining an identilication number. .,.;,'._ ·. • ,..,..,--__ ... , . . . I·
2: Page 1 of: Enter the total number of pages used 10 complele this manifest, i.e., !he fifst page EPA F0(m 8700-22 Rev, 9/86 [DHEC 1988 (R!:V, 0186)] ~h.: .e
number al continuation sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) if any. ·
A.. State Manif~sl Document Number. .Leave blank. _ ., "'. , . ·:-:·· ~-
8: Stale Generalor ldentiflcallon Number: Leave blank: J
3. Generator's Name and Mailing Address: Enter the name and mailing address ol lhe generator who ~iii man3ge the returned maniles: lorms.
,. Generator's Phorie Number: Enter a lelephone number with area code where an authorized ag_enl of_ lh_e· 9~{1er~tor ca_l_! b,e reac;:~.ed _if!,;.h.e ever:1., , :, .~
emergency including nighls, weekends, and holidays. ., ·. , .. _,. · · ·-", ~
S. Transport 1 Company Name: Enter lhe company name or the first transporter who will transport lhe waste. I
6. U.S. EPA ID Number: Enler !he U.S. EPA twelve digit identHication number of the first transporter identified in item 5.
C. 'Slate Transpor1er's 10 Number:. Leave blank: _ ,...,"'" ,..., ,.,, ., .1 ·•c,.,,,,n . , .. ,,.,.
D. Transpor1er's Phone Number: Enter a telephone number including area code where an authorized agent of the lir_st transporter can be reached 1n the e ... ent ol . . .. . ~-. . ,·,,·'"-1:.,•l·--"':""t••~-:::•..,
an ef"'.lergency_1f')~lud1ng n1ghts, weekends, and holidays... ...... ... ··--·-· ·-··· · · ··' · ··• I
· ~ · T.. Traf\spor1er 2°Company Name: II applicable, enler the company name ·01 the second transpClrter who wili"tr.i"i\spOrt tlie waste. II more thari 2 frans;,orter ill
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transcor.ing thew e.
8 .. U.S. EPA ID Numbed! applicable. enter the U.S. EPA twel've digit 10 number of the second transporter identified in i!em 7.
E
F •. Transpor1er's Phone Number: Enter-a telej:,hon·~ number includi~g area code where a'r'l'aGtA&;ife"ci'.iQ~~r&rth~ ~~~o'n&l~nspor.er can be reacr.ed i e
Stale Transporter's ID Number: Leave blank. . · · I
9.
10.
c:
e'lenl ol an emergency including nights,.wcekends, and.holldays. . •n ., \ .• , ~,:, · r -... ,.. ,. ·~~-~ e ·· .
Designated Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal racility desii;natec: :c receive rne
waste listed on this manifest The address must be the site address, which may differ lrom·the;mailing address:-.,.,.._-.. ··· · '· · · · --
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identirication number al the designated treatment: storage: Or disposal facility iCen:die::: in i:em 91
Stale Facility's ID Number: Leave blank. • · · · · · · ~ · · ·
H;. Facility's Phone Number: Enter a telephone number including area code where an aulhoriz'ed agent of the facility can be reached in :~e e ... ent ot an
emergency includirig nighls, weekends, and holid3Ys.
~.s: DOT Ducriplions: Enter proper shipping name, hazard class and 10.Num_ber (UN/NA) lor each waste as identified in 49 CFR 1 71-1 ii. II aCCi:icnal st•
1s needed. use a U.S. EPA Form_ 8700-22~ Rev. 9/86 (OHEC 1988A) Conhnuatron Sheet. .. :, , ., ,,;,•••c . ,.,,. -~ . ~• ... ---.. -... , , . -.,, , -,
1 ,·.
12.. Conlalners (no. and type): Enter.number ol conlainers for each waste and the appropriate abbreviation lrom Table I (belo-.y) lor the rype al containers .. TABLE I . . . . . , .
. OM= Metal drums, barrels, kegs TT=: Cargo tanks (tank truck~·)"·..:.., . ....,. .CM =:.Metal boxes,.car1ons, cases. rol~?Hs·. ~· I•
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes; cartons. cases ·
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ans. cases
TP = Tanks portable CY= Cylinders BA= Burlap, c1olh, paper or plas:1c ~ags
13 .. Total Ouanlily: Enter total quantity of waste describe"d on each line, relative to the units used in item 14, I
14. Uni! (weight/volume): Enter the appropriate abbrevintions from Table II (below) !or the unit of measure:
Table II
P II Pounds L = Liters K = Kilogrnms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (!iauid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Wasle Management Regulation A.61 ·. 79.261 Su::;,a~s C ar.dlo
identity the hazardous wasle on each line.
J. Addilional Descriptions lor Malerials LI sled Above: In lhe spaces provided. enter the authorization n~mber (from the S.C. DHEC Authorization f.eoue~t F , )
for each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted for lreatment. storage or disposal in Soutn Carclina. 1ne
generator must obtain prior authorization from lhe treatment. storage or disposal facility. ~ · , 1•
K. Handling Codes lor Wastes Lisled Above: Leave blank. ·: . .
15. Special Handling lnstrucllons and Addillonal Information: Generalors may use this space to indicate special transportation, treatment. storage or disp.., I
inlormation or Bill al Lading Information. For international shipnienls, generators must enter in this space lhe point ol departure (city anc s:a1e) !or tnose
shipmenl.S destined for treatment. storage, or disposal outside the jurisdiction al the United States._ · :..';., .. :,i-..... .,. -~ -, ... ,.,.,.,, ., . . .• -
16. Generator Certillcalion: · The generalor must AEA0,·s1GN (BY HANO IN INK), and DATE the cer1ilicalion slatement. ti a mode other than hi(ihway is usec: e
word "highway" should be lined oul and !he appropriate mo_dc (rail, water, or air) inserted In the space below. H anolher mode in addition to tr.I? hign· ..... ay mo 1_S .
used, enter the appropriate additional mode (c.g.,_and rail) in !he space below. ~ '
TRANSPORTER SECTION . ·.. . . _. .. , . . . _ . ·
.. 17: Transp·orter 1 Acknowledgement: Enter .. ,he,name ol the personfaccep(ing _the waste on behalf of the first transporter. That person rr.us: ·ackn:i .... 11•
acceptance ol the waste described on the manilest by signing (DY HAND 1N INK) and entering the DATE al receipt. ~
18. Transpor1er 2 Acknowledgement: Enter, ii applicable. lhe name or the person accepting the waste on behalf ol the second transporter. Tha: perscr: r:-:us:
acknowledge acceptance ol the waste described on !he manilcst by SIGN.ING (BY HAND IN INK) and entering.the DATE al receipt ,
FACILITY SECTION . I
t9. Discrepancy Indication Space: The authorized representative of the designated racility's owner or operator must nole in this space any discrepancy ~et,,., n
the wasie described on the manifest and the waslo ac1Ually received at the facility. Owners and operators of facilities who cannct resolve s1;n1!icar.:
diicre.p_an.cies within 15 days recei,.,ing the waste must submit lo lhe Depar1menl a leller with a copy of the manilestdescribing the discrepanc, ar.C a.:er.i:•,,
reconc1l1 •l Tht trealment. storage. or dlsposol laclllly must enter the actual weight ~I was le in pounds in the spaces provided if the amount nries any !r~r., :
1g1cihe(I by the generator in ilom 1 J or ii tho generator usos a uni I al mens11re olher !hon pounds. · , .
20. F aclllly Owner or Operalor Certllh:allon: Prinl or type tho nome of !ho person occepling tho w.Jsto on behnll ol lhe owner or operator of \he t.Jc11,1-,,. Tt,.JI person I
must acknowledge acceplanc"e ol lhe wasle described on the manliest by SIGNING (BY HANO IN INKf and enlering !he DATE ol receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OES1G~O,TEO'
REC:"1'JE THE WASTE on THE s.c. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hanrdous Waste Mi;t
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
I PLEASE PRINT or TYPE (Form desinned !or use on elite !12-Dilchl tvnewriter)
UNIFORM HAZARDOUS 11. Generator'sU.S.EPAIDNo.
Form A 0roved. 0MB No. 2050-0039 E,p;re, 9,30.aa
Manlreat , 2. Page 1 Information in the shaded a,eas is n0I
1, , .• o~ou:no~q ~0R 01 1 required by Federal law, but is by State law.
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WASTE MANIFEST N, C, D, 0, g, 7, <.. 0, b, 7,
l Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield,
4. Generator's Phone I 919 1 934-9711
5. Transporter 1 Company Name
Willms TruckinQ Co-Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
NC 27577
6. U.S. EPA ID Number
• S • C• D• 0• 7• 3• 7• n. g, 2' q 6Nt "'· .... s'Phono iX,•0 n7 l,7F, 7.a'l T, ,.
8. U.S. EPA ID Number -~1-~';'f ·•·10 ;i_ :/-,; ,, .. ,.,.,;;~,: · ,,.,., t-,_~·-_.;,/;~',;,.:-,·· ••... \
I I I 1 1 1 I I I I I ·,:gf -·--· ·5, -...:~'.;.<''.':,,~~--'·· =·.; . .:..-., • ·,•, ;.~'"'~;\~ .. ..::<·:·:·-..• "i
10. U.S. EPA ID Numbei
;~~~~~o~ 'B~~ ;~i 25 'S, C, D, 0, 7, 0, 3, 7, ' ~ f\ ~ :~¼~:t~,'\'j\,::!11?'~63/4:~~I:sci'a'~';i}
11. U.S. DOT Descdption (including Propar Shipping Name, Hazard Class, and ID Numbar) 12. Containers 13. Total Quantity 14. Und
No. Type wvv~
d.
·, I ' ' ' ' '
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71586
1 e. CENERATOR'S CERTIFICATION: I herebydecl•reth■ ttho content., olthl:, con•lgnment■re lullyand •ccuretelyde,crlbed above by pro~, ,hipping neme ■l'ld ■r■ c•a-fled.
packed. marked. and labeled.and are In f!II re,pecta In proper condition lor trensport by hlghwey according to app11eable ln1ernatlonal end n■llonal gov■rl"lrnen1 ,a,g,..1at1on• and
ll'le laws ol th• Sla!e ol Soulh Carolinn.
111 am a large quan1iry gene,alor, I certify lhal I have a program In place to reduce the volume and loxlcltyofwa.,lageneraled to Iha de,gr-1 have detarmlne-d 10 b4 econor,,ica.lly
prac11cable and thal I have selected the practicable method ol treatment. ,torage, or dl,posat currently avaltable to me which minimize, tho present and luiure tr'HNI to human
heal1h and lhe environment OR. ii I am n smoll quanlitygonorator, I hove mado a good loith eNort to minimize mywa,t.e generation and ,elect the be1t wa11a m■n■gemen1 metnod
11'1al is available to me and tha1 I can allord.
I Printed/Typed Name ISignalure /f7 __.,/ /l // Monlh Day Yoar
l-1-----2R~O~C~ER:_!L::..,:. C~O~A1lJ~-~--_L _ ____j'M~~~_.,, -~ ·..,.;<"'XQ::;;J; •• _i...::I '21-a~---•~tl~•·?i:1L,5J.L, I.I£ ,,t'!_i,7~
·~ 17, Transporter l At,mowledgement of Receipt ol Materials · ?7
I A Printed/Typed Name \ !Signature Q -.,. ~ I~,,,'{'"'\ ~, --" -~ . ""-., ,. () Montn Day Yw
tD ,'1, I 7:,,\ l"I.~
o 18. Transp0rter 2 AcknoWledgement of Receipt of Materials \ A l-"'.:"".-'-:,-c....,;--~-'-'--'"-'--------,..,.,..-------,---..,,..-:}-------------,,:--,--=---:,--i
I LTRE-+--Pn-·n-ted_'_Ty_p_ed_N_•m_• ______________ J_s_ig_n_a1u_r_• ________ -_____________ _,M._on .. lh .... _D_.a_y .... _v ........ -t r I , I , I ,
19. Discrepancy Indication Space
: • ._i ..._.,....,_.._._...,i'bo. ' lu...wu...wllbs.
I ~ !----~---------b I pi,,, d I pi,,,
:::;: 20. Facility Owner or Operator; Certification ol receipt or hazardous malerials covered by this manilosl except as noted In llem 19.
Pnnled/Typed Name I Signature I EPA Form 8700-22 (Rev. 9/86) Previous Edlllons nre Obsolnle (OHEC 1988 (Rev. 10/86))
Month
I · I
Day Yoar
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···-
IMPORTANT: TYPE (on a 12-pitch (ellte) typewriter] OR use FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST1BE LEGIBLE!
. ,. ·-· --,~ .. ,
GENERAL INFO.RMATION: Federal Regulations require generators and lransporters of hazardous waste and owners or operators ~f hazardous waste_tr_eatml
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA F
8700-22A Rev:9186 (OHEC 1988A) loi both inter-slate and inlra-sUllc transportation. Transporters who transport hazardous was!e in!o the United States Ir
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters ot hazardous ,,.:as!e:ar.c
owners or operators of hazardous waste treatment. storage. or disposal facilities to complete the following information. . I GENERATOR SECTION
1.
2;
A. e:
1
·-s.
6. . c.
D.
. T..
8 ..
Generalor's U.S. EPA ID Number. Manifesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue live d1g1t
number assigned to this manifest by thegeneralor beginning with 00001. lfyour company does nol have a U.S. EPA Identification Number, please con:act S.C.
OHEC at [phone] about obtaining an Identification number. I
Page 1 of: Entl?r the total number of pages used to complete lhis manifest. i.e., the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P.EV 10186)] ~lus
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
State Manllest Document Number. .Leave blank.
Slate Generator Identification Number:~ Leave blank. • ., l
Generator's Name and Mailing Address: Enter_ the name and mailing address ol the generator who will manag·e th·e returned manifes: lorm·s. ·· •'I( :
Generator'• Phorle Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in !he evE!nt ol
emergency including nights, weekends. and holidays. ·
Transport 1 Company Name: Enter the company name of lhe first transporter who will transport !he waste.
U.S. EPA 10-N~mber: Entei-the U.S. EPA twelve digit identification number ol the lirsl transporter idenlilied in ilem 5.
'Slate Transporter's ID Number: Leave blank .
Transporter's Phone Number: Enter a telephOne number including area code where an author_i;ed agent of lhe first transporter can be reache::! in the event of
an emergency including nighls, weekends. and holidays. . . ·• · · · · ·, . · · ••.
.. Tran~porter iC~.:npany Name: II a,p°plicable. enter the c~mpany name 'Ci the se~Orldfr.il1s'P-orter who wm'tra"n'sP6rt the waste. II more lhari 2 trans;,orters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 {DHEC 1988A) continuation sheet and Hsi the transporters in the order they will be iransoor.ing the wa .
U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit ID number of the second transporter identiried in item 7.
E,. Slate Transporter's ID Number: Leave blank. • I
F.. Transporter's Phone Number: Enter a telephone number including area code y.,here an au'thO;iZed age~i'Ofthe seCO"nd lfa'nsporler can be reache::! in
event ol an emergency including nights, weekends. and holidays. . -,.
9. Designated Facilily Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal lacility designated to receive !he
waste listed on this manifest The address must be the site address. which may differ lrom the'mailing '"addreSS~-:-. ~-. --.•. ·--•v -· ., •• ~ , . • •••
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment. stoiage. Or disposal facility iCen:died in item 9.
G:. Slate Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authoiiz.ed agent cit the facilitY can be reached in tr,e e..,e'nt or an
emt!rgeney including nights. weekends, and holida)'s. · · .., • · ·
11~ ~.s; DOT Oucrlplions: Enter proper shipping name, hazard class and ID_Num_ber (UN/NA) for each waste as identified in 49 CFR 171-1 77 .. lf aC:~i:icnal spf
rs needed. use a U.S. EPA F_Or!l,1.8700-22A Rev. 9/86 (DHEC 1988A) Contmuallon Sheet. • "''!'""' .. ..,,, •'1'-' ... ,,,,,.:-·•..., ... ,,I.,._., .... p, ~,..,, ·-,, 1 :, • ,
12.. Containers (no. and type): Enter number of containers !or each waste and the appropriate abbreviation rrom Tab.I~. I (below)_,ro'r the type ot c_ontajners, . TABLE I , :;, ..
OM = Metal drums, barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. cartons, cases. roll cHs· I
OW= Wooden drums. barrels, kegs TC= Tank cars CW-~ \:VOOden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= F_iber or plastic boxes. cartons. cases
-TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plas11c bags
13 .. Total Quantity: Enter total quantity of waste describe"d on each line, relative to lhe units used in item 14. -·
14. Unit (weight/volume): Enter the appropriate .ibbrevintions lrom Table II (below) lor the unit of measure:
Table 11
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters. Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specHiedin South Carolina Hazardous Waste Management Regulation A.61-79.26.1 Su::par:s C ar.d I
identity the hazardous waste on each line.
J. Additional Descriptions tor Materials Listed Above: In the spaces provided, enter theaulhorizalion number (from the S.C. DHEC Authorization Request Form)
for each waste stream tlst~d in section 11 above. Nole: Be!ore any hazardous waste can be accepted !or treatment storage or disposal in South Carc-lina. tne
generator must obtain prior authorizalion from the treatment, storage or disposal facility. .. :<:I'
K. Handling Codes !or Wasles Lisled Above: Leave blank. · , . · • '.' , .
15. Special Handling lnslructlons and Addillonal Information: Generators may use this space lo indicate special lransportation, lreatment. storage or disp I
Information or Bill ol Lading Information. For international shipments. generators mus! enter in this space lhe point of _departure (city and s:ate) for tnose
· shipments destined tor treatment, storage, or disposal outside the jurisdiction or the United Stales. · ·;: -,. ---: ·· .. ,, • -~,...,~ , .,,.. 'f: ,:,r. .,..I,
16. Generator Certiflcal!on: The generator must READ,'SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used.
word '"highway·· should be lined out and the appropriate mode (rail. water .or air) inserted in the space belo...:.. If another mode in additior. :o the hignway mo s
used, enter the appropriate additional mode (e.g.,_and_ rail) in the space below.
' 11: Tran'sporter 1 Ack_nowledgeme~~: .• Eriter the.name ol the person accepling'lhe waste on behalf of the firs~ tran~porter. That person.rr.us! ackn6,;...1e
TRANSPORTER SECTION • I
acceptance of the waste described on the manifesl by signing (BY HANO IN INK) and entering the DATE ol receipt. · ·. . .• ~. . .. ::; ,:,ri .• , , _1
18. Transporter 2 Acknowledgement: Enter, if applicable. the name of the person accepting the waste on behalf of the second transporter. That perscr. mus:
acknowledge acceptance al the waste described on lhe manifest by SIGNING (BY HANO 1N INK) and entering lhe DATE ol receipL -, •1.
FACILITY SECTION · .
19. Discrepancy lndicalion Space: The authorized representalive ol the designated facility's owner or operator must note in lhis:iPace any discrepancy betw
!he waste described on the manifest and the waste actUatty received al lhe facility. Owners and operators ol facilities ._Who cannc1 resolve srgndicar.:
L dlscrepan_cies within 15 days receiving the waste mus! submit to the Departmenl a letter wilh a copy ol the manifest describing the discrepancy and ar:emo11
reconerlt •L The trealmenL 11orage, or df1posol lactrlty mual enter the acluol weight C!I wosle In pounds in the spaces provided ii the amount Yaries .any !rom !
apecilied by lhe generator in ilom 13 or ii the generator usos a uni! ol mensi.,re other 1han pounds. .
20. Facility Owner or Operator Cerllllcallon: Print or type the name or the person occepling tho waste on behnll or 1ne owne,· or oper.110~ ol the •~c1t,1y. Tti~I person
must acknowledge acceptance ol lhe waste described on the manifest by SIGNING (BY HAND IN INK)" and entering the DATE ol receipl
IF ASSISTANCE 1s NEEDED 1N COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT·; STORAGE, OR DISPOSAL FACILITY DESIG~u.reo I
RECf:!1/E THE WASTE on THE s.c. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm, .. . .
,I South Carolina Department of Health
and Environmental Control
Bureau of SOiid & Ha.z.ardous Waste M;t.
2600 Bull Str~t. Columbia. SC 29201
Phone: [phone]
Emergency & Holiday~ (803)734-5-12,
I Pl.E.A.SE PRINT or TYPE {Form desioned for use on elite r12-nitchl t. .. •ewriler)
UNIFORM HAZARDOUS 1,. Generalor'sU.S.EPAIDNo.
Form A
Manlteal 12. Page 1
I, t.,0:(,U:"()~6 ~°a of 1
roved. OMS No. 2050-0039 Expires 9-30-8.a
Information in the shaded a,eas is nol
required by Federal law, but is by State law.
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WASTE MANIFEST N, C, D• O· g, 7, ,;, O, 4, 7,
1 Generator's Name and Mailing Address
Channel Master
P, O. Box 1416, Smithfield,
' C. Generalor'sPhone( 919 I 934-9711
5. Transporter 1 Company Name
NC 27577
6. U.S. EPA ID Number
l t~~'.1.:<?;_::,·. _.,
.. · -::·~,;-~, \j',' ,.: ..
=c/,$taie',· ..... . .... I 10:)i,;-=· , ·t /--'.•:.: ·.-:,,, .. =-,.,:::. <.: .. ;;· ,·,.
Willms Truckina Co Inc. Si Co Do 01 71 1, 71 n. a. ?. a. . OAT·" .... ,,.... i'Phono\,,s <>n '\'/7 ~ 7-" o..,.,., •
7. Transponer 2 Company Name
9. Designated Facility Name ar1d Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
8. U.S. EPA ID Number
10. U.S. EPA ID Number
, s, C1 D1 0, 71 01 3, 71 •
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity It Unit l'W&it.~', . .:..
No. Type 'MN~ . . <'/:: ':<· .. · .;:\
I ~ L Y'F : .. 0-'·1"' f",
Hazardous Waste, Solid, nos ORM-E .·,• 1 1 1 1~': ~~ I',.
~l-..;N;'.:A~::_9_:1~8~9 _________________________ ..)...J•L·..J•L.'.l..j:D'...r'T:..+-L'L'.i.'.:'2.J'.'.:O..)..~Y-l,:··.:.;.;!::if:::::ID:::!;1:;:D:;i::6:!i.:;1-1.
I i 1,:b_. -----------------'------'-----------+-.J1~1L+-L '-l-J'LL'L '.J'-·+--i·..;;1~:=' =·=· =·=· =··=·=· :::::.;;i;;.j:
I R ~ ' ' ' ' ' ' ' iL:-'-'-.._· ... :,
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15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71587
, e. G~NERA TO R'S C ER TI_FICATION: I hereby declare that tho contents ol this con■l.onment are fully end accurately doscrlbod abovo by proP4'r ahlpplng "•m• and are ct•~ .. t1eca.
packed. marked, and labolcd,and aro ln 1111 rospecta In proporcondillon lor lron1portbyhlghway according to applica.bta lnlarnaUonal and national govornmant ro,g1,,1Jatlon• arod
vie I•*• of u,. St.ala ol Soultl Carollna.
111 am a largo quantity genaralor, I cor1ity that! have a program In place lo roducelhevolumo and toidcltyol wa,tegenerelod totha d~roe 1 have datarmlna<I to b9 oc:onoml,eally
prachcabta and that I have selected the pracllcable malhod ol lraatmenl, storage, or dlsposal currenlly available to me which mlnlmiz.H the pre Mn! and lutura ltltNl to human
health and tha environment: OR. II I am a small quonttrygonorolor, I hove mado a good faith aHor1 lo mlnlml.te my was le generation and select tno boll w■-t• management rrooino<I
that i1 available to mo and that I con allo,d.
I Printed/Typed Name !Signature ,.;r7 £) /1 1 Month Day Yw
~".":"":~-""':"":"-"".""'.'_""'.'RO~.;C.:.ER~L.;C;:.:O:::A::;.T:.::S:,_.....1. ___ ;e;r,IL :i.~, ~-,.::· ·.:i·--·~-:::7.:.....~~~~~-r----l'L.:r1:i.!?;~·1.:•<~-t..',1,j'J>::i,7A. ~ 17. Transponer 1 A~Knowledgemenl ol Receipt of Materials /'\ // ...-, / // -"'
I ::; P'.)ill~TypedName / ,/', 7 , ISi~eL.,/ \ _u_ ---=.;,/ -//. #.
s pC.H/?/v . ✓ '/., ~,cA_.:; <.....--Y.O.//, -. r r/T.t.n /;
p ~ j.:1::8:., . .::Tr::•:.::ns::po::rt:.::e:;.rJ'c.:.,A::ck:::n::o.::w::le::dg,:e:.:;m.::e:::nl:,:o:;_i.::A::ec::e:::iP::_l::ol:::M:::a:::le::_ri::•l::s ___ -r.c __ / __ .,.'-./ __________ • ________ ---:.,--:---:c----::---i
Mon:n Day Year
vJ,rg' P, /,I? 11
11
.R~..:.+--P_n_n_led-/T_y_p_ed_N_•m_e ______________ ji.,S_ig_n_•_lu_r•-----------------------.&M-o.:nl.lh..L-0.lai.y..1.-Y.lear--j ~ I , I , I ,
19. Discrepancy lndicalion Space
F ,,,
I ? I------'----------~ 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted In llem 19.
Printed/Typed Name I Signature
I EPA Form 8700-22 (Rev. 9/861 Previous Ed1trons are Obsolete (DHEC 1988 (Rev. 10/8611
• .. 1 .L..1..L.l..-1...Jpi,,. ' lw.. ........ w...L..Jllb,.
b I pi,,. d I libs.
Month Day YNI
I , I , I ,
'.
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFO_AM HAZARDOUS WASTE MANIFEST '-,1.
IMPORTANT: TYPE {on a 12-pitch (elite) typewriter) OR USE°FIRM POINT PEN -PRESS DOWN HARD ;:/ ALL COPIES MUST ~E L_EGIB~~!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatml
storage. or disposal licililies to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)) and. ii necessary, th~ continuation sheet U.S. EPA F
8700-22A Rev.-9/86 {OHEC 1988A) loi both inter-state and inlrn•slate transportation. Transporters who transport hazardo\Js waste into the United Sta"tes 1,·
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters al hazardous was1e ar.c
::::::~::e~•~:~l:f:,azardous waste treatment. storage, or disposal lacililies to complete the following information. I
1. Generator's U.S. E_PA ID Number. Manifest Document Number: Enter the generalor's U.S. EPA twelve digit idenlification number and the unicue live digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:act S.C.
OHEC at [phone] about obtailling an ldentilicallon number. · . -... ,
2; Plge 1 of: Enter the total number of pages used to complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 1 0t86JI clus
number or continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A. St.ate Manifest Document Number: .. Leave blank. '
e: Stale Generator ldenHflcatlon Number: Leave blank. . , , ·r1 ,,-, 1,,;
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage !he returned manifest forms. .
.t. Generator's Phone Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in tne event of
emergency including nights, weekends, and holidays. ,. , -, \''
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enler the U.S. EPA twelve digit idenlilication number of the first transporter idenlified in item 5.
C. 'Slate Transporter's 10 Number: Leave blank.
D. Transporter's Phone Number: 0Enter a telephClne number including area code where an authorized agent of the first transporter can be ~ea~~,e.~ ~n the ~v~~t,?J
an er,:iergency lr:,c;luding nights, weekends, and holidays.. ___ · · ·, · · 1 ·
. T. .. TraMsporter 2° Cofflpany Name: II 3p'plicable, enter the C
0
omi,a·~y flame-~; !he sec-;;·~·dtr8ris'PClrter who wm't~a'nsPOrt the waste. II more thari 2 Ira_ns;::>orters. I
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in !he order they will be transoor:.1ng !he wa .
8 .. U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit 10 number al the second transporter identified in item 7.
E. .. Slale Transporter's ID Number: Leave blank. • ..--r.-I
F •. Transporter's Phone Number: Enter a telephone number including area code :,yhere an authorized agent of the second transporter can be re acned in
. event al an emergency including nights. weekends, and holidays. · ·· · · ·,
9. Designated Facility Name and Sile Address: Enter !he company name and site address of the treatment, storage, or disposal facility designated 10 receive the
waste listed on !his manifest The address must be the site address. which may differ from the mailing address:· ,-~ -·-•· , •. , · ·· • ,,-,-; ·· · -1 10. U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number al the designaled treatment. storage, or disposal facilif'/ iden:ified ~n item 9.
G:. Stale Facility's IC Number: Leave blank. ·
H;. Facllily's Phone Number: Enter a telephone number including area code where an aulhorized ·ageiit of the facility can be reached in tr,f{ even! ol an
emergency including nights, weekends, and holida)'s. .
11'. U.S: COT Oescrlplions: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identified in 49 CFR 171 •1 7i. If adC:i:icnal sof
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. • _ _ · . , .
12... Conlalners (no. and type): Enter number ol conlainers !or each waste and the appropriate abbreviation from Table I (below) ro, the type ol c::ontail'.'ers n~, ..
OM= Metal drums, barrels, kegs TT= Cargo tanks {lank trucks) CM= Metal boxes, cartons, cases. roll ctts' 1• I
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes, cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
" TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bais
13 •. Total Quantity: Enter total quantity ol waste described on each line, relative to the units used In item 14. I
t4. Unit (weighl/volume): Enter the appropriate abbreviations lrom Table II (below) for the unil of measure:
Table II
P = Pour,ds L = \,.ilers K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liQuid only)
· r. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Sutpar:s C ar.d I
identity the hazardous waste on each line. · J: Additional DescripHons for Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. OHEC·Aurhorization Request Fo I
for each waste stream tistP.d in section 11 above. Nole: Be lore any hazardous waste can be accepted for treatment storage or disposal in South Carc-lina. tne
generator must obtain prior authorization from the lreatment, storage or disposal lacility. , •• ,·-J
· K. Handling Codes lor Wastes Lisled Above: Leave blank. _ , .
15. Special Handling Instructions and Additional Information: Generators may use this space lo indicate special transportation. treatment. storage or disp I
information or Bill al Lading Information. For international shipments, generators must enler in this space lhe point or departure (ciry and s:a1e) !or tnose
shipments destined !or treatment, storage, or disposal outside the jurisdiclion al the United States. · .. .. . · • ,. • . , I
16. Generator Certiflcalion: The generator must REAO,'SIGN (BY HANO IN INK), and DATE thecertiliCation Statement. II a mode other than highway is used.
word "'highway" should be lined oul and the appropriate mode (rail, water.or air) inserted in lhe space below.II another mode in addition to I1"',e highway moc
used, enter the appropriate additional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION .
11: Transporter 1 Acknowledgeinent: Enter the name ol the person accepting the waste on behalf ol the first transporter. Thal person rr.usl acknowlel
acceptance of the waste described on lhe manifest by signing (BY HANO IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name ol lhe person accepting the wasle on behalf of the second transporter. That person must
acknowledge acceptance of the wasle described on the manifest by SIGNING {BY HAND IN INK) and entering the CATE or receipt I
FACILITY SECTION · .
19. Discrepancy Indication Space: The authorized representative of the designated lacility's owner or operator must no1e in this space any discrepancy betw
the waste described on the manilest and the waste actUally received at the facility. Owners and operators of facilities who cannct resolve s1;n1ticar::
discrepancies w1Ihin 15 days receiving the wasle must submit lo the Dnpartmont a lefter with a copyol the manilest describing 1he discrepancy ar.d a:-:emotl
,econ~il• ii. The trulment. lloreoe, or dl1i:,oeal lacllllV mutt onlor ll'lo ecIuot wolghl (!I waalo In pounda In lho apoc:ol i:,rovidod ii Iha amounl varies .any from t i
specil,ed by lhe generalor in ilom 1:J or II tho generator usos a unit of mcns11ro olher thnn pounds. ,
· 20. Faclllly Owner or Operator Cerllllcallon: Print or type the name of the person occepling tho waste on behnll ol the owner or operator ol the tac,hly. That person
must acknowledge acceptanc·e of lhe waste described on the manilest by SIGNING (BY HAND IN INKf and entering the-DATE ol receipt
•• •ssrsT•NCE ,s NEEOEO IN COMPLETION OF THrs MANIFEST, CONTACT THE TREATMENT, STORAGE. OR 0IsPOSAL FACrLrTY oEsrc;w.rEo I
~,C,"JE THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt. ~
2600 Bull Street, Columbia. SC'29201
Phone: [phone]
E PRINT or TYPE
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
ewriler
1. Generalor's U.S. EPA ID No.
N C D 0
P. O. Box 1416, Smithfield, NC 27577
( Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
1
Menlf••I
Document No. 0 0 1 0 0
Emergency & Holidays: • (803)73-1-5'24
Form A roved. 0MB No. 2050-00J9 E.tc,ires 9-30-e.a-
2. Page 1
of Information In the shaded areas is n01
required by Federal law, but is by Stata law ..
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
H~fard·o,i"s··\ia,ite, Solid, nos ORM:E'
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71588
12. containers 13. Total Quantity 14.Unit -l'.W&SllltMublr:J+~
No. Type 'MN~ .. ·.,,:,_: ·":f·.' =-:i .)=~/~
I D T 2 0 Y
1 e. GENERATOR'S CERTIFICATION: I hereby decl•re th•I !he contents of this conslgnm•nt •re rully on~ •ccur•tely dHcrlbed •bov• by proper shipping n•m• •nd ara c1e ... ne<1.
packed, marked, and ra·beled,and •re In 11II re1pecta In proper condition fortr•n1portbyhlghway •ccordlng to•ppllcable lntarnallonal and naUonal governmantre,gulatlona •I'd
via laws of 1ria SI.Illa of South Carolina.
If I am a larga ciuant1ty generator. I certify lhat I have a program In piece to reduce tha volume and to1dclty olwaatagon•raled tou,a deg,_ I hava dalarmlna-d 10 be aconor,,6c.alty
pract1ca01a and Iha! I hava selected Iha pracllcat>le mathod of treatment. 110,age, or dlapoul currently available lo ma which mlnlmlzaa Iha praunt and lutura tnrNI to 1'11,1_,nan
haatth and lhe envlronmcnt;OA,111 am a small quantltygonoralor,I hove made a good faith oflortto mlnimlza mywasiogenerallon and 1alac1 tne b4al wa11a managamant ""'9tnod
that i1 availat>le 10 me and tha1 I con afford, · • .., · "'
Printed/Typed Name Signalure ~ Month Day Year
0
17. Trans ner 1 A<.:Knowled emenl ol Receipt of Malena s
/
1D frj-.ftc/t
18. Transpo r 2 Acknowledgement of Receipt of Malerials
Printed/Typed Name Signalure Month Day Year
C
19. Discrepancy Indication Space
I I !lbs. C I libs.
b I !lbs. d I lltl,,
10. F1ciliry Owner o, Operalor; Cer1HiCallon of reeelpl ol hazardous molerials covered by this manifest excepl a, noted In llem 19.
Prinled/Typed Nam, Signature Monlh Day Yur
PA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete {OHEC 1988 (Rev. 10/86)1
t .....
'h ~ ;:i;~~ :i, ! . ,}:.,' ~ l ;
. ' . ' . ' STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS. W~STE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN• PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
. ' GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardoys was:e treatnil
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA F
. e700-22A Rev:9/86 (OHEC 1988A) tor both inter-state and intra-stntc trnnsportation. Trnnsportcrs who transport hazardous was!e into the United Sta.tes Ir
another country are responstDle !or completing the manilesl Federal and State regulalions also require generators and transporters ol hazardous waste ano
::::::~::e~::;l:INhazardous waste lrealmenl. storage. or disposal lacililies lo complete lhe lollowing inlormalion. I
1. Generator's U.S. EPA ID Number-Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five d1g1t
number assigned to this manifest by thegeneralorbeginning with 00001. Hyour company does not have a U.S. EPA ldentilication Number. please con:act S.C.
OHEC at [phone] aboul obtallling an Identification number. I
2,; Page 1 ol: Enter the total number of pages used to complete this manliest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (P.EV 10186)] ~luS
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A.. Slate Manllesl Document Number: .Leave blank.
e: Stale Generalor ldenliflcallon Number: Leave' blank. I
1 Generator's'Name and Malling Address: Enter the name and mailing address ol the generator who will manage the returned manifest lorms.
,. Generalor's Phorle Number: Enter a telephone number with area code where an aulhorlzed agent of the generator can be reached in the event o
emergency including nights, weekends, and holidays. ·
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve dlgil identification number of the first transporter idenlilied in item 5 .
. C. 'Slate Transporter's ID Number: •. Leave blank: ,
0. Transp?rter's Phone Number: Enter a telephone number Including area code where .an authorized agent of the lirst transporter can be reacheC in the event or
. an er,:iergency.ir:,c:luding nights, weekends, _and holidays... .... . . .--· .. -•···-· . -··-......... .. ·. ·. ·. :,· . ._. •.· · -,. " , · ·•· '),
••
1
·~ • T..' .. Tra'nspOrter 2° Coinpany Name: II 3p°plicable, enler the company name of the second transporter who will transport the waste. II more thari 2 trans;:,orters 1 ·
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in !he order they will be 1ransoor:ing t':e wa .
8.. U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digil 10 number of the second transporter identified in item 7.
E.. Stale Transporter's ID Number: Leave blank. I
F .. Transporter's Phone N~mber.: E~ter a telephone number"i_ncl~ding area code :vvhere an auth0riied "agE?Oi';t',h; ;~COnd 1~3ns?or1er can b: react-.e-:!_ i~
• event ot an emergency includmg nights, weekends, and holidays. ' ,., ' .,. ' ~ '
9. Designated Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal racility designated to receive the
waste listed on this manifest The address mus I be the Sile address, which may differ from the marnn9' address:·-~~.~ ·-,,. .,..,... ~ -. --. ~~-. ~ . --~-. I
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designat~d treatme~l• sjo~ag~._9r_p~sp_o.~al facility iden:1fiec;i _in it~_m 9.
G:. State Facllity's 10 Number: Leave blank. , . _. _ . • _
H;. Facility's Phone Number: Enter a telephone number including area code where an aulhorized agent or the facility can be reached in the event ol an
emergency including nights, weekends. and holida)'s. · · •
·. 11; ~.S: DOT Oescrlplions: Enter propersh.ipping name, hazard class and ID_Num_ber (UN/NA).f.o,reach waste as ide.nlilied in 49 C. FR'. 71 -1 77. If aC:di:icn~I spf
,s needed, use a U.S. EPA Form B7q0-22A Rev. 9{~6. (OHEC 1988A) Contmuallon Sheet. -. ,., _ . ~,, 1r1,,,.,1.,,,.0, •,r-, .. ·:rr,p· . .,. , -:: . • ,. .
12.: Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation fr_ofl'! T~bl.e, I ('?elow).for. the type 9!. c_:;:>nta!~ers.
TABLE I . .
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) z-.••c ./;•.¥ ~ .. ty,~t?,[ ~oxe_s .. ca0on,s, case~. ,'9\1.?tts' 1 "· ,c .,
OW:;:, Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
--TP .. Tanks portable CY= Cylinders BA= Burlap, clolh, paper or plastic t.ags
13 .. Total Quantity: Enter tolal quantity ol waste describe'd on each line, relative to the units used in item 14.
14. Unil (weight/volume): Enter lhe appropriate abbreviations from Table II (below} !or the uni! of measure: I Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid ontyl
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subpar:s C ar.d I
identify the hazardous wasle on each tine. ,
J. Additional Oescriplions for Malerials LI sled Above: In the spaces provided, enter the authorization number (from the S.C. OHEC·Authonzatio_n Aeciuesl For )
for each waste stream liste:id in section 11 above. Note: Before any hazardous waste can bC accepted for treatment. storage or disposal in South Carclina. ine
generator mus! obtain prior authorization lrom !he lrealment; storage or disposal facility. · ..... · · '"i.,· ~ ~ · ·. • ~r ,r-~--~1;
K. Handlln9i"Codes !or Wastes Listed Above: Leave blank. · . - ·
15. Special Handling Instructions and Additional Information: Generators may use this space lo indicate special transportation. treatment. storage or disp I
information or Sill ol Lading Information. For inlernalional shipments, generators must enter in this space !he poinl ol departure (city and s:ate) !or those
shipment3 destined for treatmenl. storage. or disposal outside the jurisdiction of the United Slates. · . , . .,.,.,.. -,~ • ·" •--1
16. Generator Certillcalion: The generator must READ,.SIGN (BY HAND IN INK), and DATE lhe certilicalion statement ti a mode other than highway is Used
word "highway" should be lined out and the appropriate mode (rail, wnter.or air) inserted in !he space below. If another,mode in. addition :_o It':~ hignway µ:g_ ,. ,J
used, enter the appropriate additional mode (e.g .•. and. rail) in the space below. · •
TRANSPORTER SECTION , . . . . .. .. _,_ _, t . 11: T,anspor1er 1 Acknowledgement: Enter the name ol the person accepting lhe waste on behalf of the first transporter. That person rryust ackn~,..le
acceptance ol the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE ol receipt. 1
·, • 1
18. Transporter 2 Acknowledgement: Enler, ii applicable, the name of the person accepting the waste on behalf ol the second transporter. That person mus:
acknowledge acceptance ol the waste described on the manilcst by SIGNING (BY HANO IN INK) and entering the DATE al receipt . ' • 1
FACILITY SECTION.. . . ,
19. Oisc,epancy Indication Space: The authorized representafrve or the designated facility's owner or operator must note in this space·any discre~:iancy betW _ · ·
the waste described on lhe mantles! and the waste actU.:illy received al lhe facility. Owners and operators of facilities who cannct resol-.-e s1i;n1li'car.: ·
~-cllsere~an.cie, w11hin 15 days receiving tho waste must submit 10 the Oepa,tmenl a lellerwil~ a copy of the manllesl describi~g the discrepancy ar.d a~er:,6.,
reconcile 1L The 1rea1ment. s1orage, or dlsposol laclllly must enter the actuol weigh! (!I was1e m pounds in 1he spaces provided ii the amount -.-aries any !r:,m t
1pecili~d by lhe generator in itom 13 or Uthe generator usos a unit ol mens11re other than pounds. .
20. Facility Owner or Operalor Certlllcallon: Prlnl ortypelhe nameol lhe person accepting tho waste on behalfol the owner or operator ol the lac,hty. Tt1.Jt person
must acknowledge acceptanc'e ol the waste described on the manifest by SIGNING {BY HANO IN INK)and entering the DATE or receipt
IF ASSISTANCE 1s NEeDeo 1N COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR 01sPOSAL FAC1uTY oes1a~,ATEo I
_REC!:1'/E THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. ., .
' ' ' . " ' · n -,I\/!
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Ha.urdous Waste Mgt.
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Gene,0I0,'sU.S.EPAIONo.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
S C D O 7 0 3 7
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number}
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling lnslructions and Addilional Information
.. , GSX Work Order No. : 71589
Form A
2. Page 1
ol
Emergency & Hol;days: (803)734-5'24
roved. 0MB No. 2050-0039 E.x ·res 9-30-8,8
Information in the shaded a<eas is n01
required by Federal law, but is by State law.
A;'i~Manifes!OocumotllNu<nb« · ,, .... ,.,,·,,., ;,: }))/:/+-:-:,.:,.
12. Containers 13. Total Quantity It Unit l'W&stil....,.,_,~ . ..;..
No. Type 'M/VrJ \j/:,-~-i-t---,~;:,?:.i}..,~!~
l D T 2 0 Y
19. G!HERATOR"S CERTIFICATION: I hereby declare thal lhe conlants of this conslgnmenlerelully and eccuratolydo1crlbod above by proper ■hipping name end are cla ... neo,
pocked, marked, and 18beled, and are in all res peels In proper condlllon for transport by highway according to appUcable lnternatlonal and national govornmanl re-Qulatlona &NI
tl'le ta .... a ot 11,e SI.ate of South Carolina,
HI am a largo quan11ty generator, I certify that I have a program In place lo reduce the volume and toxicity of waategeneralod to Iha dog,_ I have dolarmlned to be .conomlc::ally
practicable and that I have selected Iha pracUcabta method ol lrealmant. slorago, or dl!Jposal currently avallab1o to ma which minimizes the present and futura thr-t to l'lumen
l'lealtl'I and the environment: QR, HI am a small quanlltyganorolor, I have mado a good faith etfort to minimize my westa generallon and ,elaCI the bail wa1ta management no-.O'IOd
ff\al is available lo ma and·lhal I can allord.
Printed/Typed Name ROGER L COATS
17. Ttanspor1er 1 Ac.:,mowledgerTienl of Receipt of Materials
Printed/Typed Name
,--:;, // Qc ~
18. Transparter 2 Acknowledgemenl of Receip1 of Malerials
Printed/Typed Name
19. Discrepancy Indication Space
Signalure
Signature
Signature
JO. ,Icllity Owner c, Oper■lor: Ctnlflcallon ol receipt of hazardous malerlals covered by this manlfesl except ea noled In Item 19.
PrinTedlTyped Nama Signature
PA Form 8700•22 (Rev. 9/86) Previous Edlllona ore Obsololo (DHEC 1988 (Rev, 10/86)1
•I .......... _._.__..
b L.I .L.J...J-1.....1
Day Year
Mont:,
vs
Month Day Year
jibs. CI !lbs.
jibs. d I libs.
Month Day y..,
IMPORTANT:
i · r. i .i•,
STATE OF SOUTH CARO~INA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEASLTL COPIES MUS·T-~BE L.EGIBL.E'.
TYPE {on a 12-pitch (elite) typewriter} OR USE FIRM POINT PEN· PRESS DOWN HARD ,,
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or.operators ol hazardous waste 1reatml
· storage. or disposal licilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 {REV 10/86)1 and, ii necessary, Iha continuation sheet U.S. EPA F
8700-22A Rev:9/86 (OHEC 1988A) loi both inter-slate and intra-stale transportation. Transporters who transport hazardous waste inlo the United Staies Ir
another country are responsiOle !or completing the maniresl Federal and State regulations also require·gencrators and transporters of hazardous waste ar.c
owners or operators of hazardous waste treatment, storage, or disposal facilities to complete the following information. I
GENERATOR SECTION •.• . .
1. Generator's U.S. EPA 10 N·umber ~ Manlfesl Document Number: Enter the generalor's U.S. EPf ~we1Je;sigit i~entificalion numb~r a.~.d :h.~ y~1~ue}i':'e 9!9!~
number assigned to this manifest by the generator beginning with 00001.11 your company does no! ~ave a U.S. _EPA Identification Number. please con:as.t S.C.
OHEC at [phone] about obtalrling an Identification number. · . · · · .,. · · I
. 2.: Page 1 of; Enter the total numberol pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P,EV 10186)1 plus
\ _ ·~ number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. 1,,; .' , ,· ,. ,.. _1 •• "( : 1 ,-.. 1
A. St.ale Manliest Document Number: .Leave blank. ,. · ··
a: Stale Generator Identification Number: Leave blank. · ' · -,, · I
3. Generator's Name and Malling Address: Enter the name and mailing address al the generator who will manage lhe returned manifes: forms.
•· Generator'• Phor\e Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in ·1n·e evt!nt ol
emergency including nights, weekends, and holidays. · ·
5. Transport 1 Company Name: Enter lhe company name ol lhe first transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number of the first transporter identified in item 5.
C. 'Slate Transpor1er's 10 Number: Leave blank. '
0. Transporter's Phone Number: 0Enter a telephOne number Including area code where an aulhorlzed agent of the first transporter can be reacheO::: in the even! al
,\t. , aner,:tergency,i,:i_c;ludingnighls,weekends,andholidays .. ,,. ..... . .. · ---·••·-· ·-·--···· · ··. · · .. ·. · 1., · r..· .. Tra'nsporter 2· Cofflpany Name: II applicable, enter the company name ·01 !he second transporter who wili'transPort the waste. If more lhari 2 trans~orters I
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoor.ing the wa .
8 •. U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7.
E .. State Transpor1er's ID Number: Leave blank. I
F .. Transpot1er's Phone Number: Enter a telephone number including are3 code ~here an authori~ed agent or lhe second transporter can be reached in
event ol an emergency including nights, weekends, and holidays. · ·
9. Designated Facility Name and Sile Address: Enter the company name and site address ol the treatmenl, storage, or disposal facility designa1ed 10 receive 1he
waste listed on this manifest The address must be the site address. which may differ from the niarnnQ ad-dreSS~~---· -· -..... ,. "' --· ..... ' " ·"" ~ -· -· .,.
10. U.S. EPA ID Numbei: Enter the U.S. EPA twelve digil ldentification number ol the designated treatmenl. storage,_or dispos~I iacility iCen:died !n i!em 9 .•
G:. Slale Facility's 10 Number: Leave blank. · ·
H;. Facilily's Phone Number: Enter a telephone number including area code where an authorized agent of thC facility can be .reached in tr,e event 01 ·an
emergency including nights, weekends. and holidays.
11'. U.S: DOT Descriptions: Enter RrDpershipping name, hazard class and 10 Number (UN/NA) !or each waste as idenlilied in 49 CFR 171-1 7i.I1 aCCi:icnal spl
is needed, use a U.S. EPA Form 87q0-22A Rev. 9/86 (DHEC 1988A) Continualion Sheet. __ . . , .
12.. Containers (no. and type): Enler number ol containers lor each waste and the appropriate abbrevi.iUon from.Table I (below) for the rype ol containers. TABLE I • . . . • ., •
OM= Metal drums. barrels, kegs TT= Cargo tanks (lank trucks) CM =_Me~at boxes, cartons, cases, roll ctts· I·
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
... TP • Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Ouanlily: Enter lolal quantity ol wasle described on each line, relative 10 the units used In ilem 14. I
t4. Unit (weight/volume): Enter the appropriate .ibbrevintions from Table II (below) lor the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liQuid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 -79.261 Sut:;:,ans C ar.d I
idenlily the hazardous wasle on each line.
J. Addilional Descriplions lor Materials Listed Above: In the spaces provided, enter the authorizalion number (!rem the S.C. OHEC Aulhorization Rec:iuesl Fo I
for each waste stream listed in section 11 above. Nole: Belo re any hazardous waste can be accepted tor tre'atment storage or disposal in South Carc-lina. tne
generator must obtain prior authorizalion lrom the treatment, storage or disposal facility. · ··1
K. Handling Codes lor Wasles Usled Above: Leave blank. .
15. Special Handling Instructions and Addillonal lnlormalion: Generators may use this space to indicate special transportation. treatment. storage or disp I
information or Bill cl Lading lnlormalion. For international shipmenls, generators must enter in this space !he point of departure (Cir'/ and s:a1e) lor tnose
shipments destined tor treatment, storage, or disposal outside the jurisdiclion ol the United States, · . . I
16. Generator Certlflcalion: The generator must AEAD,.SIGN (BY HAND IN INK), and DATE lhecertilicatlon statement.11 a mode other !han highway is used.
word "highway" should be lined out and !he appropriate mode (rail, waler.or air) inserted in the space below. II ari0ther' mode in addi!ion to I1"',e highwav r:io
used, enter the appropriate additional mode (e.g.,_and rail) in !he space below. · •
TRANSPORTER SECTION
11: Transpot1er l Acknowledgement: Enter ,the name ol the person accepting the waste on behalf ol lhe lirst transporter. That person rr.ust acknowtef
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name al the person accepting the waste on behalf of the second transporter. That person mus;
acknowledge accepIance of the waste described on the manifesl by SIGNING {BY HAND IN INK) and entering the DATE of receipt 1·
FACILITY SECTION .
19. Discrepancy Indication Space: The authorized represenlative of the designated facility's owner or operator must note in this space any discrepancy Oetw
the waste described on the manifest and the waste ach.JiJlly received at the facility. Owners and operators of facilities who cannot .resolve s1;n,licar'.!
:_. discrepancies w1Ihin 15 dnys receiving the waste must submit to the Department a lefler with a copyol the manifest describing the discrepancy ar.d ar;:em;:,11
reconcile il The 1reatment. storage, or dlsposol lactrlly mus I enter tha actual weight (?I wasle In pounds in the spaces provided ii the amount varies ~ny !r~m t
10ecilied by lhe generolor in itom 1 J or U the genornlor usos a unil of monsi.,re olhcr thnn pounds. .
20. facility Owner or Opera1or Certlllcallon: Prtnl or type lhe name ol lhe person occepling the wosle on beholl ol 1he owner or operator ol the lacllity. T!lat person
must acknowledge acceptanc'o ol the waste described on !he manifest by SIGNING (BY HANO IN INKf and entering the DATE or receipt
IF ASSISTANCE 1S NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIG~JA.TEO I
REC!?".'~ THE WA.STE 00 THE S.C, DHEC MANIFEST SECTION AT (803) 734•5200 WEEKDAYS FROM 8:00 nm TO 5:00 pm.
_.ft;:;7-; •. 1;.
I ~ "'1. .-,. '~Y,,\'
:,,;., --'-!"· \-·
~'
South Carolina Department of Health
and Environmental Control
Buraau of Solid & Hazardous Waste Mi;t
2600 Bull Strei:!t. Columbia. SC 29201
Phone: [phone]
I
I
I
I
I
Eme,gency & Holidays: (803)734-5-12'
ILE.J..SE PRINT or ~PE (Form desioned for use on elite f12-oitch1 tvnewriler)
UNIFORM HAZARDOUS I'· Geno,alo,·,u.S.EPAIONo.
Form A
• Menlfoe1 , 12, Page 1 .. 110c-"mf"' No, ol 1
roved. 0MB No. 2050-0039 E.xoire., 9-30-U
Information in the shaded areas is no1
required by Federal law, but is by State _law. WASTE MANIFEST N, C, n, O, g, 7, ~. o, , .. 7, l• '·-U, U, Io, L
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield,
,. Gene,a<o(s Phone ( 919 I 9 34-9 711
S. Transporter 1 Company Name
Willms TruckinQ Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
NC 27577
ki~Miinif8"t CJoci,m.,.J Hutnb« ·.
)::i:6Xt/t/·</=
6. U.S. EPA ID Number ·c}Siaiit'.t""·'·' .... s I[)\,'.-:• ' ...
1S1 C• D• 01 7• 3• 7• n, 9, 2J Cl. 0/T ...... , 'if'hoM:·,,.onol,7~7--''\'l'l'l
8. U.S. EPA JO Number '':
' ' ' ' ' ' ' ' I I I
10. U.S. EPA ID Number
Pinewood, SC 29125 , S, C, D, 0, 7, 0, 3, 7, ' 9, 8 '
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard crass, and fD Number} 12. Containers 13. Total Quantity U.Ur.it
No. Type 'lllNcl
I ' ' ' ' ' '
d.
I I I I I I I
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71590
19. CIENIERATOR"S CERTIFICATION: I hereby decll:ue lhel lhe content• olthis con,IQnment •r• fully end •ccur•telydescribod ebove by proper •hipping n•m• and are ctau,ha-d,
paci.eo. marl..od, and tahoted,and ore in 11II rospacls in proper condition !or lranspor1 by highway according to applicable lntarnatlonal and na!lonal government r..;:;utauon, and
lt'la laws ol the State ol South l,;arotino.
111 am a large Quantity generator, 1 cor1ity Iha! I have a program In place to reduce the volume and loxlclty of waste generated to the degrN I ha,;e dalarmlnod lo be economic.atty
prachCab!e and tha\ I ha11a sa!actad lha practicable malhod ol lroatmonl, storage, or dlapoaal currently available to ma which mlnlmlzn the prawnl and lur..ira tnrMI to P"h,lfY,..:'\
heatlh and !ho environment: OR. II I am o small Quantity gonorolor, I hove mado a good loith otfort lo minimize my waste generation and selocl the best wa1te management m-etl">Od
thal is a11ailaC>ta 10 me and \hot t con aflo,d.
Printed/Typed Name Month Oay Year
1 O,,?; s, j ,,?, -Df"IGER L COATS ISignalure 1,c,~,
;; f-1"7".-;:T:.:•::•nc:s:,p:.:o:;-rt:.:•:.' .c' ,':A:::"::':.:no:.wc.l:.:ed::geee:,f""':;:_;"''/c:oc.l :.R::•::c•::i,:.Pl:.:o::lc.M:::a::l::er:::ia::ls:__ ___ r.:,-:,--:---""-,.....,.::... // ___ _,,~/'7/'--------------:-:':--:-=--::---::c-i · lij ;?Ty:~/ame /,X·/-5./4_ ISignalure✓/) /P:/40 / ~ ~p;,~,~
o ~,"a::,. :;,Tc..,aln.:.s_po_rt~' e:,,r"'2LA-c'"kn_o_,wc.,lc_dJ.g~e::::m'J.en~lC..o::I ::,R:_cc-,ei.;,pzl_o"r M:-:--al-e.,-ria""ls ___ ....l ___ L.:...~L::::..._L-'~;,~ y-~;:::,_ _ _;'.,__:..:.,_:: _____ ....E::.l::....~L.X....1:---j Rf-"================---,-----------=----------------,-,--1
I T Printed/Typed Name !Signature Month Day Year
~ ' ' I I I I . -+--,--------J...---------~...r-.i..~ 19. Discrepancy Indication Space
F
I f I f.,.,,--,,-,,-,,---,,.---,,-.,.,.--,--;:;: 10. Facility Owner or Operator; Certilic:allon or ,ecefpl ol hazardous malerials covered by this manilesl excepl as noted In Item 19. I PrinledlTyped Name I Signalure
1:PA Form 8700-22 (Rev. 9/86) Previous Editions aro Obsoloto [DHEC 1988 (Rev. 10/86)]
• ~I ,._._......., ........ l'to. ' L..I .w........_-'-'pto.
b I l'bs. d I l'bs.
Monlh Day YNI
I , I , I ,
t STATE OF SOUTH CAROLINA INSTRUCTIQNS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM PO1NT PEN -PRESS.DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste 1rea1ml
storage, or disposal ficililies to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1986 (REV 10/86)) and, ii necessary, th~ continuation sheet U.S. EPA F
8700-22A Aev.-9/86 (DHEC 1988A) loi both inter-state and intra-slate transportation. Transpor1ers who transport hazardous waste into the United States Ir
another country are responsible for completing the manifest Federal and-Stale regulations also require generators and transporters at hazardous waste ano
::~:::~::•:•~;;,:f:azardous waste lreatment, storage, or d;sposal lac;1mes to complete lhe lollow;ng ;nlormaUon. I
1. Generator's U.S. EPA ID Number• Manllesl Document Number: Enter the generator's U.S. EPA twelve digit idenlilication number and the unicue live digi_!
number assigned to this manifest by the generator beginning wilh 00001.11 your company does not have a U.S. EPA ldentilication Number. please con:act S.C.
OHEC at (803) 734•5200 about obtairilng an ldentiliCatlon number. · · • I
2.: Page 1 ol: Enter the total number of pages used to complete.this manilest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (B~V 10186JI .;:lus
number ol continuation sheets EPA Form 8700·22 Rev. 9/86A (OHEC 1988A) ii any. . ~. :
A. State Manifest Document Number: .Leave blank.
B;
3.
· Stale Generator ldentrflcallon Number: Leave blank. · I
Generalor's Name and Malllng Address: Enter the name and mailing address of the generator who will manage the returned manifest lorms.:. _ ,
· ,. Generator's Phorle Number: Enter a telephone number with erea code where an authorized agent of the generalor can be reached in _the even! ot
emergency including nights, weekends, and holidays. ·
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enler the U.S. EPA twelve digit identification number of !he first transporter identified in ilem 5.
C. ·Slale Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: 'en1er a telephOne number including area code where an authorized agent of the first transporter can be reache: in the event of
an en:iergency_i,:ic;luding nights, weekends, and holidays .. , ..... . ... ______ . --··· _ · · -: .. · 1.
· T.. Tra"nsporter 2° Coinpany Name: If applicable, enter the company name ·of the second lranspo.rter wiio witi"transp0r1 the waste. If more thari 2 trans;:,orrers l
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters In the order they will be·transoo~ing the wa ..
8 •. U.S. EPA 10 Number:lf applicable, enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7. :
t E.-Slale Transporter's ID Number: Leave blank. . · J ' • '~
F •. Transporter's Phone Number: Enter a telephone number including area code :,"here an authorized agent ol the seCond transporter can be reacr.ed in,;~~
· event ol an emergency including nights, weekends, and holidays. · ·
9. Designated Facilily Name and Sile Address: Enter the company name and site address of the treatment, storage. or disposal facility designatec :o receive the
waste listed on this manifest The address must be the site address. which may differ lrom the mailing address. ·-•. ~
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit idenlirication num~er ol the designated treatment. storage. or disposal facility iden:ified in item 9 .•
G:. Slate Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol lhe facility can be reached in tr.e e ... ent of an
emergency including nights, weekends, and holida)'s. · ·
11·. U.S; DOT Descriptions: Enter Rroper shipping name, hazard class and 10 Number (UN/NA) for each waste as identified in 49 CFA 171-17i. II addi:icnal sol
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet .
12.. Containers {no. and type): Enter number ol containers tor each waste and the appropriale abbreviation lrom Table I (below) lor the rype ol conIainers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll cttS I
OW 1:1 Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
N• TP = Tanks portable CY= Cylinders BA= Burlap. cloth, paper or plastic :lags
13 .. Total Ouantily: Enter total quantity ol waste describ8d on each line, relative to the units used in item 14. I
14. Unit (weighl/volume): Enter the appropriate abbrevialions rrom Table II (below) for the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (1iQuid only)
I. Wasle Number: Enter hazardous wasle numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Subpar:s C ar.d I
~-identity the hazardous waste on each line.
J. Additional Descriptions for Malerials Listed Above: In !he spaces provided. enter the authorization number(lrom the S.C. OHEC Authorization Reouest Fo I
· lor each waste stream listP.d in section 11 above. ~le: Belore any hazardous waste can be accepted for lreatment storage or dispos~I in South Carc-lina. lhe
generator must obtain prior authorization from the treatment, storage or disposal lacitity. I
K. Handling Codes for Wastes Listed Above: Leave blank. · . ·
1 S. Special Handling lnstrucllons and Addilional Information: Generators may use this space to indicate special lransportation. treatment. storage or disp t
Information or Bill al Lading Information. For international shipments, gcneralors must enler in this space the point ol departure (city and s:ate) !or those
shipments destined for treatmenl, storage, or disposal oulside the jurisdiction al the United States. ·
16. Generalor Certification: The generalor must READ,'SIGN (BY HANO IN INK), and DATE lhecer1ificalion statement. If a mode other than highway is usedl
word "highway" should be lined oul and the appropriate mode(rail, water.or air) inserted in the spaCe"below.11 another mode in addition to tl·,e highway mo
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION
11: T,.insporter 1 Acknowledgement Enler the nanie or the person accepting the waste on ~ehatf al the first lransport"er. Thal person rr.ust acknowlel ·
acceptance ol the waste described on the mantles! by signing (BY HAND IN INK) and entering the DATE of receipt. ,a. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf of the second transporter. That person r:ius:
acknowledge acceptance ol the wasle described on the manifest by SIGNING {BY HAND IN INK) and entering the DATE of receipt -
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized representative of the de~ignated facility's owner or operator mus! note in this space any discrepancy betw
!he waste described on the manilest and the wasle actl.ially received at the facility. Owners and operators of facilities who cannot resolYe si;nilicar.:
discrepancies w1Ihin 1 S days receiving the waste must submit lo lhe Department a lefler with a copy al the manifest describing the discrepancy ar.d ar:em::iI1
reconcile 1t. The lreatment. storage, or dlsposol laclllty mus I enter the actuol weight ol wasle in pounds m the spaces pro..,,ded ,1 the amounl varies any from t
1pec1l11td by lhe generator m Itom 1J or ,I tho generator usos o un,I ol monsi.1ro other lhan pounds. .
20. ,aclllty Owner or Operator Ce,llllcatlon: Print or type tho name of the person occepllng tho waste on beholl ol lhe owner or opera1or 01 the l.1crl1ty Tt1.11 per!IOn
mus! acknowledge acceptance ol the w11sle described on tho manllest by SIGNING (BY HAND IN INK) and onlering !he DATE ol receipt
1F ASSISTANCE Is Neeo~o IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR 0IsPOSAL FACILITY oesIoe,uEO I
R[Cf"/E THE WASTE On THE SC. DHEC MANIFEST SECTION AT [phone] WEEKOAYS FROM 8.00 nm TO 5 00 pm
I South Carolina Department of Health
and Environmental Control
Bureau or Solid & Hazardous wa,te Mgt.
2600 Bull Stteill. Columbia.. SC 29201
Phone: (BOJJ 73-4-5200
Emergency & Holidays: (803)73-4-5424
Form A roved. 0MB No. 2050-0009 E..xpires 9-30-aa
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Menifee! Oocumenl No, WASTE MANIFEST N c n o 1400103
2. Page 1
ol
lnlormation in the shaded a<eas is not
required by Federal law. bul is by State Ia .....
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4, Generator's Phone [phone]
S. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
C D O 7
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
.. Hazardous Wast~, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71591
.. -,:_f·,.-
'FAt· ··· .. !i"""l'tffl':_:>l:,,,$,:.'
l~~~;~~,~~~~-~~~[.·:'.'.~f ;:~;:,:(~;-:.;>,/_ .-'..: ,·,·,-i 'L'.'.-1i.>J-::,;:i.:,·::-:
,2. Containers 13. Total Quantity U. Unit L Wata~ ,;
No. Type WIN-:J :;,; _;-;.•.;:-:{
I D T 2 0 Y
, e. C!'.NERATOR·s CERTIFICATION: I herebydectere lh11t1he contenls ol lhls conslgnmontare lullyand accurately described above by proper 1hlpplng r,1ma al"ICI a,a c1a1a,r1..ci.
pecked. marked. and labeled, and are In all rospecls in proper condlllon for transport by highway according lo appllc.abla lnternalional and national go"'ernment r.-gula11on1 and
!/'la laws ol the SUl!e ol South Carolina.
111 am a large quanl1ty generolor, I certify thal I havo a program In place 10 roducethe volume and lo,clcltyol waslegeneretod to the d~rff I have datarmln.cl to be economically
prachcable and th al I have selected the practicable method ol lrealment. storage. or dlspoul currently available to me which minimizes tho present and future tn, .. 1 to human
health and the envi,onmcnt: OR. ii I i'lm o smoll quonlitygonorator. I hove modo o good lailh etlort to minimize my waste generation and sol eel Iha bell waate managemanl ""8tl"-.od
tnal is available to me and thol I con onord.
Printed/Typed Name RO.GER L. COATS Signature
17. Transponer 1 Ac.acnow!edgement ol Receipt or Materials
18. Trans parter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name Signature Mont!1 Day Yoar
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certificalion ol receipl of hazardous malerials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature MooU'I Day YNI
EPA Form 8700•22 (Rev. 9/86) Previous Editions nro Obsoloto IDHEC 1088 (Rev. 10/86))
STATE OF sourn CA;~~INA 1NsTRUCTl~~s FOR ·u~1;~RM HAZARDOUS WASTE MANIFEST ' · I I
IMPORTANT: TYPE (on a 12-pitch (elile) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE! I
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and o:.VnE!rs or operators al hazardous waste treatml
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and, ii necessary, th& continuation sheet U.S. EPA F
8700-22A Aev:9186 {OHEC 1988A) loi both inter-slate and inlra-stolc transportation. Transporters who transport hazardous wasIe into the United States I _
another country are responsible lor completing the manifesl Federal and State regulalions also require generators and transpor1ers of hazardous waste ana
owners or operators al hazardous waste treatment, storage, or disposal facilities to complete the following information. I GENERATOR SECTION
1. Generalor's U.S. EPA ID Number• Manlfesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue tive digit
number assigned to !his manifest by the generator beginning with 00001. If your company does not have a U.S. EPA ldentilication Number. please con:act I
OHEC at [phone] about obtail1ing an Identification number. · .
2; Page 1 of: Enter the total number of pages used lo complete this manifest, i.e., the lifst page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10186)1 ~lus
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any. ·
A. State Manifest Document Number: .Leave blank.
a: Slate Generalor ldenliflcallon Number: Leave blank. · · I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned maniles: forms.
~-Generator's Photie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in tne event o an
· emergency including nights, weekends, and holidays. ·
5. Transpor11 Company Name: Enter the company name al the lirsl transporter who will transpor1 the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit idenlilicalion number ol the first transporter idenliried In item 5.
C. 'Slale Transpor1er's ID Number: Leave blank.
0. Transpor1er's Phone Number: 0Enter a teleph0ne number including area code where an authorized agent of the first transpor1er can be reache~ in the event ot
·.~ t •.. T..'. Tra'nspor1er 2' C~fflpany Name: 11 api,licable, enter the c'Omi,any iiame ·c;; !he seCO'ndtr.irisPClrte·rwho wili'tra.'risPOrt !he waste. II more !hari 2 tra_ns;,or1ers I:
, . an erryergency inc:luding nights, weekends. and holidays. · · · ·, · · I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be 1ransoor:1ng thew .
t.
a.: U.S. EPA ID Number:!! applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. Slate Transporter's 10 Number: Leave blank. . · · I
F .. Transporter's Phone Number: Enler a telephone number including area code ~here an authorized agent of the second transporter can be react-.ed 1n
event ol an emergency including nights, w·eekends, and holidays. · · .
9. Des!gnaled Facilily Name and Site A.ddress: Enter the company name and site address of th_e treatment, st(!rag!!! gr ,9L~posal (~cility designated :a re;_eive !he
waste listed on this manifest The address must be the site address, which may differ lrom the mailing address. . I
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number al the designated treatment. storage, or ·disposal lacility identified in item 9 .
. G:. Slale Facility's ID Number: Leave blank. '·
H;. Facility's Phone Number: Enter a telephone number including area code where an autho;ized agent of the racility can be reached in the evE!nt ol ·an
emergency including nights, weekends. and holida)'s. . ·
11'. U.S: OCT Descrlplions: Enter proper shipping name, hazard class and 10 Number (UN/NA) for each waste as identified in 49 CFA 171-177. If ade!i:icnar sof
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ,.-, ... . ,
12.. Containers (no. and type): Enter number al containers !or each waste and the appropriate abbreviation lrom Table I (below) lor the iype o! c::in1a1ners. -
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases. roll cffs·
OW= Wooden drums, barrels, kegs TC= Tank cars CW; woOden boxes. cartons. cases ·,
OF= Fiberboard or plastic drllms. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases I
-~ · TP = Tanks por1able CY= Cylinders BA= Burlap, cloth. paper or plastic tiags
13 .. Total Quantity: Enter lotal quantity of waste described on each line, relative to the uriits used in item 1,4 ..
14. Unit (weight/volume): Enter the appro'prialc abbreviations from Table II (below) for the unit al measure: I Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liQuid oil I
I. Wasle Humber: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Su. ~par.s C ar:d
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number(rrom lhe S.C. DHEC Aulhorizat1on Request Form)
for each waste slream listed in section 11 above. Mote: Belo re any hazardous waste can be accepted for treatment storage or disposal in South Carc-lina. the
generator must obtain prior authorization from the treatment, storage or disposal lacility. · · I
K. Handlin9 Codes for Wastes Us led Above: Leave blank. · . ·
15. Special Handling Instructions and Addillonal Information: Generators may use this space' lo indicate special transpor1ation. treatment. storage or disp ~ I
Information or Sill of Lading Information. For inlern<llional shipments, generators must enler in this space lhe point ol depar1ure (city anC s:ate) for inose
shipmentJ destined tor treatment, storage, or disposal outside lhe jurisdiction ol the Uniled States. · J
16. GeneulorCer1illcalion: The g~nerotor mus! READ,'SIGH (BY HANO IN INK), and DATE thecer1ilicalion statement. II a mode other than hignway is used e
word ··highway·· should be lined out and the appropriate mode (rail, water.or air) inserted In lhe space below. If anolher mode in addition to the hignway r.io s
used, enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION .
11: Transporter 1 Acknowledgement: Enter the name al the person accepting lhe waste on behall of the first transpor1er. That Person l"r.ust acknow1ef
acceptance of the waste described on the manirest by signing (BY HAND IN INK) and entering the DATE ol receipt. •
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behall al the second 1ranspor1er. That perscn r.ius:
acknowledge acceptance or the waste described on the manilcst by SIGNING (BY HANO IN INK) and entering the DATE ol receipt I
FACILITY SECTION ' , ·
19. Discrepancy lndicalion Space: The authorized representative al the designated lacility"s owner or operator mus I note in this space any d1screoancy betw w
th1 waste described on lhe manifest and the waste actually received at the facility. Owners and operators of facilities who cannot resolve s1;n1licar:t
~-. discrepancies w1lhin 15 d~ys receiving the waste must submit lo lhe Dr.par1ment a letler with a copyol the manliest describing the discrepancy ar:d a:-:emotf
r1concile iL The lreatmenl storage, or dlsi:,osal lacllily must enter lhe actual weigh I ~f waste in pounds in the spaces i:,rovided if the amounl vanes iny !r::im r
specilie,d by the gen.erotor in ilom 1J or ii !he oenerotor usos a unil ol mons1Jre olhcr than pounds. .
20. F•clllty Owner or Operator Certification: Prlnl or 1ype !he name or Iha poraon occoptlng Iha woato on bohnll ol 1he owner or oper.:ilor ol the f,3c11t1y. Tt1.11 P•rson ·
mus! acknowledge acceptance cl the waste described on the manilest by SIGNING (BY HAND IN INK) and enlerlng the DATE ol receipt
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE T. REATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
AECf":E THE '.VASTE On THE S.C. OHEC MANIFEST SECTION AT (80:3) 7:34-5200 WEEKDAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
EASE PRINT or TYPE
UNIFORM HAZARDOUS
WASTE MANIFEST
l Generator's Name and Mailing Address
Channel Master
N C n 0
P, O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
Form A
2. Page 1
of
But88U of Solid-& Haz.ardous Waste M~
2600 Bu!I StretiL Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)73-4-5-424
roved. 0MB No. 2050-0039 E.ipires 9-30-&a
Information in the shaded areas is nol
r~uired by Federal law, but is by State la ....
11. U.S. DOT Description (incfuding Proper Shipi,ing Name, Hazard Class, and ID Number} 12. Containers 13, Total Quantity 14. Unit l'Wa!:I Hldbef ·'.' ...
No. Type 'MN(J \=::,-,:~,~-:.i.;v<N
a.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
~ .. ~~-~·w•:~;:{;~7i1.~;;'rt:;;ii111ili1!i~~~,!,~;;tJ~1§!i;/:~t~Ul1~lli1i:i~t%1lvl~;f ii1,;)~.~i:i;l!i•,,1
a.U:.ili..]-Jo,2,7,7,4!-Jli110121W;.i\n)!L;0-LLJ-J i 1 1 1 ,-, 1 1 1 HJ:
b. Lu -'--' -'---'--'-..J_J' -I .......... 1li[;!i[~:iil!1:::t~ W ~.'-1 ..L......l-L..-1..-'.J-L.).. , ,,.,1ti•:
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71592
2 0 Y
1 e. GltNERA TOR'S CERTIFICATION: I hereby declore lhol tho contents ot lhls con,ignmenlare lullyand accuratoly da1crlbod above by proper ahlpping name and are c1a1ad1ed.
packed, ma,kltd. and labeled, and ore In 1111 rcupecls in proper condlllon lor transport by highway according to applfcable lnternaUonal and natlonal go ... arnmenl r.-gulation1 at>d
tl"le laws o! Iha St.ala ol South Caroline.
111 am a lar~e quantity gencrolor, I certify thnl I havo a program In placo 10 r~uce the volume and toxlcltyol we:11tegener11ted lo the degr-1 have determined to be oconomlcatty
practicable and that I-have selected the practicable method ol treatmont, sloroge, or disposal currently available lo me which mlnlmiu,1 Iha pres.on! and lut\Jre thrNI to hum.a:'\
heolth and !he environmcn~ OR, ift am a small quantltygonorator, I hovo mado o good laith effor11o minimize my waste generation and solocl the be1t wette managemenl m-e~
n,at ilavailat:ile 10 me and 1hot I con ollord.
Printed/Typed Name RO,GEK L. CUAI:> Signature Month Day 'r'w
0?;
17. Transponer 1 A<.:i<nowled ement of Recei I ol Materials
Printed/Typed Name Signature
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
• I pt.. C I libs.
b I pt,,. d I pt..
20. Facility Owner or Operator; Cer1ilication of receipt ol hazardous malerials covered by !his manifest except as noted in Item 19.
Printed/Typed Name Signature Month Oey YNt
PA Form 8700-:22 (Rev. 9/86) Previous Editions are Obsolole (DHEC 1988 (Rev. 10/86)1
·•· -
I
f f i, <J ·'-';"-· h-:/:_-~l
STATE OF SOUTH CAROLINA INSTRUCTIO~S FOR UNIFdRM HAZARDOUS WASTE MANIFEST - : I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and trnnsporters ol hnzardous waste and owners or operators ol hazardous waste treatml
sI0rage. or disposal licitities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, ii nece"ss"ai-y~ thEI continuation sheel U.S. EPA F
e700-22A Rev:9/86 (DHEC 1988A) tor both inter-stale and intra-state lrnnsportation. Transporters who transport hazardous waste into the United States Ir
another country are responsible !or completing the maniresl Federal and State regulations also require generators and transporters ot hazardous was!e ano
owners or operators ol hazardous waste treatment, storage. or disposal lacilities to complete the following information. I GENERATOR SECTION
1.
2;
A.
a:
3.
'·
5.
6.
C.
0.
T.
8 ..
E.-
F ..
9.
10.
·G'..
H;.
... , ,:
Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manifest by the generator beginning with00001. lfyourcompany does not have a U'.S. EPA Identification Number. please con.:act S.C.
OHEC at (803) 734•5200 aboul obtalrling an identification number. · · . •·
Page 1 ol: Enter !he total number of pages used to complete this manifest, I.e., the lifst page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10186)1 ~lus
number of continuation sheets EPA Form 8700·22 Rev. 9/86A (OHEC 1988A) ii any.
· St.ale Manilesi Document Number: .Leave blank.
Slate Generator ldenliflcallon Number: Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned maniles! lorms.
Generator's Phorle Number: Enter a telephone number with area code where an authorized agent of !he generator can be reached in tne event ol ,
emergency including nights. weekends, and holidays. · ,,
Transport 1 Company Name: Enter the company name of the lirst transporter who will transport the waste. I U.S. EPA ID Number: Enter the U.S. EPA twelve digit idenlilication number of the lirst transporter identified in item 5.
'Slate Transporter's ID Number: Leave blank.
TranspOrter's Phone Number: Enter a telephOne number including area code where an authorized agent ol the first transporter cari Ce reached in the event ol
an en:iergency irycluding nights, weekends, and holidays. · · · · ·. · · · 1· ·
. Trarlsporter 2·Co~pany Name: II applicable, enter the c~mp~·~y ~ame ·o; !he se~o-;diran;-p-c)rte'r'Wiio wili"ti-a.'nsPOr1 the waste. If more thari 2 trans;,orters I
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheel and list the transporters in the order they will be transpor:ing the wa .
U.S. EPA 10 Number:11 appli_cable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
St.ale Transporter's ID Number: Leave blank. . -. ,... I
Transporter's Phone Number: Enter a telephone number including ~rca code ~here an authorized agent of the second transporler can be reached in ·~
even! ot an emergency including nights, weekends, and holidays. ' -·
Designated Facility Name and Site Address: Enter the company name and site address of the lreatment, storage. or disposal facility design_a1ed 10 receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing· addi-ess. · • · . I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the de~ignated treatm.ent.' storage, or disposal facility iden:iliej in item 9.
Stale Facility's 10 Number: Leave blank. • 1
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in fr,it•e~n1·of.an
emergency including nights, weekends. and holida)'s. , . ' '
U.S: DOT Descriptions: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identified in 49 CFR 171-1 ii. If aC:di:icnal spf
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheel.
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation !rem Table I (below) lor the ryp(! o! containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM~ Metal boxes, cartons. cases .. roll cHs· r•
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. car1ons. cases I OF z Fiberboard or plastic drums, barrels, kegs OT= Dump lruck CF= Fiber or plastic boxes. canons. cases
~-. -TP • Tanks por!able CY= Cylinders BA= Burlap, c1olh, paper or. p!as:1c bags
13 .. Total Quantity: Enter lotal quantity ol waste describe"d on each tine, relative lo the units used in item 14.
14. Unit (weighl/volume): Enter lhe appropriate abbreviations lrom Table 11 (below) !or lhe unit of measure:
Table II I
P = Pounds L = UterS K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in Soulh Carolina Hazardous Waste Management Regulation A.61 • 79.261 Sut;,ar:s C ar:d I
identity the hazardous wasle on each line.
J. Addilional Oescriplions lor Materials Listed Above: In the spaces provided, enter the authorization number{lrom the S.C. OHEC Authorization Request Fo I
for each waste stream tistP.d in section 11 above. Nole: Bero re any hazardous was le can be accepted !or lreatment storage or disposal in South Carclina, tne
generator musl obtain prior authorization from the treatment. storage or disposal racility. I
K. Handlin9 Codes lor Wastes Listed Above: Leave blank. . ·
15. Special Handling lnslrucllons and Addillonal Information: Generalors may use this space lo indicate special transportation. lreatment. storage or disp I
,. ... information or Sill or Lading Information. For international shipments, generalors must enter in this space the point of departure (city and s:ate} ror !hose
shipments destined lor treatment, storage, or disposal outside the jurisdiction of the United Slates. · .
16. Generator Certillcalion: The generator must REA0,·s1GN (BY HAND IN INK), and DATE !he certiliCation slatement:U a mode other than highway is usedl
word "highway" should be lined out and the appropriate mode (rail, water. or air) inserted in the space below: II another mode in addition to the highway mo
used, enter the appropriate addilional mode (e.g.,_and rail) in the space below.
TRANSPORTER SECTION 11: Transporter 1 Acknowledgement: Enter t~e name ol lhe person accepling lhe waste on behalf or the rirst transporter. That person rr.ust acknowlef
acceptance of the waste described on the manHest by signing (BY HANO IN INK) and enlering !he DATE ol receipt.
18. Transporter 2 Acknowledgement: Enler. H applicable, the name or the person accepting the wasie on behall ol the second transporter. That perscn mus:
acknowledge acceptance ol lhe waste described on lhe manifest by SIGNING (BY HAND IN INK) .i.nd entering lhe DATE ol receipL
FACILITY SECTION . . I
19. Discrepancy Indication Space: The authorized representalive ol the designated facility's owner or operalor must note in this space any discrepancy betw ,
the waste described on the manifesl and the waste ac!Ually received at lhe lacility. Owners and operalors of facilities who cannot resolve s1;n1ricar,I
dl1crepan_cies w1Ihin 15 doy1 receiving tho wosto musl submit to the Of'Jportmenlo reno, wilh o copy of the monilest describing the discreoancy and a~em;11
,1co~~1le ,L Tht treelment. 1I0,ege, or dlspo1ol locl_llly must anter the acluot wolghl C!' wosle In pound.s In the apoce.s provided ii the amount varies any trom 1
spec,l1ed by the generalor in itom 1 J or II the generntor usos o unit ol mons1.1re olhcr lhan pounds. , ,
20. Facility Owner or Operalor CerUllcallon: Prlnl or type !he nome ol 1he person accepting the waslu on behalf ol lhe owner or operator ol the lacil,ty. Th.lt person
must acknowledge acceptanc'e ol lhe waste described on the manifest by SIGNING (BY HANO IN INK}and entering lhe DATE of receipL
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIG'1HEO I
REC,".'E THE WASTE on THE s.c. DHEC MANIFEST SECTION AT (803) )34-5200 WEEKDAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haz.ardous Waste Mgt
2600 Bull Streel. Columbia, SC _29201
Phone: (BOO) 734-5200
Emergency & Holidays: [phone]
LUSE PRINT or TYPE {Form desi ned !or use on elile 12· ilch ewriter Form A roved. 0MB No. 2050-0039 E.xoire:s 9-30-U
F
UNIFORM HAZARDOUS 1. Gene,ato,'sU.S.EPAIDNo. M11nllesl Oocumenl No. WASTE MANIFEST N c n o o 400105
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato,'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Si\8 Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
2. Page 1
ol lnlormalion In !he shaded ., .. , is no1
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity It Unit l"Wa:iwNunJber''+
No. Type 'M./V~ '.\1-~ .. ,-,_)· }·(· :~·-~\~{~
a.
b.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T 2 0 Y
,_.,_.,_.1.....,1 't
,W
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71593
, I. QINtRA.TOR'S CERTIFICATION: I hereby dectere lhel !he conlent• olthl1 con•lgnment ere lully end eccuretetyde1crlbed ebov• by prop.er 1hlpplng name and ere c1 .... t1ec1,
packed. ma,k&d. and 1a·beled, and are In all respects ln proper condl1ion for lransport by highway eccordlng to applicable lntornallonat and national gova,nm•n1 r~utat1on1 al"ld
tl"le laws ol the SUiia of Souttl Cerotlno.
II I am a large quantity generator, I cortify that I havo a program ln place to reduce the volume and 10,dcltyol waste generalttd lo lhe d&9roe I have determlne-d 10 be oeonomlcally
practicable and that l have solecled the practicable method of treatment :slorage, or disposal currently available to me which minimizes the prasenl and futvra tTlrMt lO l'luman
l'lealtl'I and the environment; OR. HI am a small quantitygonoralor, I have mado a good railh effort to minimize my waslo generation and select tTle be1I ..-a11e management ~trlOd
mat is available to me ar,d the! I con allord. •
Printed/Typed Name ROCER L.CQ~
Month
,1
0
Signature Month Day Yea,
19. Discrepancy Indication Space
' I jibs. CI libs.
b I pt,,. d I libs.
ltl---------------~ 20. Facilily Owner or Operator; Cer1ilication of receipt ol hazardous moteriats covered by this manifest except as noted in /lem 19.
Printed/Typed Nama Signalure Month Day YNI
EPA Form 8700-22 (Rev. 9/86) Previous Editions .o.ro Obsolote (OHEC 1988 (Rev_. 10/86))
STATE OF sou
1
TH CA~O~INA 1Nsi-Rucr10Ns FOR uJ;~~RM HAZARDOUS WASTE MANIF~ST " I , I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS OOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION:· Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatml
storage, or disposal licililies to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, ii necessary, tha continuation sheet U.S. EPA F
8700•22A Rev:9I86 (OHEC 1988A) foi bo1h inter-stale and intrn-slatc transportation. Transporters who transport hazardous waste into the United States Ir
another country are responsiOle !or completing the manilesl Federal and Slate regulations also require generators and transporters of hazardous waste a'no
owners or operators ol hazardous waste treatment, slorage, or disposal f3cililies to complete the !allowing information. •• GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manllesl Document Number: Enter the generator's U.S. EPA twelve digit identilica!ion number and the unic;ue live dig ii
number assigned to this manifest by the generator beginning wilh 00001.11 your company does not have a U.S. EPA Identification Number. please contact S.C.
OHEC al [phone] about obtairling an Identification number. · • I
2: Page 1 ol: Enter the total number of pages used to complele this manifest, i.e., the (iist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10186)] ~tus
number ol continuation sheets EPA Form 8700·22 Rev. 9186A (OHEC 1988A) if any.
A. State Manifest Document Number: .Leave blank. ,
e: Slate Generalor ldenliflcalton Number: Leave blank. I
3. Generator's Nimo and Mailing Address: Enter the name and mailing address of the generator who will manage the returned maniles: forms.
,. Generator's Phoiie Number: Enter a telephone number with area c·ode where an authorized agent al the generator can be reached in tne event o
emergency including nights, weekends. and holldays. ·
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. I 6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identilied in ilem S .
. C. 'Slate Transporter's ID Number: Leave blank.
O. Transporter's Pho_ne Number: 0Enter a teleph~ne number including area code where an authorized agent of the lirst transporter can be reached in !he even! of
,,,. i.. . ·r. ... Trarlsporter 2' Coinpany Name: If 3p'pticable, enter the cOmp~~y iiame -~; !he sec~·~trans·pc,rter Who wilt' ti-a'n'sPOrt the waste. II more thari 2 !rans;:,orters t
an en:iergency. inc:;luding nights, weekends, and holidays.. · · · ·, . · 1.
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list !he transporters in the order lhey will be rranspo~ing the wa .
'8 .. ·u.s~ EPA ID Number:lf applicable. enter the U.S. EPA twelve digit 10 number ol the second transporter identified in ite~ 7.
E .. Stale Transporter's 10 Number: Leave blank. · · · .
F .. Transporter's Phone Number: Enter a telephone numb~r including area code :,yhere an authoriied agent ol the second transpor1er can be reacr:ed in I
• :·· , ·· event cl an emergency including nights, weekends, and holidays. ·
9. Designaled Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal lacility designaled to recei..,e the
waste lisled on this manifest The address mus! be the site address. which may ditfer from the mailing address.
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identilication number cl the designated treatment. storage. or disposal facility iden:ified in item 9 .•
G:. Stale Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number Including area code where an authorized agent ol the facility can be reached in the event ol an
emergency including nights, weekends, and holida)'s.
11'. U.S: DOT Descriptions: Enter pr~pershipping name, hazard class and ID Number(UN/NA) lor each waste as identified in 49 CFR 171-1 Ti. II aCdi:icn.al sol
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. .
12.. Containers (no. an·d type): Enter number ol containers !or each waste and the appropriate abbreviation lrom Table I (below) lor the type cl containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (lank trucks) CM= Me.tal boxes. cartons. cases. roll cttS I
OW= Wooden drums, barrels, kegs TC = Tank cars CW = Wooden boxes. cartons. cases
OF ::i: Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
-TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or p!as11c tiags
13 .. Total Quantity: Enter total quantity ol waste described on each line, relative to the unils used in item 14. •.
14. Unil (weight/volume): Enter lhe approprialc abbre..,iations !ram Table II (below) for the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards' G = Gallons (liquid only)
I. Waste Number: Enter hazardous wasle numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Sut:par:s C ar.d I
identi~ the hazardous waste on each line.
J. Addilional Descriptions lor Materials Llsled Above: In the spaces provided. enIerthe authorization number(from lhe S.C. OHEC Authorization ReQues! Fe )
for each waste stream listP.d in section 11 above. Nole: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. tne
.. 1 generator must obtain prior authorization lrom the treatment, storage or disposal facility. · I
'K. Handling Codes lor Wastes Listed Above: Leave blank. . ·
15. Special Handling lnslrucllons and Additional lnlormalion: Generators may use this space to iridicale special !ransportation. treatment. storage or disp l
,,. • inlormalion or Bill ol Lading lnlormation. For international shipments, generalors must enter in lhis space the pain! ol departure (ciry and state) for tnose
shipments destined lor treatment, storage, or disposal outside the jurisdiction ol the United Slates. ·
16. Generator Certi!lcation: The generator must REAO,'SIGN (BY HAND IN INK), and DATE the certification statement. ti a mode other than highway is usedl
word ··n·ighway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. If another mode in addition to lt':e highway r:io s
used, enter the appropriate additional mOde {e.g.,.and. rail) in the space below.
TRANSPORTER SECTION 11: .. Transporter 1 Acknowledgement: Enler the name or the person accepting t~e waste on beha/1 ol the lirst transporter. Thal person rr.ust acknowl~t
acceptance al the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt. 1
18. Transporter 2 Acknowledgement: Enter, ii applicable, lhe name or the person accepting the waste on behalf of the second transponer. That perscn r:ius:
acknowledge acceptance ol the waste described on lhe manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
FACILITY SECTION . . I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in this space any discrepancy belw
the waste described on lhe manilesl and the waste actually received at lhe facility. Owners and operators of facilities who cannct resolve s1gn1licar.t
L ol1c,epancie1 within 15 doya receiving tho wosta must submit to lhe Of!pertmenl o 1etler with a copy ol lhe manifest describing !he discrepancy and ar.emctf
reconcile il The Irea1ment. storage, or dlsposol laclllty mus! enter the actual.weight ~I wasle in pounds In !he spaces provided H the amount varies any tr:::m r
specified by lhe generator in itom 13 or II the generator usos a unit ol mcns11re other thon pounds. ,
20. F•cllily Owner or Operator Cerlllicallon: Print or type the nameol the person occepting the woste on behatrol tneowner or operator ol lhe lac11t1y. Tt1.:lf person
must acknowledge acceptance or the waste described on the manifest by SIGNING (BY HANO IN INK)' and entering the CATE or receipL
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIGNATED I
P,ECc''-'E THE WASTE On THE S.C. DHEC MANIFEST SECTION AT (803) 734,5200 WEEKDAYS FROM 8:00 nm TO 5:00 pm.
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I
South Carolina Department of Health
and Environmental Control·
Bureau of Solid & Haz.ardou.s Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holiday,: (803)734•5"24
LEASE PRINT or TYPE (Form desl ned for use on elite 12-Itch rller Form A roved. 0MB No. 2050-0)39 Ex 'res 9-30-88
T R
A
N s p
0 R
T E
R
UNIFORM HAZARDOUS
WASTE MANIFEST
1 Generator's Name and Mailing Address
Channel Master
1. Generlltor's U.S. EPA ID No.
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
4. Gene,ato(s Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
Manlf••t Document No. 0 0 1 0 6
2. Page 1
of Information in the shaded a<eas is nol
required by Federal law, but is by State law.
9. OesignaIed Facility Name ilnd Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description ~ncluding Proper Shipping Name, Hazard Class. and ID Number)
a.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Speciat Handling Instructions and Additional Information
GSX Work Order No.: 71713
12. Containers
No. Type
1 D T
115. GENERATOR'S CERTIFICATION: I hereby declare that the conlenls of thl• conalgnment are fully and accurately de■crlbed above by proper ahlpplng name and are cl..-lfl.cf.
packed. marked, and 1a·beled,arid are In all respects in proper condition lortransportbyhlghwayaccordlng to applicable International and national government regulalkm• al"ld
the laws ol the State ol South Carollna.
tf I am a large quanllty generator, I certify that I have■ program In place to reduce the volume and toidclty ol waste generated 10 the dogrff I have doletmlned to be, .conomlcalty
practicable and that I have setected the pracllcabla method ol treatment, storage, or dlspoaal currently 11vallable to me which mlnlmlt.aa tho praNnl and future lhrNI to human
health and the environment; OR, If I am a small quantity generator, I have made a good faith aflort to minimize my waste generation and select the be•! wa•t• manaoomenl method
that 11 available to me and that I can aflord.
Printed/Typed Name Signature ~· ~ Month Day Year
RO.GER L. COATS d
17. Transporter 1 Ae;Knowledgement of Receipt of Materials
Prinled/Typed Name Month Cay Year
0•"1
·')
18. Transp0rter 2 Acknowledgement ol Receipt of Materials
Printed/Typed Name Month Cay Year
19. Discrepancy Indication Space
1i
I
L ! ;20::. :F=••=i=lity~:o:w:n:e,~o:,:o:pe::ra;1o;r.:, c:e:r11:n:ca::uo:n:o;.l.:.rec=•_.IP.:.l.:.•l;.h.:aza=r.:.do.;.u;.;•;.m..;a,;1e=:r.:l•c.:'•cc•:.;ov.:.•;:;r.:.ed:..:.by,_th=l•;.m;.a;.n;.H.:.es::t..:•;.••::•:::P.:.t a;:;•:.;"°;..:;:'ed::..:ln=lt•;:;m:..:.19:;. _____________ .,.,..-f
Printed/Typed Name Signature Month Day Yw
':::t-=~:::-::::=~~=~==,.,,,..-.-.-~,,,..,.,,,,.,,.,,,,......,.,,.,,~----------L.J.--'-.J....1__._J
EPA Form 8700-22 (Rev. 9/86) Previous Edl~ions are.Obsolete IDHEC 1~88 (Rev. 10/86))
I
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I
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I
I
South Carolina Department of Health
and Environmental Control
Bureau ot Solid & Hazard..,..Wa.,te Mgt •• ,
2600 Bull Stroo\ Columbia. SC 29201
. Phone: [phone] -.
Emergency & Holidays: (803)734-5-124
LEASE PRINT or TYPE {Form desl ned for use on ellte 12-Itch writer
UNIFORM HAZARDOUS 1. Gonorotor's U.S. EPA ID No.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
_P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 -Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and IP Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71714
Form A
2. Pogo 1
of
;jf I
roved. 0MB No. 2050-0039 Ex ·res 9-30-88
Information ita the shaded a.reas is not
required by Federal law, but is by State law.
:~*'~;~;~t'.~~~=tttffi~!i~:
i~L:t:~~i~~~tf ¼~;l:~i§;~J~Jtl~~;f:ii~:·
, 6. GENERATOR'S CERTIFICATION: I hereby declare th al !ho conlents of 1h19 conaignmonl ar• fully and accurately deacrlbed abov• by proper shipping nam• and ar• cl-...lffed.
packod, mark&d, and 1a"beted, and are In all respects In proper condlllon tor tranapor1 by highway accOrdlng to app11cabla International and na!Klnal govamm•nt re,gul•tlon• and
ttle laws ol Iha Stale ol South Carolina.
If I am a large Quantity genara1or, I certify !hat I have a program In place lo reduce the 110lume and toxicity of waate generated to th• degree I have determined to be aconomlcatty
practicable and that I have selected the pracllcabte method of treatment. storage, or dlspoaal currently avallable lo ma which minlml:r.a• the preaanl and future ir,rMt to human
health and the environment; OR, If I am a small ciuantlty ganaralor, I have made a good lalth atfor1 to mlnlml:r.o my waste generation and ~•tact the boa I waate rnan~gement method
that is available to me •nd that I can afford.
Printed/Typed Name Signature Day Year
Month Day Year
19. Discrepancy Indication Space ·~ • I jibs CI libs.
b I jibs d I llbl.
L i ~20==-~F:•=c=il=ily=:o=w=n=•~r o~r=O~=P•~r=•=to=r,=C=•=rt=ifi=•c=•=tl=on::-_o ... lr..:•.cc.;.el.:.p_t o.;.l_h;;:aza~r..:d.co.cu•.;._m;;,•,.;l•c,rl..:•c:l•..cc:.:o ... v.:.•rc:edc:..:byc,..:lhc;l.:.•.;;m;;•:;.n;:;~.:."':.:t..:•;;'.:.<•:,P:;l.:•.:.•.;;n.:.ot;:edc:.:ln:;..:;lt.:.•m:;;...1.:9:.. --------------'--~
• ';,-;:~~Pri=n-:ted~/T::-y-:p:-:;ed7,;Na=m~•'::':';;-:;:-;;-:"~::'.".".:"e.~:":':~~~~~~:es1::,gn-:a::-tu~r•,.,.,,.....-,-::-:,,=----------------.J...I....I...JUL....&....I
EPA Form 8700•22 (Rev. 9/86) Previous Editions ere Obsolete (OHEC 1988 (Rev._10/86)]
Monlh Day Year
I
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I
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I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa.ste Mgt
2600 Bull Street, Columbia, SC 29,201
. Phone: [phone]
Emergency & Holiday,.: (803)!34·5424 -.-1
LEASE PAIHT or TYPE (Form desi ned for use on elite 12· Itch writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-Ba
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generalor's U.S. EPA ID No.
l Generator's Name and Mailing Address
Channel Master
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
•· Generato~sPhono 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
0 1
SCD070
11. U.S. DOT Description ~ncluding Proper Shipping Name, Hazard Cfass, and ID Number}
a ··-·------· Hazardous Waste, Solid, nos ORM-E
NA 9189
d.
GSX Work Order No.: 71715
2. Pago 1
of
1 D.T
Information In the shaded a,eas is not
required by Federal law, but is by State law.
::1~f'i'6","i~
2 o y 1,,,a,a,fi,I
1 CS. GENERATOR'S CERTIFICATION: I hereby declare that the contents ol this con•lgnment are rutty and accurately dHcrlbed abova by proper •hipping name and ara cl~n.d.
packed, marked, and la°beled, and are In all respects In proper condition for transport by highway according to appllcable lnlernatlonal and natlonal govammant ra-Qulatlona and
the laws of the State ol Soulh CaroUno..
111 am a large quantity generalor, I certify that I have a program In place to reduce lhevolume and toxfcltyofwa•tegeneraled lolhedegree I have determined to be economlcally
practicable and that I have selected the practicable method of treatment. storage, or dlspoaal currently available to me which minimize• the preaent and lutura thr .. 1 to human
health and the environment: OR, II tam a small quantity generator, I have made a good lailh effort to minimize my waste generation and eelect the beat waate management method
th.at la available to me and that I can afford. -· · -• ·
Month Day Year
I~ :L: .................. L
libs. C I libs.
jibs. d I Jibs.
11---------------:::: 20. Facility Owner or Operator. Certlncallon of receipt of hazardous materlals covered by this manttest except as noted In Item 19. I Printed/Typed Name . Signature .
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)1
Month. Day Year
I
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I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haz.ardous Wa.,te Mgt ·
2600 Bull Stree\ Columbia. SC 29201
. Phone: [phone] _
Emergency & Holidays: [phone]
l.£ASE PRINT or TYPE (Form desl ned for use on ellle 12· ftch Fonm A roved. 0MB No, 2050-0039 Ex ires 9-30-Ba
F
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato(sPhone 919 934-9711
5. Trans porter 1 Company Name
Willms Truckin Co Inc.
7. Transponer 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Numbt,r)
d.
, 5. Special Handling Instructions and Additional Information
GSX Work Order No.: 71716
2. Paga 1
of Information in· the shaded a<eas is not
required by Federal law, but is by Stale law.
16. GENERATOR'S CERTI_FICATION: I herebydeclsre that the contents ot thlsconaJvnmentare lullyand accuratelydaacrlbed above by pro~r •hipping name and are claa.ifl.:t.
packod. mark&d. and labeled, and are In all respects in propereondition !or transport by highway according to apptiC.11.ble International and natlonal government r119utatlona and
the laws of Iha State ol South Carolina.
111 am a large quantity generalor, I certify thal r have a program In place to reduce the volume and toxicity of waste generated to the di,gree I havedatermlnad to be oconomlcally
practicable and that I have :selected lhe practicable melhod ol treatment. storage. or dlspoaal currently available to me which minimizes the present and future throat to human
health and the environment,: OR, Ill am a small quantity generator, I have made a good faith effort lo minimize my waste generation and seleetthe boat waate management method
that is available to me and that I can afford. ·
Month Yeat
0
Year
Month Dey Yeat
!lbs. CI libs.
If • IL..L..L..L_._.
b IL..L..L..L ........ !lbs d I !lbs
f ~20~=-~F:•=c=il=ity=O:=w=n=•=r o=r=O==P•=r=•=•o=r.=C=•=rt=ifo=•c=•=•i=on~_o_f r..:•..:c.:.•i.cp_t o.:.f_h_aza..:.r..:d..:o..:u•:.....m,•,.;••,,ri..:•..:l•..:c:.:o..:v::.•r..:ed.:..:b.:.y..:lh;;;i.;.•..:m;;;•;;.n;;;tt.:.••:.:•..:e;;;x.:.ce::p:;t.:•::.•..:n.;.o;;;led.:..:ln::.::lt::.em:.....1.:9:.. -----------------l
I Prinled/Typed Name Signature Month Day Year
~~=--,~,..,........,,,,,,_..,,.,_,,.,~~--,--,-,,.,.--------'-..J-L..~ EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsol~le (DHEC 1986 (Rev. 10/66))
I
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I
I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2£00 Bull Stree\ Columbia. SC 29201
. Phone: [phone]
Emergency & Holiday,: [phone]
LEASE PAINT or TYPE (Form desl ned for use on elite 12· ilch Form A roved. 0MB No. 2050-0039 Ex 'res 9-30-Ba
UNIFORM HAZARDOUS
WASTE MANIFEST
2. Page 1
of Information in the shaded a<eas is not
required by Federal law, but is by State law.
3. G~~:~~~~•~:;~~~ing Address ~1m~:~~\?!:'~~\~;Ji!11;'..
i:':.:.· ..,:,,,.:.:~•,,r:::~:,:;r'c.:•:..:!_;_~::,Ox::,ne:..Ll-4-';C.,~s.,9'-..J.s_m-"-!-";C:~C..~-'!'-';:.:.i,_d,_l _' _N_c_2_1_5_1_1 _____________ ---,E-~~~;:~rl:~1fi'l:llf;;;t\'~'f/;~;~~-;1';::l
5. Transporter 1 Company Name
Willms· Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
11. U.S. DOT Description (incfuding Proper Shfpplng Name, HBZJJnJ Cls5S, and ID Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No .. : 7171 7
, e. GENERA TOR'S CERTIFICATION: I hereby declare thet the content• of this consignment are fully and accul'at:ely described above by proper ahlpplng name and ara cl&..in.ct.
pack ad, marked, and libeled, and are In all respects In proper condlllon tor transport by highway according to applicable International and national govammant ra,gulatlona and
the lews ol tho State of Soulh Carolina. ·
111 am a large quantity generalor, I certify that I have a prOQram In place to reduce the volume and toxicity of waste generated lo the degree I have determined lo be economically
practicable and that I have selected Iha practicable malhod ol traalmant, storage, or dlspoul currently available to ma which minimize• the present and future threat to human
health arid Iha anviroriment: OR. II I am a small quarilltyganerator, I have made a good faith effort lo minimize my waste generation and select the beat was la management methOd
mat·ls available 10 me and that I con affou;t.
p I I, .......................... 111>1. C I llbl.
L.. .._.,..,1.,.._._.,1 lbs. d I pt>s. I ~L bl
I ~ 20. Facility Owner or Operator, Certification ol receipt ol hazardous materlals covered by this manrfest except as noted In Item 19. I Printed/Typed Nama _ Signature •
EPA Form 8700•22 (Rev. 9/86) PreVious Editions are Obsolete (DHE_C 1988 (Rev. 10/86)1
Month Day Year
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
. Phone: [phone]
LEASE PRINT or TYPE (Form desi ned for use on elite 12· itch writer
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
•· Generalor's Phone 9 l 9 9 3 4-9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designaled Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
L
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
b. LLJ-1 d.LLJ-1 1-)
.,,_._,..,,,,.,.,......-,.,,,.,..,...,.,..,,;,,,v,W.-.•M•N,'>~•C<•,•~<•<-,,.,...,,.,<-"·,;,,
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71718
Emergency & Holidays: [phone]
Form A roved. 0MB Nci. 2050-0039 E, ·res 9-30-88
2. Page 1 of. Information in lhe shaded a<eas is n01
required by Federal law, but Is by Stale law.
litltllil~v~iltltiilf:
lli~k~l~:1~i~:t1t1~1}11Jl~1i!it
12. Containers
No. Type
· ' l D T
'[~"ifa'f'~',~11
~ffel I~/::
1 e. GENERATOR'S CERTIFICATION: I hereby declare th al tho contonls or lhls consignment are fully and accurately described abOve by proper shipping name and are claaaifted,
packed. marked, and labeled, and are In all respects In proporeondillon tor transport by highway according to applicable lnlarnatlonal and national govammanl r.-.,ulatlona and
lhe laws o1 tho State ol Soult\ Carolina.
111 am a large Quantity generator, I eertlty that I have a program In place to redueethevolumeandtoxlclty ofwaaleganeraled lo the degree I have determined to be ec:onomlcatty
practicable and that I have selected the praetlcable method ol treatment. storage, or dlspoaal currontty available to me which mlnlmlzOI the present and lutura thtNI to human
health and the environment; OR, II I am a small quantity generator, I have made a good faith effort lo minimize my waste generation and aeloct tho bell waste mana'-ement methOd
that Is available to mo and thnl I ean afford.
11-+--P-r;n_,ed_,_ry_ped--N-•m_• _________ ._c_o_A_T_s_..J_s_;g-na_,._,_· __ :.t.:,::;!~~~;_...f~:::.:~--=~==' :::::~:::::::... ___ .J..'.::J.::/Jli:DLayLl:ii:Y:i.ear~
~ 17. Transporter 1 At:Knowledgement of Receipt ol Materials
~ Printed/Typed Name Signature -~ k-,~1J.Cc_rv<-~:..i:,~¥-:-'"":-!:.l....:=£,..!.V"-""'7'fF2':!:..!.":::.,.,,,..,....,..,----L....t:..:l~ .. ~-"'"'~':::!C'Jr--"<"-'-....:,Z!:,~~,tt:?::::::_.;!;E:-41. _____ _l.<2,J~,4J,.)Lbq.-.;il
o 18. Transporter 2 Acknowledgement Receipt ol Materials
~
I
~l-''-Pn.:..n:.:l:.:ed:;/:.:T.:yped.:..;;;;N:.:a:.:m.:e==.:;:;.:;:;..:.:..c:.::.=c..:.:..:;..=='---"'TS_;_gn_a_ru-,-.----------"-------------------,.,----1
H:\ ..,....,--______ _._ ________ _._.__._.__._
19. Discrepancy Indication Space
Month Day Year
F • I Jibs. C I libs.
I~ b I Jibs. d I Jibs.
11---------------~ ~20=·::F:.:a:,ci.:lity':-::O;_;w:.:n:.:•;,' ':'or:;O:,Pc,:e:;ra:;lo:;c.:., C::•:;rt:.:ifr:;,ca::..:lio:;n;;o:;f:.:r::ecc.:e:::iP:.:f.:o:;f h.:aza=r.:d::ou:;•:;m;;a:;:1,,er,::;•:::l•:.:cc.:o:.:v::er.:ed::..:b!..y::th:::i•:..:m;;•::n;;~.:e::sl.:e::xc::e~p::.I ::••:.:n:::o::led::..:l;;n;;lt::em:::..:1::9·;_ ______ ---,.,--,--,,--.,.,--l
I Printed/Typed Name Signature Month Day Yw
~....,..,,.,.,..,.,..,.,,.._~...,......,,.--.....--~...,.,......------------L...i....l-~ EPA Form 8700-22 (Rev. 9/86) Prev;ous Edi1;ons are Obsolele (DHEC 1988 (Rev. 10/861)
I
I
I
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generelor'sU.S.EPAIDNo.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address Channel Master
Manlfeet
Document No.
0 0 l l 2
Form A
2. Page 1
ol
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
Emergency & Holiday,: [phone]
roved. 0MB No. 2050-0039 E.x ires 9-30-88
Information in the shaded Meas is not
required by Federal law, but is by State law.
r.'~-~:;•n~· •~r~~,o~·,·~· ~!h~oo~~~· ~1~4~!~~~9:S-m~!!..~"-~'-:_!"-;!..1!.l !.f _· _N_c_2_1_s_1_7ll.U~E?A:io;;;;;;;~-----1·~~[1r';1l,~;:;;~~s~~;~~:;,::i::,iit~J:~;;f~t?~·,i;;lii!!'{Nt:\~$;t)JJ?l:i\~~
15. Transporter 1 Company Name · Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address GSX Services of SC, Inc. Route, 1 Box·255 Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
d.
~,l'J• ' . ' . ,•q,o, , . ....... • ,,·•
-·-· ---·--•-'f--·~•·..:.--,:-=--=""""'='_,.__ -··· Hazardous Waste, Solid, nos ORM-E NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71719
,t,' -• ....... =--=--.-... ~
1 D T 2 0 y
~I f"FFf""71
~;A I 114-
18. GENERATOR·& CERTIFICATION: I herebydecl•re that the conter,ts oflhlscor,sf,;ir,mentarefully ar,d accuratelydeacrlbed above by proper ahlpplr,g name and ua ct .... n.ct.
packed. mark.ct. and 1a·beled, and are In all respects In proper condition tor transport by highway according to appllcable lnternallonal and nallonal govammel'lt regulallons and
the laws of the State ol South Carolina.
111 am a large quantity generelor, I certify that I have a program In place to reduca the volume and toxicity of wa■le generated to the degree I have determined to be oconomblty
practicable and that I htive selected the practicable method ol lrealmenl, storage. or dlspoaal currently avaltabte to me which minimizes th• present and lutura thr-t to human
health and the environment; OR, 11 l am a small quantity generalor, I have made a good faith effort to minimize my waste generaUon and select the best waste management method
that is available to me and that I can afford.
lk,.k..,P,..rin-ted_,r_y-ped_N_•m_•...,.-,--B::,P~,c~_:..E-:R..:!,.:·;C:O:'.:::A:..T.:.S::,_..1s_ig_n_•t_u,_e __ ~~~::!::;......1~:.:..l~~-~~£:;;,_ __ _:~d~IL!ty..,~
T 17. Trans ner 1 A<.;Knowled ement of Receipt ol Materials .~~~P~,i~n==============--TS-ig-n-,t-u,-e--~~~-------,---p-~--
7
--------~
p
0 I ii,;..:;.,:.:=::.=,::=-:..:..=::::.:=~=:.::.=::::.'..:..::::::::;:;;:::. ___ r.S~ig_n_a_ru_r•-------'::_ _____________ ....,.,....,,--=---:-:--1 Month Day Year
19. Discrepancy IAdication Space ·~ • I p1>s. C I lll>s.
b I I p1>s. d I lll>s.
11---------------~ 20. Facility Owner or Operator; Ceni0callon of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
I Printed/Typed Name
'=':--:-....,..,,.,,.,.,,.,,.,,,.....=-::,-::-...,......,..,,,,....--,,,--,-~~----,-----------1-L-L-l....1....I.-J EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/.86))
Signature Monlh Day Year
I
I
I
I
I
I
.•· --.
~ South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N c D
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name af)d Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name. Hazard Class, and ID Number)
a.
d.
Form A
2. Page 1
of
12. Containers
No. Type
;.~½-~~,~~;~:~l;~;i~;;:;!,::i1~i:~ilt1~:::~1,l;:!:~11t~)1;£11!1} f :11~11~:i~~,z~l
alE.MJ-!0,2,71714!-!1'1,0,2!}Ndi\/h;c.LLJ-! 1 1 1 1 !-! 1 1 I ·I@
1 ,. .J.,,J::-J• ... ) ii
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71720
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Street Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-1!8
Information in the shaded areas ia not
required by Federal law. but is by State law.
, e. GENERA TOR'S CERTI_FICA TION: I hereby dect•re that tho content• ol thia con•lgnmonl are lully and accuralety doacrlbed above by pro~r ahlpping name and are claaailled,
packed, marked. and labeled, and are In all respects In propercondlllon forlran•por1 byhlghwoy according to appllcable lnlarnallonal and natlonal government re,gulatlona and
the laws of !he State of South Carolina.
111 am a large quantity ganeralor, I certify lhal I have a program In place 10 reduce the volume andtoxlcltyol waategenerated 10 lhe dogrN I h•-determined lo be oconamlcally
practicable and that I have selected the practicable method ol treatment. storage, or dlspoaal currently avaltabte to me which minimizes the present and luture thrMI to human
health and the environment OR, If t am a small quantity generator, I have made a good faith ettor1 to minimize my waste generation and select the beat waate management method
that is available to me and that I can afford.
·~"'.":""P:-ri-nled-/T-yped-,-:-N-•m_•-:-,---/1--0.,.,.G=--ER,--L.~C~O~A-T_s_..J.-=-e::-~~~~-'~d~...:::UJ:.l. ~~~i!:.,. ___ ;........J~:t.L.ODaL.!y..lli:Y:Uw~
~ 17. Transporter 1 Ae;Knowfedgement of Receipt ol Materials
I ~ Printed/Typed Name
s p
o 18. Transporter 2 Acknowledgemenl ol Receipt of Materials
I
~ l-'-P=-r7in::.,eo=/c,Ty::p::.eo::.ccN.:.a.cm..:e.::..:======.:.:...cc==---+::,----:,-L---------------------,-,--,--:,--:-:---1
i.;.;.,i~---------L-----------&....1~~
Month Day Year
19. Discrepancy Indication Space
F
I! • I pbs. C I pbs.
bl jibs d I pbs.
! ~::20'";;--;F;a~c-::i-li71y~-o;w;;n;e,,r~'70-r~O~p;e:;;ra;1::o-r.~, .::C-.:.e-rt;1.:.n'"c;;a;';ll::o-n;.:.ol:.:r;.•c:;•::IP::'.::o::.I h:.:aza:::::r..:d;.o:;u•:.;m:::;;a•::er:.:l•::l•:,c:;o::•;.er::ed:..:b:!..y.::lh::l•:.;m::•:;n::ff::•:;••:.:a::x::ce::!p::l::as:.n::o::led::;:;l::n.;;ft::em~1,::9·:....-------:-,--.,-
Printed/Typed Name Signature I ~E;::P:':A-:F::'.o~r::m-:8:;7;::00:;:-:·2:;2;--:(,;;R::e:-,.-:9:':1';:'86:;;)-;P;:r-:::ev-:i::ou'.-:s:"E~d::;i;:-lio::n::s:--:a::re~O:':'.b::so'.':1::el;:e-:[:::D~H-:,E:,:C-:1;::9';:'88::-::(R;:e-,-. 1::0;:/;::8':'6)::-)----------------...L..,....fl...L..&...-'--'
Mootti Day Yea,
I
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa,te Mgt
2600 Bull Street Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
LEASE PRINT or TYPE writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
NCDO 7 0
3. Generalor's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor's Phone 9 1 9 9 3 4-9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc,
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
~~~,m~~,i!~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71721
Information· in the shaded areas is not
required by Federal law, but is by State law.
, 6. GENERA TOR'S CERTIFICATION: I hereby declare that !he con1ent• of this con•lgnment ara fully and 11ccurer.ly de•cr\bed above by proper •hipping name and ar. c1...in.c,.
packed. marked. and la'beted. and are In all respecls fn proper condition tor transport by highway according to appllcable lntarnallonal and natlonat government r99utation• and
tne taws of the State of South Carolina.
111 ain a large quantity generator, I certify that I have a pr<>Qram In place to reducethevotuma and toxicity ofwaalageneralod lo the dogroe I have determined lo be economtC&lly
practicable and that I have selected the practicable method ol treatmenl, storage, or disposal currently available lo me.which minimizes the pres.ant and luture throat lO human
health and the environment OR. II I am a sma11 quanlitygenerator, I have made a good faith effort lo minimize my waste generation and aelact the b,e.tWaata management method
that is available to me and that I can ottord.
c1.d-.r-Month Yea,
0
Month Day Year
ti It'
Month Day Year
F a ,_I ....... _._.__.__.pi,,. c I 111>,. I ~~ bl. . . .
L.. L..J....L..J....l.,Jl1bs. 6 I 111o.
It-,,----,---~-----~-~ 20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by this manifest except as noted In Item 19. I PrlnlediTyped Name Signature
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
Month Day Yw
I
I
I
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1.Generator·,u.s.EPAIDNo.
WASTE MANIFEST N c D o
Form A
2. Page 1 of
Bureau of Solid & Hazardous Waste Mgt
2600 Bull S~ee( Columbia. SC 29201
Phone: [phone]
Emergency & Holiday~ [phone]
roved. 0MB No, 2050-0039 E.x ires 9-30-88
Information In the shaded areas is nol
required by Federal law, but is by Stale Jaw.
3. G~~~~~:~an;;;~~ ~~ing Address ~St:t=:;:~~:~tJ!~~t:r;~'.~lffi~J!Z:
1-•::.·..:::.:•::.~;;;•r:.::~"l;::.r·::.•-'.!:..:~O"'~".'-'-l-4-'!'-'~"9"--'-S-m~~'-'~"-~"'-=-'~'-';'-i"-d"l_'_N_c __ 2_1_5_7_7 ______________ _,~11#~~j~;rJ~~t~;ij~J~;lif,~!:~~0~*:~;~~;;:;1:~r~
6. U.S. EPA ID Number
SCD073
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route·, 1 Box 255
Pinewood, SC 29125
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
SCD070
11. U.S. 'oor Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
~0~.~ ~:~;~~:~~1ll!~~r~1ri!,[,!i~!!;!~;:~::j;i;1~,?J~I1~1~1~11:;1~:~~~1r~~~11
a.lf..i.li..]-ID121717141-lli11D12Lt!WhHMc.Li..J-I I I I I 1-1 I I I Ir@
b. Li..J-1 1~lli!l!jii!!liiJ~·L.+J-:-I } ! I,,_ ):I 1 },.} ,ill
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71722
16. GENERATOR'S CERTIFICATION: I hereby declare Iha! !he contents of this conaignmenl are fully and accurately described above by proper shipping name and ar• cJasaiflod,
packed, marked, and laheled, and are in alt respects in proper condition fortranspor1 by highway according to applicable International and natlonal government reQulatlona and
ttie laws ol the State ol South Carolina.
If I am a large quantity generalor, I certify thal I have a program In place lo reducathevotumeandtoxlclty ofwaategeneraled lo the degree I have determined to be economically
pr11cticabl11 and 1h11t I have selecled the pr&.clicable method of treatment. :storage, or dlspoaa.l currently available to me which minimizes tho pruent and future lhrMl to human
heelth end the environment: OR, 111 am a :small quanlitygonorator, I have made a good lalth ettor1 to minimize my waste generation and select the be1t w111ta management~
mat Is available to me and thal I can afford.
Printed/Typed Name Signature
~ 17. Transporter 1 Ac,;,mowledgement of i terials
~ P pedNamej ,·_/4 Signature
p o 18. Transport Acknowledgement of Receipt ol Materials Rf---"',--==:z...:============-----,-----~------------------,-;;-;--::----:-:---f I ~i-4--P-ri-nl_ed_,_r_y_ped_N_a_m_• ______________ ..J._s_ig_n_ai_u_r•-----------------------l'-l-.l.....l-..L..J-i
19. Discrepancy Indication Space
Month Day Year
F Ir • I pbs. C I !lbs.
b I !lbs. d I pbs.
! ~2=0=-~F=a=ci=lity=:o=w=n=•=r=or=O=p=•=ra=t=o,=·=C=•rt=i=fic=•=li=on:-.:.of..:r.:.•c.:.•:.:ip..:t..:o .. rh..:aza=r..:d..:ou.:.•::.:m.:.•:;ct.:.•',.:l•c.l•c..c.:.o..:v.:.•'..:ed.:..:b:..Y.:.lh.:.l•::.:m.:.a.:.n.:.tt..:es.:.l..:e..:x.:.c•::P..:l.:.a•::.:n..:o..:led:.:.;l.:.n.:.11,.:•m.:..:1.:.9·.:..: _____________ -I I Printed/Typed Name Signature
• ~Ec:P:-'A~F-o,-m-:a-=100~--:2"'2"'(-::R.,.e-v."'9'°1"'a"'s'"1 =P-re_v.,.io_u_s_E:,-d~i.,,ti-on-,-.-,-•"'O"b'°s-0"'10"'1'"e"'1"0-!-H"'e"c""'19"'e"e'"t"'R'"e-v.-1'"'0'"1"e-:6,-:)I-----------------..JL-l....L.J...L..JL...I
Month Day Year
I
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I
I
I
I
South Carolina Department of Health
and Environmental Control
Bureau or Solid & Ha.z.ardous Waste Mgt
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
LEASE PRINT or TYPE (Form desi
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
SCD073
8. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71723
Form A
2. Pago 1
of
Emergency & Holidays: [phone]
roved. 0MB No. 2050-oo:r. E:l ir .. 9-30-88
Information in the shaded areas is not
required by Federal law, but is by State law.
12. Containers 13. Total Quantity t4. Unit /1/Waati~t,1+
No. Type 'MNrJ i:l§\)H:i:/:'.J::=:1\di~ff
16. GENERATOR'S CERTIFICATION: I hereby declare th al !he contents of this conslgnmenl ere lully and accuretoly described above by proper shipping name and era claaaiflecl.
packed. marked, and labeled, and are in all respect• In proper condition for transport by highway according to applicable lnlarnallonal and nattonal govemment ragulatlons and
the laws of the State of Soulh Carolina.
111 am a large quaritity generator, I certify that I have a prOQram In piece to reduce th• votume and to,ilclty or waste ganaratad to th• daor-I h•-datarmlnad to be .conomlcally
prect1eat>le and that I have selected the practicable method ol treatment. storage, or dlspoaal currently available to me which mlnlml.tes the praaont and future thrNI to ru,,man
health and the environment; OR, II tam a small quanlity genorator, I have made a good la Ith effort to minimize my waste generation and select the beat waata management method
that is available to me and lhal I can afford. '
Printed/Typed Name Signalure ~ ~ Month y..,
Signa ure
7~
Signature Monltl Day Year
19. Discrepancy Indication Space .~ L
a IL...L...L..L.J....J...Jjlbs. c !L...L...L..L.J....J..Jllbs.
b I jibs. d I ,, ...
11---------------T 20. Facility Owner or Operator. Certlflcallon or receipt of hazardous materials covered by this manifest except as noted In ttem 19.
l v~~~--'---=-'--'-==-r.~~=~--~ Printed/Typed Name Signature Month Day Yur
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsole1e (DHEC 1988 (Rev. 10/86))
I
-,.,,>;·,_
J-~~'~'
~
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa,te Mgt
2600 Bull Stree\ Columbia. SC 29201
. Phone: [phone]
Emergency & Holiday,: (803)734,5424 I PL.USE PRINT or TYPE (Form desioned for use on elite r12-nilchl •·--writerl
UNIFORM HAZARDOUS 11. Generalor'sU.S EPA ID No.
Form A roved. 0MB No. 2050-0039 Exoires 9-30-88
Manlleat ,I 2. Page 1 lnformalion in the shaded areas is not
required by Federal law, but is by State law.
I
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I
--1 G
E
N I E
R
A
T
0 I R
I
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I
I
I C
I
WASTE MANIFEST N• C· D· O· a. 7, ho"·, .. 7, Ooc!'ment No:.. of l 1, , .. O, "· l • J, ,
3. Generator's Name and Mailin~ Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone I 919 I 934-9711
;f ~lilGf =~tjHf !~tiiltt:~t~r{;_
:t~r;;,~;1~111~1:~;~ff[~~¾~f~~i:t;;
5. Transporter 1 Company Name
Willms Truckino Co
6. U.S. EPA 10 Number •c!f ...... .. .
Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
CSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. US. EPA 10 Number
, s, C, D, 0, 7, o, 3, 7,
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
a
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Addilional Information
CSX Work Order No.: 71724
~ a J~¼~B:l~J;;=;;;:i\~:;~~i;:~:gi~iI4:~:~~~Yiri~Ji:~·
12. Containers 13. Total Quantity tt Unit :;.1\Yiate~j:(
No. Type 'MNrJ. /§FJ=:f'(fl?:{)UW{
, ,l D ,T , , ,2 ,0 y
I I I I I I I
\
' ' ' ' ' ' '
I I ' ' ' ' '
1 8. GENERATOR'S C:ERTIFICATION: I hereby declare that tho content• olthla con•lgnmontar• fully and accurately de1,:rlbod abov• by proper 1hlpplng nama and are cla ... flad.
packed, markod, and 1a·beted,and are In all respects in proper condition for lranspor1 by highway according toappl!cabla lntornaUonel and n1tlon11I govarnmanl r-.gulatlonaal"'d
lho laws ol tho State ol South Carolina.
111 a.ma large Quantity generator. I cor1ify that I heve a program In ptace to reduce the volume end toxfcltyol waataganaratod to lhadogr-I have determined lo be economicalty
practicable and that l have selected the practicable method ol treatment, storage, or dispose! currently available to ma which minlml,:oa tho present and future ttuoal to human
health and the environment: OR, 111 am o small quantity generator, I have made a good lailh eNor1to mlnlmli:e myw1111t.e generation and seleCt the beat waata management meU'lod
that is available to me and that I con allord. ·
Printed/Typed Name !Ro'CER C COAT? ' " .. -~
I Signature Month Day Year ,o, c,, a 2.-,.f-,'7
I
~ 17. Transporter t Ac;Knowledgement ol Receipt of Materials
A Pr~/Typed Name ~ l../o"'ta..1/ /1, ~r
I Sign,,
u
Month Day Year
I , I , I ,
o ,a. Transporter 2 Acknowledgement of Receipt ol Materials I il--'~-Pn~.n~,ed=/~T~yp~ed:..;_N~a~m~e=::.e:..;.=..:.:..c..::.:;.;;:;;.;:.c:c.=='-----rlS~i-gn_a_lu_r_e ____________ ,------------,-.,--,---,,--.,,---i Month Cay Year
I , I ' I '
19. Discrepancy Indication Space
F a I ·~ bi~~~~ jibs. C I l!bs.
libs. d I l'bs.
I ~ 20. Facility Owner or Operator. Certificalion of receipt of hazardous materials covered by this manrfesl except as noted In Item 19. I . Prinled/Typed Name I Signature
EPA .. F(!frn 8700·22 (Rev. 9/86) Previous Editions ore Obsolete (OHEC 1988 (Rev. 10/86))
Month Dey Year
I , I , I '
I South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Mast,;,r
P. 0. Box 1416,
4. Generator's Phone 919
5. Transponer 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter. 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.~. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
a.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
Form A
2. Page 1 or
12. Containers
No. Type
1 D T
~-•~~-~
1°' ~9;:½~;1;~; ;!,;ili::1;::=,;:;:~l:!11;:;;ut;:!t~f Jl;::!!l!;!:!lf !!l!::r1~:t!;~'12ffll\1
a. lLili.J-10 I 2 I 7 I 7 I 4 J-J 1 I 1 I O I 2 I'' . ,,, q_i_]-J . f-J I\\{
b. LLJ-1 J-1 :@L~: W.:::J . •,,,•,• , J::::J . , , I 1
1
,!I
15. Special Handling tnstruclions and Additional Information
GSX Work Order No.: 71725
Bureau of Solid & Hazardous Wute Mgt
2600 Bull Streel Columbia, SC 2920t
. Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-e&
Information in the shaded a<eas is not
required by Federal law, but is by State taw.
2 0 Y
rl~~f :,;'}o~'-l .. 1;9~11
J]i E IO IO I 6 1?,t
, 6. CENERATOR'S CERTIFICATION: I hereby declare that the contents ol this consignment ere fully and accurately described above by proper •hipping name and are classifle<I,
packed, markod, and la'beted,and are In all respects in proper condition lor transport by highway according to applicable lnlernationa1 and national govemment r-.gulatlona and
tho laws ol the State of South Caro!inn. ·
If I am a large quantity generator, I certify that I have a program In place lo reduce the volume and toxicity of waste generated tothedogroe I have delarmlned to be oconomlcally
practicable and thet I have selected the practicable mothod of troalmont, slorage, or dlsposal currently available to me which minimizes the present end future throat to hum.en
health and lhe environment.: OR, 111 am a small quanlltygonorator, I have made a good lallh eflortlo minimize mywaslo generallon and select the beat wa1ta management m.thOd
that is available to !1"8 and that I can afford,
Printed/Typed Name 'R.-OCER C COATS
t -•·=----
17. Transporter 1 At1mowledgemenl ol Receipt of Materials
Transporter 2 Acknowledgement ol Receipt of Materials
Printed/Typed N_ame
19. Discrepancy Indication Space
Signature
Signature -,_,~7
Signature
20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by this manifest except as noted In ttem 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
Month
Month Day Year
• I Jibs. C I Jibs.
bJ Jibs. d I Jibs.
Month Day Year
I
F
A C I L'
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa,te Mgt
2600 Boll Stree~ Columb;a, SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c o o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Tran_sporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
a· ..... ·-----..
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71726
Form A
2. Page 1
of
Emergency & HoUday,: [phone]
roved. 0MB No. 2050-0039 Ex ;res 9-30-88
Information in the shaded areas is not
required by Federal law, but is by State law.
:~rf~;~;~,~},t~~'.;:lt;~~::=:~~~t;/;
~~=~~~E~fit~~~~it~t~ifj~;~~;J;rEJ~J
12. Containers 13. Total Quantity 1,. un~ :;;~(~~-~
No. Type WtNr:J. Jl[Tifl'?:if1\:;1Xt~Ff{
l D T 2 0 y
tafr,'6'\f,'~
jtj,F,OJOJ61I
1 6. GENERA TOR'S CERTI_FICATION: I heraby declare that Iha contents ol this conaignmenl are fully and accurately described above by proper shipping name and are clau.ille<I,
pecked. ma,kod, and labeled. and are in all respects in proper condillon for tram1port by highway according to applicable International and national government r90ulatlona •N:I.
\l'le lews of !ho Stale ol South Carolina.
111 am a large quantity genorolor, I certily that I have a program in place to reduce the volume and to11lclty of waste generated to the d~r-1 have da1armlnod to be economlcally
prachcablo and that I have selected the praclicable methOd ol lreatmont. storage, or disposal currently 11.vai111.ble to me which minimizes the presenl ■nd lutur■ threat lo human
health and the environment OR. II I am a small quantity generator, I have made a good lalth effort to minimize mywastageneratlon and select the best waste management method
ltlat is availabli, to me and that I can afford. ·
Printed/Typed·Name Rb:cER L COATS
17. Transporter 1 At;Know1edgement of Receipt ol Materials
Printed/Typed Name
Printed/Typed Name
19. Discrepancy Indication Space
Signature Month
a
Day Year
d.2-f i7
Month Day Year
a 11...1._,_1...1....L.Jl'bs. c 11...1..L.Ju...L.Jl'bs.
b I jibs. d I pbs. ,,.._ ____________ _
~ 20. Facitiry Owner or Operalor; Certification Or recelpl ol hazardous materials covered by this manifesl excepl as noted In llem 19.
Printed/Typed Name Signature Month Day Year·
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull SOee\ Columbia. SC 29201
. Phone: · (803) 73'-5200
(Form desi writer
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
NCDO 760
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
4. Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71727
Emergency & Holidays: · (803)73'-542'
Form A roved. 0MB No. 2050-0039 Ex Ires 9-30-88
2. Page 1
of lnlormallon in the shaded areas is nol
required by Federal law, but is by State law.
12. Containers 13. Total Quantity 14. Unit ~:\~,.§),~~:$¾
No. Type VNV~ \Wtt))\;(r;.\:Ffif~t\fj
1 D T 2 0 Y
16. GENERATOR'S CERTIFICATION: I hereby declare that the conlents al this consignment are fully and accurately described above by proper shipping nem• end are clue.in«!,
packed. marked. and laholcd. and are in nll rospocts in proper condition tor transport byhlghway according to applicable lnlernatlonal and naUom1I government r~u1etlon1 and
the laws of the State ol South Carolina.
II I am a large quantity gonorotor, 1 cor1ify thatl have a program ln place to reduce the volume and loxicltyol waste generated tothadogr-1 have delermlned to be economlc:.,illy
prachcablo and that I have selected Iha practicable method ol treatment, storage, or dlspoaal currently available to me which mlnlmh:o• the preMnt and lutura thr-t to hu,,,.n
he 11111, end lho onvironmonl:OR. II I em a amotl quanllty gonere.10,,I have mado a good lallh ottonto minimize mywaslo genorallon and aelect tho beat weal• m11n11g11m11n1 rnethod
that is availaC>lo lo me and thol I can afford.
Prinled/Typed Name ROGER C COATS '
Signature y..,
17. Transporter 1 Atamowledgement ol Receipt of Materials
Printed/Typed Name
Printed/Typed Name Month Day Year
19. Discrepancy Indication Space
• I pbs. C I 1~
b I jibs. d I I ptis.
20. Facility Owner or Operator, Certification of rec~ipt ol hazardous materials covered by this manifest except as noted In hem 19,
Prinled/Typed Name Signature Month D•y Year
PA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street Columbia, SC 29201
Phone: (BOO) 734-5200
Emergency & Holidays: [phone] I PLEASE PRlt/T or TYPE (Form desi ned for use on elile 12-itch writer
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Manifest Document No.
Form A roved. 0MB No. 2050-0039 E, ires 9-30-88
2. Page 1
of Information In the shaded areas is not
required by Federal law, but is by State law.
I
I
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WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel Master
P, 0. Box 1416, Smithfield, NC 27577
4. Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
6. U.S. EPA ID Number
C D O 7 3
8. U.S. EPA ID Number
0 0 1 2 1
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Container, 13. Total Quantity u. Una !L\W.~"¼
No. Type 'M!Vd %/W&PiSHMU%~})'
d.
~~~~~f7~1r·~
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71728
18. GENERA TOR'S CERTIFICATION: thereby declare that the con1en1s of thisconslgnmenlare lullyand eccuratalydescrlbed ebovo by proper shipping nem• end ar• ct...itled.
pack ad, marked. and IBbelcd,and are in all res,pocts in proper condition !or transport by highway according to appllceble lnlernallonal end national government re,oulatlona end
t1'10 laws of tho Stale of South Carolina.
11 lam a largo quantity generator. I certify that I have a program In placo to reduce the volume and loiticltyol wastegonorated to the c!ogr-I have determined to be economically
prectici1blt:1 and tho.I I have setected the pra.cticable method of treatment, slorage, or dlsposal currently avallable to me which minimize, the praaonl and future lhr-1 to human
health and the environment; QA, ii I am o smull qunntitygonora!or, I have mado a good lalth et1or1 lo minimize mywasto genera1fon and ao!ec1 the bait wa1ta management m.thOd
tnat is available to me and that I can afford.
·~l--P-rin-ted-/T-y-ped_N_•m_e_~K~O~,tG~E~R:,_:L:_C:·~O~A:.:T~~---lS_ig_n_•'_"r_e __ f:~~~.._j;~l-~~~~-~;!ii::.., ___ ~J;i.~Di.:aybl.il:Yeartz.J
~ , 7. Transporter 1 A<.:Knowledgement of Receipt of Materials
I ~ Priwy~ed ~ me CL
p o , a. Transporter 2 Acknowledgement of Receipt of Materials ~ f-"'-P-rin:c,..;edc::..c/T,.:y:.p..;ed:.:..:N:.ac:m;:ec.:.c:..:,c:cc::..:...:.cc:.:.:..:..::..:..::..:c.::.:.::.:::.: ___ --,-:S,-ig-n-a-tu-,e--------------------------,,:---,---::----,-,--i
1,-..;.....~ -----'------'-------_._._.,~
Monttl Day Year
19. Discrepancy Indication Space
F
A
I ~ '=--=--c::--=-----=-----=---,-,;:--::--~ 20. Facility Owner or Operator; Certlncatlon of receipt of hazardous materlals covered by this manifest except as noted In ttem 19.
Printed/Typed Name Signature
I EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete {OHEC 1988 (Rev. 10/86))
• I
bi
!tbs. C I !tbs.
!tbs. d I !tbs.
Monttl Day Year
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa3te Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
· Emergency & Holidays: [phone] I PL.EASE PRINT or TYPE (form desi ned for use on elite 12-itch writer
UNIFORM HAZARDOUS 1. G.onoralor's U.S. EPA ID No.
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1
of Information in the shaded &teas is not
required by Federal law, but is by State law.
I
I
I
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I
I
I
I
I
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F
A
C I
L
. WASTE MANIFEST N c D o 7 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato~sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. TranSporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
B. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Description (including Proper $flipping Name, Hazard Class, and ID Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71729
12. Containers 13. Total Quantity 14. Unit \~\~~ft
No. Type . WrNr:J hfa0X6tl1}[~.fotl~}¾
1 6. GENERATOR'S CERTIFICATION: I herebydeclara that the contents olthls conalgnmantara fully and accuratelydeacrlbed above by properahipplng name and are clas.ifled.
packed. marked, and laheled,and ore in all res pacts In propar condition for transport by highway according toappllcabla lnlarnational and national govamment r~ulatlona ar,d
the laws of the Stale ol South Carolina.
111 am a large Quantity generator, I certify that I have a program In place to reduce Iha volume and tOxlcltyofwaategenarated tothadegr-I havedatarmlned lo be economtca.lly
practicable and that I have uleeted the practicable method ol treatment, storoge, or dlspoaal currenlly avaUable to ma which mlnlmlz.aa the present and luture ttu .. 1 to human
health and the environment: OR, II I am e small quantity generator, I heva made a good laith anortto minimize my waste ganarallon and t1alact Iha beat waata management method
that is available to me and that I can attord.
Printed/Typed Name RO.GER L. COATS
Printed/Typed Name
19. Discrepancy Indication Space
a ... I ......... _._.,........,jll>l c ... I ......_......,__._.!lbs.
bJ Jlbl dJ Jibs.
11---------------~ 20. Facility Owner or Operator: Certlflcatlon ot receipt or hazardous materials covered by this manifest except as noted In ttem 19.
Printed/Typed Name Signature Month Day YUi
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)1
I
I
I
I
I
I
I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
.Phone: [phone]
LEASE PRINT or TYPE (Form desi ned for use on elile 12-itch writer
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
•· Generato~sPhone 919 934-9711
5. Transporter 1 Company Nami!
Willms Truckin Co Inc.
7. Transporter 2 Company Name
6. U.S. EPA ID Number
S C D O 7 3
8. U.S. EPA ID Number
Manlteat
Document No. 0 0 1 2 3
Form A
2. Page 1
ol
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-68
Information in the shaded areas is not
required by Federal law, but is by State law.
;~~::;J~~,.~~'.~~;i;~;;f!ltl~\t~~~~~~;
1&~11Jfli~~~W&~{~~f:i:1Jl!ttf!'.l~Ji~'.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Container, 13. Total Ouantily 14. Untt (Lj~NIJmlioi;j\!\(
No. Type Md. {/f\hHnf~f@K&;i.!%1'
d.
15. Special Handling Instructions and Additional Jnrormalion
GSX Work Order No.: 71730
1 e. GEN ERA TOR'S CERTIFICATION: I hereby declare that the contents 01 this consignment are fully and accurately described above by proper ahlpplng name and are claaaifled.
packed. marked, and laheled,and are In all respects In proper condition tor transport by highway according to applicable lnlernallonal and national government re,gulatlona and
the laws ol Iha State of South CaroHna.
111 am a large quantity generalor, I certify that I have a prooram In place to reduce the volume and toxicity of waata generated to the degree I have determined lo be economleally
practicable and that I have selected Iha practicable method ol treatmenl., storage, or dlspoacll currently available lo me which mlnlmlt.es the present and future thrut to human
health and the environment; OR. II I am a sma11 quantity generator, I have made a good laith effort to mlnlmlte mywasle generation and Hlect the boat waste management mathOd
Iha! is available 10 me and lhal I con afford.
F a c.l .L.J....J...L.J...J!lbs. c I, -L.L..L..l,._._.!lbs.
I ~~ bl L... L.L..L..1,...J...Jpi,,, d I jibs.
I f-,_,;--::--,---,-----,,-,,,.---,--~ 20. Facilify Owner or Operator; Certificallon of receipt ol hazardous materials covered by this manifest except as noted In Item 19. I Printed/Typed Noma Slgnoluro
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86)]
Month Day Year
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Wa,te Mgt
2600 Bull Street Columb;a, SC 29201
.Phone: [phone]
Emergency & HoHdays: [phone]
PL.EASE PRINT or TYPE {Form desl ned for use on elite 12· itch writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
I
I
I
I
I
I
UNIFORM HAZARDOUS 1. Generator·,u.S.EPAIDNo.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
CD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71731
Information In the shaded a,eas is not
required by Federal law, but is by State law.
12. Containers 13. Total Quantity 14. Unrt A\Vi'isti,"Nii,ibiirff,
No. Type VNVfl M{%f'.{Q'fz;tf%",jff{i'
1 e. GENERATOR·s CERTIFICATION: I hereby doclaro th al tho contants ol this consignment are fully and accurately de1crlbed above by proper 1hlpplng name and ara claaadl«j.
packed, marked, and la'beled, and are in all respects in proper condition for transpor1 by highway according lo app11cable lnlernatlonal and national government regulation• and
trle laws ol lhe State ot Soulh Carolina.
If I am a largo quantity ganeralor, I certify that I have a pr<>Qram In place lo reduce the volume and loxlcltyolwaslegeneraled to the degree I have determined to be aeonomlcalty
practicable and that I have selected the practicable method ol lrealment, storage, or dlspoaal currently available to me which minimize, the present and future threat to human
health and the environment; OR, II ram a small quantity generator, I have made a good lallh effor1 to minimize my waste generation and select the boat waste management method
that is available to me and thal I can afford.
·~f-,.-:Pr.,;n ... ted:i./-Ty_p_ed_N_•m_•...,.....,..R,,o .. :_c.,.E .. R_L.,.._c..,o.,.,..A_T,.,S,.... ---.l;.S.-ig_n•~tul,-re_....1,:..,:~~;.i..-.:.....a.-.,;~:=;:;;;;,:;:;. ~~---J.::::.U~l.J..L,y:l.l..,L.9
T eriats .~~~~~~\____:=.__~H---~~---------=-.:-=--=-1
~ e-1-'a .... _T_,a;..n.cs.;.po.:.rt..c•c..• ... 2:.;A..cc:..k ... n..:oc.wc.led=gc:•_m..:• ... n ... t o:..I __ R_e;.;c __ ,-';pc.t.co_t Mc...c•..:•• ... ,; ... ,1.c'---~------------------------------------1 I 1-i4 __ P_r;_nt_ec1_,_T_y_ped_N_•_m_e ______________ ...J._s_ig_n•-t-ur_• ______________________ --1 .................... --1-1
19. Discrepancy Indication Space
F Ir 11---------------~ 20. Facility Owner or Operator; Certification of receipt of hazardous materials covered by this manifest except as noted In Item 19. I Printed/Typed Nama Signature
EPA For~ 8700-22 (R~v. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
Month Day Year
• I jibs. C I jibs.
b I jibs. d I jibs.
Month Doy YNI
South Carolina Department of Health
and Environmental Control ·• IPL.EASEPRINTorTYPE (Formdesi nedtoruseonelite 12-itch writer
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Stree~ Columbia, SC 29201
.Phone: [phone]
Emergency & Holidays: [phone]
I
I
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F
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
N C D 0
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-Ba
2. Page 1
ol Information in the shaded areas is nol
required by Federal law, but is by State law.
~•:.·..:G::~::.~::•:o;~:::•0::..(.::•.:.:.::~;::0~:::•:.J..1_4-'!'-t"-9"'' ,.Ls_m~!=~c:~-=-'!'-;'-1"'1 .. f_·_N_c __ 2_1_5_7_7 _________________ Fr:±:;~11t~i:~~~;1::is1;~:~~;::~;J~:~:Ai~~~~:~>}'.:::::::::
5. Transporter 1 Company Name 6. U.S. EPA ID Number
Willms Truckin Co Inc. SC DO 7 3 7
7. Transporter 2 Company Name 8. U.S. EPA ID Number
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including .Proper Shipping Name, Hazard Class, and ID Number}
d.
~§~~~!~~
15. Specialtfandting Instructions and Additional Information
GSX Work Order No.: 71732
1 e. GENERA TOR"S CERTIFICATION: I hereby declare that tha contents of this con•lgnment are fully and accurately de•crlbed above by proper ahlpplng nam• and are c1...,.;ned.
packed. marked. and la'beled, and are ln au respects in proper condition !or transport by highway according to applicable International and nallonal govemmer,t reoulallona and
ttte laws of the State ol South Carolina.
If I am a large quantity generator, I certify thatt have a program In place to reduce the volume and toxicltyolwastegeneratod totha dagr-I have determined 10 be .conomteally
practicable and lhat I have selected the praclicable method ol treatment. storage, or dlspoaal currently available 10 ma which minimize• the present and futura lhrNl to human
health and !he environment OR, lfl am a small quanlltygeneralor, I have made a good faith effort lo minimize my waste generation and aelectthe beat waste management method
that Is available lo me and Iha! I can J!Hord.
19. Discrepancy Indication Space
If • !....._...._.....,_.....,Pbs. c !...._......._......,_,!lbs.
bl pt,s. d! pt>s.
+ ~2'"0-. "'F""a-ci"'lity--:0-w_n_e_r o_r_O_p_e-ra-,o-r.-, c-.-r1-ifi-,c-a-llo_n_or receipt of hazardous materials covered by this manifest except as noted In Item 19.
y t--::-=-;-,:--:-:-:--'--'------'------,-::,--,'--'--'--'---'--'-=====;;;......;,;.;, ______ ....,.,-.,.......,...-..,..,.-1 I .,.,....,""'"Pr-in:-led=/T.,.y:-p,:,ed-:Ne,a-m_•.,..=.,,.-,-..,,.=---,,--,--,,,,',e,Si"'gn_•_tu_re _____________________ ,.,,1.M_on,1,th...1_°".,,1,,,Y,.,,1._Y,1,oar...1
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (0HEC 1988 (Rev. 10/86)1
I South Carolina Department of Health
· and Environmental Control
Bureau ol Solid & Ha.urdous Waste Mgt.
2600 Bull Street, Columbia, SC 29201
Phone: (BOJ) 73-4-5200
Emergency & Holidays: (603)734-5-42'
I LE.A.SE PRINT or TYPE (Form desioned for use on elite r12-oilch1 tvnewriler)
UNIFORM HAZARDOUS · 11. Generalor'sU.S.EPAIDNo,
Form A "'roved. 0MB No. 2050-0039 E.toires 9.30.ga
Manlfost , 2. Page 1
.. _RoS;umenl No. ol Information in lhe ,haded a,eas is not
required by Federal law, bul is by State law.
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WASTE MANIFEST N, c, D, O, q, 7• <. O, b, ,. l· 4 ,U ,1. ,2 ,6 1
1 Generator's Name and Mailing Address
Channel Master
P, 0. Box 1416, Smithfield, NC 27577
,. Generalor's Phone I 919 I 9 34-9 711
5. Transporter 1 Company Name 6. U.S. EPA ID Number 'CRS:taiet" •'••··•·10:":c/'--;..:··,,,,-_J_.'.::r;.,, .. ~=-,<t;.-,;;.-,,·~---
Willms TruckinP Co. Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood. SC 29125
• S• c, D• O• 7• 3• 7• n. g, 21 I}· (jft"' ·•'Phont;,Uqn'>hi:.;.i'>'>'11·:,
8. U.S. EPA ID Number
I I I I I I I I I l I I
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 3, 7, '
11. U.S. DOT Description (incJuding Proper ·shfpping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity 1◄. Uni! . L'. wutil tuubef''·i-·
No. Type 'Mfirj \((:<:-:~;}~'..},:ftf
a.
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71819
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,::,r ;61I 19c1i
=:.1rF 1010161~·
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1 e. C £HER A TO R'S CERTIFICATION: I hereby declare !hat Iha contents ol this con•lgnment are fully and accurately de•crlbod above by proper ahlppll"tg name and are claa .. n-o.
packed. marked, and la.be led, and are In au rospecls in proper condition for transport by highway according loappUcablo lntornalion111I and naUonal gov·ernrnanl r9,gulat10ns al'>d
u,a t•ws ol lh• State 01 South Carollna.
If I am a 1aroe qu■nlrty generalor. I cartity that! have a program In place lo reduce the volume and toxicity ofwastegeneraled to the degree I have dalarmln.-d to~ aconomteauy
prachcable and 1ha1 I have solecled the practicable method of trealment. storage, or dlaposal curren11y available to ma which minimize a tho preMnt and lutura tr\,_, to hu,,.,..n
health and 11,e environ men~ OR, ill am a smo.11 quanlitygonoralor,I ho.va mado a good foilh effort to minimize my waste generallon and salac1 th• betl wa11• managamar,t ma,tnod
that is avail,.t>le 10 me and lhn1 I cnn onord.
Prinled/Typed Name ROCER L. COATS I Signature
17. Transporter 1 Ar.;,mowledgement of Receipt of Materials
Printed/Typed N3me
"--'--J , I ( "' ,,.......-J -::::s-;__ "\< s: <'.h,--
I Signature
18. TransPorter 2 Acknowledgement ol Receipt ol Materials
Printed/Typed Name I Signature
19. Discrepancy Indication Space
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Month oa., YNJ
,<'.'.l,9-, c,,,, P,7
Montn oa., Yw
1;),'?,1f,.:i1 ;,7
Month Oay Yw
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!lbs. C I !lbs.
·~!-,----------------~ 20. Facility Owner or Operator; Certilica!lon of receipl ol hazardous materials covered by this manifest except as noted In /!em 19.
b I !lbs. d I !lbs.
Printed I Typed Name I Signature
IEPA Form 8700-22 (Rev. 9/86) Previous Ed1!1ons are Obsolole [DHEC 1988 (Rev. 10/86)]
Monlh Dey YNI
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STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ·I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -f'RESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generalors and transporters of hazardous waste and owners or operators or hazardous was:e trea:ml
storage. or disposal ficilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)] and. ii necessary, the continuation sheet U.S. EPA Fo
8700-22A Aev:9/86 (DHEC 1988A) tor both inter-stale and intra-stale transportation. Transporters who transport hazardous waste into the Uni_ted S:a:es Ir
another country are responsible for completing lhe manifest Fed.era! and State.regulations also require gencralors and transporters al hazarCous ,..-as:e ar:c
owners or operators al hazardous waste treatment. s_lorage. or disposal lacilities to complete the !allowing information.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number• Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and :he unicue tive digit
number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number. please con:act S.C.
OHEC at (803) 734•5200 about obtaining an Identification number. · I
2: Page 1 of: Enter the total number'of pages used to complete lhis manirest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REI/ 10186)] i:;lus
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A {OHEC 1988A) ii any.
A. Stale Manifest Document Number: .Leave blank.
a: · Stale Ceneralor ldentiflcallon Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address al the generator who will manage the returned maniles: forms.
4. Generator's Phorle Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the ever.t cl
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who wilt transport the w8ste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number of lhe first transporter identilied in item 5 . I . C. Slate Transporter's 10 Number: Leave blank. ·
0. Transporter's Phone Number: 'enter a teleph0ne number including area code where an authorized agent of the first transporter can be reache-: in tne event of
an en:iergency.i,:i~/uding nights, weekends. and holidays... , ..... . ... ··-----. -··-···-.. ... '. · · .'. I
T.. Transporter 2 Company Name: II applicable, enter the company name or the second transporter who will transport the waste. If more than 2 !rans;iorters l
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:.ir.g th_e wa .
8 .. U.S. EPA 10 Numbed! applicable, enter the U.S. EPA twelve digil ID number of the second transporter identHied in item 7.
E .. Slate Transporter's ID Number: Leave blank. , I
F .. Transporler's Phone Number: Enter a telephone number including area code ~here an allthorized ageflt oi°the second lranspor.er can :e reacr.ec in
e-.,ent al an emergency including nights, weekends, and holidays. ·
9. Designated Facility Name and Site Address: Enter the company name and s(te address ol the IreatmenI, storage, or disposal facility desi~natec to receive the
waste listed on this manilesl The address must be the site address, which may di!fer lrom lhe mailing address. ~ · I
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the designated treatmenl, storage. or disposal racility identdieC in item 9.
G:. Stale Facility's to Number: Leave blank. •
H;. Facility's Phone Number: Enter a telephone number Including area code where an authorized agent of the racilily c_an' be reached in :r,e event or an
emergency including nights, weekends, and holidays. ·
11: U.S. COT Oescrlptlons: Enter proper shipping name, hazard class and ID Number (UN/NA) loreach waste as identified in 49 CFR 171-1 ii. If ac-:1:icnar sot
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number al containers for each waste and !he appropriate abbreviation from Table I (below) ror the type al containers.
TABLE I
OM = Metal drums. barrels, kegs TT= Cargo Ianks (tank trucks) CM= Metal boxes, cartons, cases. rcl1 cHs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. car1ons. cases
OF= Fiberboard or plastiC drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. car.ans. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plas::c ~a£;s
13 .. Total Quantity: Enter total quantity ol waste described on each line, relative to the unils used in item 14.
14. Unit (weighl/\'olume): Enter the appropriate abbreviations lrom Table II (below) for the unit ol measure: I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yard~ G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specilied in South Carolina Hazardous Waste Mnnager:nent Regulation A.61 • 79.261 Sutpar:s C ar.d I
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Abo-.,e: In the spaces provided, enter the aulhorizution number (lrom the S.C. DHEC Authorization ReQues1 Fo I
!or each waste stream listf!d in section 11 above. Nole: Berore any hazardous waste can be accepted ror treatment. storage or disposal in Soutn Carc-lina. tne
generator must obtain prior authorization from the treatment, storage or disposal lacility. • I
K. Handling Codes for Wastes listed Above: Leave blank.
15. Special Handling lnstrucllons and Additional lnlormalion: Generators may use this space lo indicale special transportation. treatment. storage or d1so 1
information or Bill al Lading lnrormation. F"or international shipments. generators mus! enter in this space the poinl ol departure (City anc s:ate) tor :nos~
shipments destined lor trealment, storage, or disposal outside the jurisdiction of the United Stales ... ,_· , , .-
16. Generator Certification: The generator must READ,"SICN (BY HAND IN INK), and DATE lhe certificaliOn state'm'en1
1. If a m"ode other than highway 1s usec:.
word "highway .. should be lined oul and !he appropriate mode (rail. water.or air) inserted in the space below. II another mode in addition :o tr.e 11ignway moc
used, enter the appropriale additional mode {e.g .. and rail) in the space below.
TRANSPORTER SECTION ,
11: TranSporter 1 Acknowlidgement_= Enter lhe name of the person accepting the waste on beha_ll of the first· transporter. Tha~ person rr.us: ac\...n:o-,,.!et
acceptance of the wasle described on the manifest by signing (BY HAND IN INK) and entering the DATE al receipt. ·
18. Transporter 2 Acknowledgemcnl: Enter, if applicable, the name al the person accepting the waste on behalf or the second transooner. Tha! p-er5cr: r:-:'..)5:
acknowledge acceptance al the waste described on !he manifest by SIGNING (BY HAND IN INK) and en!ering the DATE al receipl I
FACILITY SECTION · ·
19. Oisc:repanc:y Indication Space: The authorized representative al the designated lacitity's owner or operator must note in this space any discrecancy betw __
the waste cescribed on the manifest and the waste actUally received al the facility. Owners and operators of facilities who canncl resoh·e s1;niricar::
discrepancies within 15 days receiving the waste mus! submit to the Deparlment a letler with a copyolthe manilestdescribing the discrepancy ar.d ar.em.:,I
reconcil• it. Th• treatm•nt. 110,age, ordlspcsnl laclllty musl enter the acIuotwelght (!I woSle in pounds In the spaces provided ii the amo1.inI var,u any lrom :
si:,ecilied by the generator in ilcm 13 or ii the generator uses a unit of meas11re other lhan pounds. .
20. Facility Owner or Operator Certification: Print or lype the name ol the person accepting the wasle on behalf ol Ihe·owner or operator ot \he I.Jc1l,I•r Th.JI ;:,er son
must·acii.nowtedge acccpt.1nc·c ol tho wasle described on lhc manifest by SIGNING (DY HANO IN INKf and entering the DATE or receipt.
,, A<StSTANCE 15 NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT. STORAGE. OR OISPOSAL FACILITY DESIClllATEO I
REr~11.'E THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (803) 73<1•5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & HWrdous Waste Mgt
2600 Bull Streel Columbia. SC 29201
· Phone: [phone]
Emergency & Holiday,: (803)734-542C
I l.£ASE PRINT or TYPE (Form desioned for use on elite r12-nitchl .. -ewriler)
UNIFORM HAZARDOUS 11. Generalor'sU.S.EPAIONo:
Form A roved. 0MB No. 2050-0039 E.xDires 9.30.ga
Manlro•t ,2. Page 1 Oocumenl No, ol 1
Information in the shaded areas is nol
required by Federal law, but is by State I•"'·
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WASTE MANIFEST N• C• D• O· q, 7, 6, o, t .. 7,
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
,. Generator's Phone I 919 I 9 34-9 711
1, , .. o ,0 ,1,2 ,7
5. Transporter 1 Company Name 6. U.S. EPA ID Number 'c'.1:Stiia··=· ··· ···•.<M·•.,-·-·,., ·e lD~/1/ , · ,·.:. ,.; <·;',<; __ ·· ·•,
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
10. U.S. EPA lD Number
:~~~:~o!. B~~ ~~i 25 • S, C, D, 0, .7, 0, ~ 7, '. ~ 8 I [~,mi~0;1~:tK±:J6\?4;~t~ba'~2:1
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity )4. Unit
No. Type 'MNd
L
b.
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71820
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11. GENERA TOR'S CERTIFICATION: I hereby declare lhel the conlonls ot !his con1ignmentaro lully end accurately ducrlbod ebova by proper ehlpplng name and a,, c1a, .. n.c:i,
packed, marked, and 111·b11Led,and are In all respects In proper condition !or transport by highway according to app11cab1a lntarnalional and national govarnmanl te-Q1,,1lat10n1 al"d
tno taws ol the Slala ol South Carolln_a.
It I am a large Quantity generator, I cor1ify that I have a program In place loreducalhavolume and lo,clcltyol wasleganeraled lo the d90rae I have determined 10 btl .conomlcelty
practicable and that I have Hlected the prac1icab1a malhod ol treatment. storage, or disposal currently ave.l1abla to me which mlnlml.tes the pres.enl and lutur• tl'lrMI IO t11.1man
health and the envi,onmcnt: QA, 111 am a small Quantity gen orator, I hove made o good faith effor1 to minimize my waste generation and select the beat wul• management m,ett,Qd
that is available 10 me and that I eon allo1d.
Printed/Typed Name ROGER L COATS I Signature
17. Transpor1er 1 Ac,;Knowledgement ol Receipt of Malerials
Printed/Typed Nar; } ' r I / C SP!# 6i Signature
18. Transp0r1er 2 Al nOwtedgeinent of Receipt ol Materials f}
Printed/Typed Name I Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Cer1ilicallon of receipl or hazardous materials covered by !his manilesl except as nolod In llem 19.
• I
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Montn Day YNI
, 0 ,.<;,rd ,t...rP.,"7
Montn O~•JY-1 Year ~ -"--~ 1/ .I7 LJ (I, ,I
Month
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Jibs. C I
Jibs. d I
Day Year
' I '
!1t>s.
!lt>s.
y
. Printe-d/TypedName I Signature I PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolo1e (DHEC 1988 (Rev. 10/86)1
Mooth Day Yw
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IMPORTANT:
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL .
GENERAL INFORMATION: Federal Regulations require genP.ralors and transporters of hazardous waste and owners or operators al hazardous was:e trea:ml
·storage, or disPosal licililies to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and, ii necessary, thf;I continuation sheet U.S. EPA Fo
8700-22A Aev:9/86 (DHEC 1988A) loi both inter-state and intrn-slatc tr,1nsportation. Transporters who transport hazardous waste into Ihe United States Ir
another country are responsible for completing the manilesl Fed.era! and Slate regulations also require generators and transporters of hazarCous -... ·as:e at.c
owners or operators ol hazardous waste treatment, storage. or disposal faciht1es to complete the following tnlormallon. I
GENERATOR SECTION
1. Generator's U.S. EPA 10 Number• Manifest Document Number: Enter the generator's US. EPA twelve digil identrficauon number and :he unicue t1ve d1,;11
number assigned to this manliest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:ac1 S.C.
OHEC al [phone] about obtaining an Identification number. · I
2; Page 1 of: Enter the total number of pages used lo complete this manliest, i.e., the first page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (P.::'.1/ 10186)] ,clus
number of continuation sheets EPA Form 8700·22 Rev. 9/86A (OHEC 1988A) ii any. .
A. Slate Manilest Document Number. .Leave blank.
B:
3. ••
St.ate Generator ldenliflcaUon Number: Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address al the generator who will manage the returned manilest forms.
Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent ol the generator ca·n be reaC:hed in the even: cl .
emergency including nights, weekends. and holidays. ·
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number of lhe first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: 'enter a teleph~ne number including area code w_here an authorized agent ol the first transporter can be reached in the event ot
an erryergency.iry~)uding nigh~s. weekends, and holidays... ...... ... ..-·---.-........ _ .. ... ·. · : . .·. •
T.. Transporter 2 Company Name: II applicable, enter the company name or the second transporter who will transport the waste. II more than 2 trans;ioners
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoo~ing the wa
U.S. EPA 10 Number:lf applicable, enter the U.S. EPA twelve digit ID number of !he second transporter identified in item 7.
Slate Transporter's ID Number: Leave blank.
F •. Transporter's Phone Number: Enter a telephone number including area co.de ~here an authorized agent al the se.cond transporter can be reached_ in I
event of an emergency including nights, weekends, and holidays.
Oesignaled Facility Name and Sile Address: Enter the company name and site address al the treatment, storage; or disposal facility desic;nateo 10 receive the
waste li3ted on this manifest The address must be the site address. which may difler from the mailing address. ·
8 ..
E.
9.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number o! the designated treatment, storage, or disposal lacility iCen:die::! in i:em 9 .•
Stale Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the lacility can be reached in :r.e event ol an
10.
G:.
emergency including nights, weekends, and holidays.
U.S. OOT Oescrlptlons: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identified in 49 CFR 171 • 1 ii. If aCci:icnar s;il
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. .
Containers (no. and type): Enter number of containers tor each waste and the appropriate abbreviation from Table I (below) for the type at c:::n:ainers.
11:
12..
TABLE I
OM = Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. rc:ill cHs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW ::i Wooden boxes. cartons. cases
OF= Fiberboard or plastiC: drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. car:or,s. cases
TP = Tanks portable CY= Cylinders BA= Burlap, doth. paper or ptas::c ~a~s
13 .. Total Ouantily: Enter tolal quantity ol waste described on each 1ine, relative to the unils used in item 14. I
'14. Uni! (weight/volume): Enter lhe appropriate abbreviations lrom Table II (below) for the unit ol measure:
Table II
P = Pounds L::: Liters K: Kilograms T = Tons M = Metric Tons N::: Cubic Meters Y::: Cubic Yards G::: 9,allons (liouid only)
I. Wasle Number: Enler hazardous waste numbers as specilied in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Sut::,ar:s C ar,d I
identify \he hazardous waste on each line. · · ·
J. Additional Oescriplions tor Malerials Llsled Above: In the spaces provided, enler the authorizolion number (lrom the S.C. DHEC Author12:at1on Request Fo ,)
for each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepled lor treatment stor~ge or disposal in Sou.!h Care-tin a. 1ne
generator must obtain prior authorization from lhe treatment. storage or disposal facility. . J
K. Handling Codes for Wasles Lisled Above: Leave blank.
15. Special Handling lns1ructfons and Addilional lnlormalion: Generators may use lhis space lo indicate special transportation. treatment. storage or disp I
inlormation or Bill al Lading Information. For international shipments, generators must enler in this space the point ol departure (ciry and s:aie) !or :nose
shipments destined lor treatment. storage. or disposal outside the jurisdiction ol the United Stales. ·
16. Generator Certilicalion: The generator must READ,'SIGN (BY HANO IN INK), and DATE lhecertiliciltion statement. II a mode other than highway is usec.l
word .. highway" should be lined out and the appropri.::i.te mode {rail. waler. or air) inserted in the space below. II another mode in addition :o tr.e hignway rnoc ·
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION \ • . • . 11: Transporter 1 Acknowledgement: Enter the name ol the person accepting the waste on behalf of.the first transporter. That person rr.us! ackno...-lef
acceptance of the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the nam.e of the person accepting lhe waste on behalf ol the second transporter. That per5cn r.,•..:5;
acknowledge accep1ance al the waste described on the manifest by SIGNING (BY HANO IN INK) .:ind entering the DATE or receipt
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized representative of the designated facility's owner or operator must note in this space any discrepancy ~-:1·,._
the waste described on the manifest and the waslo actt.ially received at the racility. Owners and operators of facilities who canncl resolve s1;ndica:-,:
dlscrepan.cies w1lhin 15 d.:iys receiving the waste ~us! submit to lhe Oeparlmenl a leUer with a copyol the manilesl describing the discrepancy ar.c a:-:em:::f
reconcile •t The trealmenl storage, or disposal lac1llty musl enter the actual weight (!I waste In pounds in the spaces provided 11 the amount varres ,rny !ror.i 1
soecilied by the generator in ilcm 13 or ii the generator uses a unit al meas11re olher than pounds. , . .
20. Facility Owner or Operator Cerlilicalion: Prinl or lype the name ol the person accepting the wasle on behalf ol the owner or ooerator al the IJcd,:y. Th.::it :,er son
must acknowledge acccptanc·c ol tho waste described on !he manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt.
,, ••sIsTANCE Is NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR 0IsPos•L FACILITY OEs,a,ano I
PEC::-1'.'E THE WAS:E OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.· ·
. .
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holidays.: (803)734-5-424
I ~LE.A.SE PRINT or TYPE (Form desioned for use on e11te r12-oitchl tvnewriler)
UNIFORM HAZARDOUS I'· Genoralo,'sU.S.EPAIDNo.
WASTEMANIFEST N•C•D•O g,7,6,0,4,7,!,
Form A ... ,oved, 0MB No. 2050-00J9 E.loires 9-30-1!8
Manlleal 12, Page 1 Oocumonl N~ of 1
lnlormetion in the shaded auas is n01
required by Federal law. bul is by State la .....
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3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfiel~,
,. Gene,a,o,'sPhonel 919 I 934-9711
5. Transporter 1 Company Name
Willms TruckinD Co Inc.
7. ·rransporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
NC 27577
4·" ,(\ ,1 .o ,x
6. U.S. EPA ID Number
. , c • c, D• o, 7, 1, 7, n. q, ?, "'
8. U.S. EPA ID Number
I I I I I I I I I I I I
10. U.S. EPA ID NUmber
'CJ&aia\···,.,.;-.:;.-_,_,.-•, .. llDA~-(:/'}J..:\ :-.-:::>...: ,.::": :cA·1/f•;:
oAt ,,.,., ·' l'Plioti.1,X.Hin1/-1F.1:ai1111.•"
:~~~:~o!. B~~ ;~i2s Is, c, D, o, 7, o, ~ 7, ' ~ 8 ~ ~ttl1Jr~\:W2!,;;:t"J'63/4'~~=~'6a~1l
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 1( Unit l'W&Sfa Hta'llber';-:-~·
No. Type Wt/Vr:J. \'::=•::'.,:>,::•.';=~ '_{..,_"=l;t
a.
Hazardous Waste, Solid, nos ORM-E
NA 9189 .. ,1 D ,T , , ,2 ,0
b.
o I ' I I I '
C.
. . . .. ' ' .
d.
I I I I I I I
15. Special Handling lnstruc~ons and Additional lnlormation
GSX Work Order No.: 71821
,e. CENERA TOR'S CERTI_FICATION: I herebydecl•r• thet lhe con1ents olthls conalgnmentere lully 11nd eccur111etydeacrlbod above by proper ■hipping name and ar• c1 .... n.c11 .
. packed. ma,ked. and labeled. and are In all respec111 ln proper condition fortranspor1 by highway according to applicable lntarnallonal and national govarnmant reQutallona and
u,e laws ol the State ol Soult\ Carolina.
111 am a large quan,;ry gone,ator, I certify !hat I have a program In place to reduce tho volume and to.xlcltyol wasla ganeralod to tho do,gr-I have dalarmlne-d to be economic..ny
prac11cable and th al I have s61ecled the practicable method of troatmonl. storage, or disposal currently available lo mo which minimizes the preMnl and futura u,,_t to r,u,.,.n
health and inc environmcnl; OR, If I am a smoll Quonlltygono,ator, I have mado a good faith erl'or1 to minimize my wasla generation and select tho bell watla manaoemanl ,.,.d"lod
ltlat is availatlle 10 me and lhol I con allord.
I W~-Pr_i"_''°_'_Ty_p_eo_N_•_m_• ...:.:P..:O:.:C=ER~L::.. . ..:C:.:O:.:A:..::.T.:.s ____ 1ls_ig_n•_'u_.r•_..:1c17:.:!-:!;l.-!i::i.._.....1,;;z:Z:......:~~~~~------'l.!MD:;:o':~lh ,,,,.1.;,d~~~w;~ ,;j):;.L.I
~ 17. Transporter 1 Ac,;Knowledgemenl ol Receipt ol Materials (/
I ~ Printer7yped Nami,,i/) !Signature rJ __ '1 · ,_~ ~ f<1r)c.. / I /O.LJOJl"A,J r:, ,rr/,,;.
o 18. Transporter 2 Acknowledgement of Receipt of Materials / R!---:,-,:....:C:..:.....:....:_: _ _:=.......:........:.__;c.....;"-'.__;-C..-'----,..,,--------'----------------:,:---:---::----c-1
Mon~ Day Yw
v1 ,9117,z,f?,1
A
~ Printed!Typed Name !Signature Month Day Year
I I , I , I , I-+-------'---------._._._,_~ 19. Discrepancy Indication Space
F ,.,
I ~I----~--------~--,!: 10. Facility Owner or Operator; Certilicalion ol receipt or hazardous malerials covered by !his manifest excepl as noted In Item 19.
Prinled/Typed Name I Slgnalure
I EPA Form 8700•22 (Rev. 9/66) Previous Editions arc Obsolole (OHEC 1968 (Rev. 10/66)1
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pbs. d I l1to.
Monlh Dey ,..,
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STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriler) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL'.E!·
GENERAL INFORMATION: Federal R_egulations require generators and transporters of hazardous was le and owners or operators ol hazardous waste treatml
storage. or disposal ficililies to uSe_ the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and, ii necessary, th(! continuation sheet U.S. EPA F
8700-22A Rev.-9/86 (DHEC 1988A) loi both inter-slate and intra-slnle transportation. Transporters who transport hazardous waste into lhe United S:a:es Ir
another country are responsible ror completing the manifest Fed.era! and Slate regulations also require generators and transporters _of hazardous -,..·as:e··ar:c,
owners or operators ol hazardOus waste treatment, storage. or disposal lacilities to complete the following information. I
GENERATOR SECTION _
1. Generator's U.S. EPA 10 Number. Manilesl Document Number: Enter the generator's U.S. EPA.twelve digit identification number and :he unicue five d1g1t
number assigned lo this manifesl by the genera'tor beginning with 00001.11 your company does not h8ve a U.S. EPA Identification Number, plea·se con:act S.C.
OHEC at [phone] about obtaining an Identification number. · i• , I
2.; Page 1 of: Enter the total number of pages used lo complete this manifest, i.e .• the fiist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (R::v 10186)] _clt..:s
number al continuation sheets EPA Form 8700·22 Rev. 9/86A (OHEC 1988A) ir any.
A.. St.ale Manifest Document Number: .Leave blank.
a: State Generalor ldenlrflcallon Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and ma1ting address of !he generator who will manage the returned man1fes: !arms
.t. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in :rie e•,er.: cl an
emergency including nights, weekends. and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the w8ste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelVe digit identilicalion number of the first transporter identified in item 5.
C. Slale Transporter's 10 Number: Leave blank.
O. Transporter's Phone Number: 'Enter a telephOne number including area code where an authorized agent ol the lirst transporter can be reache~ in the event ol
an en:iergency_in~Juding nights, weekends, and holidays... , ..... ... .._ .. ____ . ____ ... _.. ... ·. · .'. .·. · I
T.. Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. If more than 2 trans;ioners r
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list lhe transporters in the order they will be transocr:ir.g :he wa .
U.S. EPA ID Number:!! applicable. enter lhe U.S,.EPA twelve digil ID number· of the second transporter idenlilied in item 7.
SI.ale Transporter's ID Number: Leave blank. I
F .. Transporter's Phone Number: Enter a telephone number including area code ~here an authorized agerit or ui·e secOnd transpor:er can t:e reacr-:e:::' in.
event of an emergency including nights, weekends, and holidays. . · · ---~
a ..
E..
9. Designated Facility Name and Sile Address: Enter the company name and site address ol lhe treatment, storage, or disposal facility designatec :o receive the
waste listed on this manifest The address muSt be the site address, which may diller from the mailing address.·· • --. I
U.S. EPA-'~ Number: Enter the U.S. EPA twelve digit identification number of the designated treatment, storage, or disposal lacility iden:ifie::: _in item 9.
Slate Fac1hty's 10 Number: Leave blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in :r.e ev~nt o! an
10.
G:.
emergency including nights. weekends, and holidays. · I
U.S. COT Descriptions: Enter proper shipping name, hazard crass and ID Number(UN/NA) lor each waste as identified in 49 CFA 171-1 ii. I! aCci:icnal so
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. . ·
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) lor the type o! containers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (lank trucks) CM= Metal boxes, cartons. cases. roll cHs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boltes. car.cr,s. cases
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TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plas::c bar;s
13 .. Total Quantity: Enter total quantity ol waste described on each line, relative to the units used in item 14.
14. Uni! (weight/volume): En!er the appropriate abbreviations !ram Table II (below) !or the unit of measure: I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Ga!lor:s (liquid only)
L Waste Number: Enter hazardous .,;.,astc numbers as specified in South Carolina Hazardous Waste Management Acgulatiori A.61-79.261 Suc;:iar.s C ar,d I
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided. enter the authorizalion number (from the S.C. OHEC Authorization Request Form)
tor each waste stream listed.in section 11 above. Note: Be lore any hazardous waste can be accepted !or lreatment. storage or disposal in South Carcli~a. tne
generator must obtain prior aulhorization rrom the treatment, storage or disposal facility. · · · 1
K. Handling Codes tor Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Addiliot'lnl lnlormnlion: Generators may use this space fo indicate special lransportation. treatment. storage or dispo I
inlormation or Bill ol Lading lnlormation. For international shipmcnls, generators musl enter in this space the point ol departure (city and s:ate) ror inos~
shipments destined lor treatment. storage, or disposal o'i.1!Side the jurisdiction ol the United Stales. · , • · ·,,, I
16. Generator Certiliealion: The generator must READ."SIGN fov HANO IN INK), and DATE the certification statement. If a ~ode other than highway is used. •
word '"highway" should be lined out and the appropriate modc(rail, water.or air) inserted in the space below. II another mode in addition :o tr.e nignway _r.,oc: .
used. enter the appropriate additional mode (e.g.,_and rail) in the space below.
mANSPOATER SECTION · . 1 11: Transporter 1 Acknowledgement: Enter the name of the perso·n accepting the waste on behall of the first transporter. Thal person must aci..no .... 1e
acceptance at !he waste described on the manilesl by signing (BY HANO IN INK) and entering the DATE ol receipt ..,, .,
18. Transporler 2 Acknowledgcmenl: Enter. ii applicable. the name al the person accepting !he waste on behall al the second transporter. Tha! perscr. r..:.:~;
acknowledge acceptance or the waste described on the manilest by SIGNING (BY HAND IN INK) and entering the DATE al receipt I
FACILITY SECTION .
19. Discrepancy Indication Space: The authorized representa!ive al the designated facility's owner or operator must note in this space any discrepancy ~-=1· .... _.
!he waste described on the manifest and the wasto actually received at the racility. Owners and operalors of facilities who canncl resolv~ s1;:,dicar,:
discrepancies within 15 days receiving the wasle must submit to the Department a leUer with a copyol the manifest describing the discrepancy ar.d ar:em::I
reconcile it The treatment. slorage. or dlsposnl laclllly must enler the ac1uol welght~f wasle In pounds In the spacea provided ii the amoun1 "ar1ts any !ror., :
specil1ed by the generator in item 13 or if the generator uses a unit ol mcns1.1re other than pounds. . .
20. F.acilily Owner or Operator Certilicalion: Prinl or type the nam~ol lhe person accepting lhc waste on behallol lhe owner or operator al the tacil,1·1, Tt,.:il ~er5on
. must ac~nowledge acccpt.1nc·o ol tho wasle described on the manifest by SIGNING (BY HAND IN INKf and entering lhe DATE ol receipt.
,, •i::s,sTANCS Is Nl!!Ot!O IN COMPLerI0N OJJ THIs MANIFEST, CONTACT THE TREATMENT, STORAGE, on 0IsPOSAL FACIurv DES1cH,•rio I
REr:-".'E THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WE~KOAYS FROM 8:00 nm TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hwrdous Waste Mgt
2600 Bull Str .. \ C-Olumbia, SC 2920\
Phone: [phone]
Emergency & Holidays: (803)734-5-42-4
ewriter Form A roved. 0MB No. 2050-0039 E.xpires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D O 7 I
J. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
•· Generator', Phone [phone]
5. Transponer 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6 .. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Cfass, and ID Number)
d.
Hazardous Waste, Solid, nos ORM-E
NA 9 I 89
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71822
1 D T
lnformalion in the shaded ..-ea, is n01
required by Federal law, but is by State law.
2 0 Y
~}.i1'F \6ITl'91~
:·:1tf IQ 10 I 6 I~~:
.. ,: .. , ..... ,. . ...... , ... , .. ~-------:_...,
/.;J I 1 I 1:.✓.{
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~~?. f I fl
1e. GENERA.TOR'S CERTIFICATION: I hereby declare lhol lho conlonts ot this con,ignmenloro lullyond occurololy described obov• by proper 1hlpplng nomo and are c.10, .. flo<I.
packed. markod, and la°beled,and are In all respects in proper condition !or transport byhlghw11y according to applicab1e lnterna1lonal and nation al government ro;ulation• ar>d
tne taws ol the State of South Carotlna.
111 am a large Quantity generalor, I cartlty thal I have a program In place to roducethovolume and toxicity of wa11egeneralod to the d~roe I hove dotermlnod to~ economically
practicable and that I have selected 1he pracUcab1e melhod ol treatment, storage, or disposal currenlly available lo me which mlnlmlzea tha present and lun.,ro tnrNI to human
health and Iha environment; OR, ii I am o small QUonlitygonorator, I hove made a good faith effort lo minimize my waste generation and select the bell waalo managomonl rnctthod
1nat is available 10 me and thnt I con ollo,d.
Printed/Typed Name RO'.CER [: COATS Signature
17. Transponer 1 Ac.:,mow!edgemenl ol Receipt ol Materials
Printed/Typed Name Signature
··"==> <:>,o-'u -'-: won.c> ~
18. TransPorter 2 Acknowledgement ol Receipt of Materials
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility-Owner or Operator; Certilicalion of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Prinled/Typed Name Signature
PA ,orm 8700·22 (J:\ev. 8/BB) Previous Edlllona are Obsolete IDHEC 1988 (Rev. 10/88))
Month
Month Day Year
Month Cay Year
• ._I .,_,_ ....... ......,l'bs. ' LI .W...L-1...l-lllbs.
b I Jibs. d I jibs.
Month Day YNI
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST :I
'lMPORTANT: TYPE !on a 12-pitch (elite) typewrilerJ OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations requiregenP.rators and lransportersofhazardous waste and owners or operators of hazardous was:e trea:ml
storage. or disposal ricilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and; if necessary, the continuation sheet U.S. EPA F
8700-22A Aev:9/86 (OHEC 1988A) for b·olh inter-state and intra-stnle tri'lnsportation. Transporters who transport hazardous wasle into the United S:a:es tr
another country are responsible !or completing the manilesl Fcd_eral and State regulations also require generators and transporters al hazardous ·,.,,as:e a,...,c
owners or operators ol hazardous waste treatment, storage, or disposal facilities to complete the following inlormalion. I GENERATOR SECTION
Generator's U.S. EPA ID Number• Manlfesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manilest by the generator beginning with 00001. llyour company does not have a U.S. EPA Identification Number. p!ease con:ac: S.C.
OHEC at [phone] about obtaining an ldentilication number. I
Page 1 ol: Enter the total number of pages used to complete this manifest, Le., the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] ~lus
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
1.
2;
A. St.ate Manilesl Document Number. .Leave blank.
a: State Generator ldenlrflcatlon Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address ol lhe generator who will manage the returned manifes: !arms
.t. Generalor's Phorie Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in :ne even: ot
emergency including nights. weekends, and holidays.
s. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number:. Leave blank:
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol lhe lirst transporter can be reache':: in the e·Jent o!
an emergency including nights, weekends. and holidays. . . _ . ' · · · I r.. Tran~porter 2 c~~pany Name: 11 applicable, enter the c~mPa~y name Oi the seC:~ndt,ans·porter Wtlo wilf tra"nspcirt the waste. II more than 2 !rans;)Orie~s I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:ir.g :he ...-a .
U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
Slate Transporter's 10 Number: Leave blank. . ,·
F .. Transporter's Phone Number: Enter a telephone number including area code ~here an authorized agent of lhe second transporter can be reacr.e-: in
8 ..
E ..
9.
10.
G:.
event ol an emergency including nights, weekends. and holidays. ·
Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal lacifily desi~nateel to receive the
waste listed on this manifest The address must be the site address, which may di/fer lrOm the maillng address.· .. ·~ · · · I
U.S. EPA ID Number: Enlei-the U.S. EPA twelve dig ii identification number of lhe designated treatment, storage. or disposal facility ic'en:ifie:: in item 9.
Slate Facility's ID Number: Leave blank.
H;. Fac:ility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in :r.e event o! an
emergency including nights, weekends. and holidays.
U.S. DOT Descripllons: Enter proper shipping name, hazard class and 10 Number (UN/NA) loreach waste as identified in 49 CFR 171 •1 77.11 acci:icnal s::,t , 1:
is needed. use a U.S. EPA Form 8700-22A-Rev. 9/86 (DHEC 1988A) Continuation Sheet. .
,2.. Containers (no. and type): Enter number ol conlainers !or each waste and the appropriate abbreviation from Table I (below) lor the type of cpntainers.
TABLE I
OM = Metal drums. barrels, kegs TT= Cargo tanks (lank trucks) CM= Metal boxes, cartons. cases. roll ct1s
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard _or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cas2s
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plas:1c :la£;s
13 .. Total Ouanlily: Enter total quantity ol waste described on each line, relative to the units used in item 14.
14. Unit (weighl/volume): Enter the appropriate abbreviations from Table II (below) for the unil of measure;
I
I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (!ic;uid onlvJ
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Manage,:nent Regulation A.61-79.261 Sut:~a~s C ar.d I
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Li sled Above: In the spaces provided, enter the authorization number (from the S.C, DHEC AuIhor1zaI1on Request Form)
tor each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted lor lreatmenl storage or disposal in Soutn Carolina. tne
generator must obtain prior authorizalion from the treatment, storage or disposal facility. I
K. Handling Codes for Wasles Lisled Above: Leave blank.
15. Special Handling lnslrucllons and Additional lnlormalion: Gcneralors may use this space to indicate special transpor1ation, treatment. storage or disposal
information or Bill or Lading 1nformalion. For international shipments. generators must enter in this space lhe poinl ol departure (ciry and s:atel tor mos~
shipments destined lor treatment, storage, or disposal outside the jurisdiction of the United States. : · I
16. Generalor Certification: The generator must READ,.SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is usec.
word "highway" should be lined out and the appropricle mode (rail, water.or air) inserled in the space below.II another mode in addttion :o Ir.e nignway r.io s
used, enter the appropriate additional mode (e.g.,,and rail) in the space below.
TRANSPORTER SECTION I
11: Transporter 1 Acknowledgement: Enter the name ol the person accepting the waste on behalf ol the lirst transporter. That person rr.us: ac\...no ... ie -,
acceptance al the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter. if applicable, the name al the person accepting the ·waste on behaH of the second transooner. That per~cr. r.-:ws:
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipl I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator mus! note in this space any discreoancy ~etw _
Iha wasle described on the manilesl and the_ wasto actUally received at lhe facility, Owners and operators of facilities who cannct resolve s1g:nilicar,t
di5cr_eoancies within 15 days receiving the waste must submit to the Department a letlerwith a copy of !he manilestdescribing the discrepancy ar.d a:-:em::'
reconcile iL The Ireatmen1. storage, or disposal lacillly must enter the actual weight ~I waste In pounds In the spaces provided if \he amount varies .1ny !rcrT1 :
si:,ecilied by lhe generator in item 13 or ii the generator uses a unit of meas!Jre olher than pounds. . . .
20. Facility Owner or Operator Cerlillcation: Print or type the name of the person accepting !he waste on behalf ol the owner or operntor ol !he l.:ic110:,. Tr1.:iI ::,er~on
must acknowledge acccptanc·c ol lho waste described on the manifest by SIGNING (DY HAND IN INK)° and entering lhe DATE ol receipt. · ·
1, •c;sisTANCE Is NEEDED IN coMPLETION OF THIs MANIFEST, CONTACT THe TREATMENT. STORAGE, OR orsPosAL F"Ac1urv oes1cH, ... reot
REC -·•.'ETHE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 73,.5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I
F
:;..>~
.,( l South Carolina Department of Health
'"-'='-'c•·~-' and Environmental Control
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo. Menifee!
Oocumonl No.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
P. 0: Box 1416, Smithfield, NC 27577
•· Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facilify Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
0 0 1 3 0
6. U.S. EPA 10 Number
D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
ol
Bureau ol Solid & Hazardous Waste M;t.
2600 Bull Streel Columbia., SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 E..t ·,es 9-30-aa
lnlormalion in !he shaded ateas is nor
required by Federal law, bul is by Siate law.
ll. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Unit l:Wa:itaNl.dblif':•i·
No. Type Wl.Nr:J :·):.->:~//·<:!·/~i)~'.£~~
a.
Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T 2 0 Y
15. Special Handling Instructions and Additional Information
.GSX Work Order No.: 71823
,e. GENERATOR'S CERTIFICATION: I hereby doeterothal lhO content, olthl, eon•lgnmenl11re lully and 11eeur11tetydo•crlbed •boYII by pro~, •hipping"·"'· lll"ld .,. cl•• .. flll'd,
packed, marked, and 1a°beled,and are in all rospacts In proper condl1ion for lran,port by highway according to applicable lntornallonal and national g0Yernmen1 r9Q..,.lat1on• al"'d
tl'le 1•ws ot 11,a St.ale 01 Soulh Caroline.
111 •m • large qu11nl1ty gonerolor, I certily th all have a program ln place to reducathavotuma and toxlcltyol wastaganeralad !Otha de,vr-1 ha Ya dolor mined 10 be economk.ally
pr11c11ca.010 and that I have solocted the practicable method ol treatment, storage, or dlspoul currenlly aYaltable to me which minimize• th• pre Mn! and lutura tri, .. 1 to hv~n
health and tho environment; OR, ii I am o small qu.anlitygonorotor, I ho YO mado a good ll!lith eNort lo minimize my wasl.o generation and select the belt wa1111 management tr4t:l"IOd
trial is available to me and lhol I con afford.
Prinled/Typed Name RO.GER L. COATS Signature Year
Month Day Year
I ~i.,,,,...,,....=...,.---=----=--,.,.....,..-~ 20. Facilily Owner or Operator; Cer1ilicatlon or receipt ol hazardous molerials,covered by this maniresl except as noled In llem 19.
• I I' Jlbo. 'I libs.
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Printed/Typed Name Signature
.EPA Form 8700-22 (Rev. 9/86) Previous Editions ore Obsolete [DHEC 1988 (Rev. 10/86)1
Month Day Year
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
lMPORTANT: TYPE (on a 12.pilch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators of hazardous was:e trea:ml
storage. or disposal ficilitie, to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)1 and. it necessary, the continuation sheet U.S. e·PA F
8700-22A Aev:9186 (DHEC 1988A) fof bolh inter-state and intra-state transportation, Transporters who transport hazardous waste into the United States !r
another country are responsible !or completing the manilesl Fcd_cral and State regulalions also require generators and transporters ol hazarCous ... as:e a.-.c
owners or operators al hazardous waste treatment. storage, or disposal facilities to complete the following informa!ion. . . I
1. Generator's U.S. EPA JO Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five d1g11
GENERATOR SECTION
number assigned 10 this manifest by thegeneralor beginning with 00001. llyour company does not have a U.S. EPA ldentilication Number, please con:ac: S.C.
OHEC at [phone] about obtaining an identification number. I
2: Page 1 of: Entei-the total number of pages used to complete this manifest, i.e., the fiisl page EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (P.EV 10186)} ~lus
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
~ State Manilest Document Number: .Leave blank.
e: · State Generator Identification Number:· Leave blank.·• ·-· • I
3. Generator's Name and Mailing.Address: Enter the name and mailing address ol the generator who will manage the returned maniles: fofms.
4. Generator·, Phorie Number: · Enter a lelephone number wilh area code where an authorized agent ol the generator can be reached in the ever,t ct
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of lhe first transporter who will transport the w8.ste.
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5. I C. Stale Transporter's ID Number:, Leave blank:
D. Tran,por1er's Phone Number: Enter a telephone number including area code where an authorized agent ol the first transporter can be reache':: in the event ct
an erryergency. i,:ic!uding nights, weekends, and holidays... . ..... . .. ------· . -· ·-···-.... ·.: .". . ·. I
T.. Transporter 2 Company Name: II applicable, enter the company name of the second lransporter who will transport the waste. II more than 2 !ra_ns;:,orte~s I
be used. use a U.S. EPA Form 8700~22A Rev. 9/86 (OHEC 1988A) continuation sheet and lisl !he transporters in lhe order they will be transoor:1r.g :he wa .
8 .. U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit 10 number al the second transporter identified in item 7.
E .. State Transpor1er·, ID Number: Leave blank. I
F .. Transpor1er's Phone Number: Enter a telephone number including area code ~here an authorized agent of the second transpor1er can t:e reacr.e~ in
event ol an emergency including nights. weekends. and holidays.
9. Designaled Facility Name and Sile Address: Enter !he company name and site address of the treatment, storage, or disposal lacility designatec to reCE:ive me
waste listed on this manifest The address must be the site address, which may differ from the mailing address. · • · , · ~ • • I
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit iden!Hication number ol the designated treatn:,enl. storage, or disposal !acility iden:1fie::J in item 9.
G:. Stale Facility's ID Number: Leave blank. . .
H;. Facility's Phone Number: Enter a telephone number including area code where an aulhorized agent cl the facilily can be reiiched in tt·,e event ot an
emergency including nights, weekends, and holidays. ·
11·., U.S; DOT Oescrlplions: Enter !:)roper shipping name, hazard class and ID Number (UN/NA) tor each waste as identified in 49 CFR 171 • 1 i7. If acci:ional sof
is needed. use a U.S. EPA Form 8700-22A Aev. 9/86 (DHEC 1988A) Continuation Sheet.
12... Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) for the type ol c::::ntainers.
TABLE I
OM = Metal drums. barrels. kegs TT= Cargo tanks (lank trucks) CM = Metal boxes. cartons. cases. rcll cHs
OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastiC drums. barrels, kegs OT= Dump truck CF = Fiber or plastic boxes. car.ans. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plast:c ::a~s
13 .. Total Ouantily: Enter total quantity of waste described on each line. relative to the unils used in item 14.
TJ. Unit (weighl/11olume): Enter the appropria!e abbre\liations from Table II (below) for the uni! ol measure: I
Table II
P = Pounds L = Liters K:; Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid only)
I. Was le Nu'mber: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Su::,ar:s C ar.d I
identity the hazardous waste on each line.
J. Additional Oesc,iption, for Materials Lisled Abo\le: In the spaces provided, enter the aulhorization number (from the S.C. OHEC Author1zat1on Request F ormJ
for each waste stream lis!P.d in section 11 above. Note: Before any hazardous waste can be accepted for lreatment. storage or disposal in South Carclina, tne
generator must obtain prior authorization lrom the trealmenl. storage or disposal lacility. · · I
K. Handling Codes for Wasle, Lisled Above: Leave blank.
15. Special Handling lnstruclion, and Addillonal lnlormalion: Generators may use this space to indicate special 1ransportation, treatment. siorage or disp I
inlormation or Bill al Lading Information. For international shipments. generators mus! enter in this space lhe point al departure (city and s:a:e) for tnos~
shipments destined !or treatment, storage, or disposal outside the jurisdiction or the United Slates. · I
16. Generator Certilicalion: The generator must READ,.SIGN (BY HAND IN INK), and DATE the certificatibri staterTlent.11 a mode other than h1gnway 1s usec.
word "highway" should be lined out and the appropriate i:node {rail, waler, or air) inserted in the space below. II another mode in addition :o tr.e hignway r:io s
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION . . -' . ·
11: Tran~porter l Acknowledgement: Enter the name ol lhe person accepting the waste on behalf of the'.lirst transporter. That person rr.usl ac~non"lel
acceptance of the waste described on !he manifest by signing (BY HANO IN INK) and entering the DATE.of receipt. · · · : ·
18. Transporter 2 Acknowledgement: Enter, if applicable, the name of the person accepting the waste on behall of the second transoorter. Tna: perscr: r.:·"s:
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt. I
FACILITY SECTION· . , .
19. Discrepancy Indication Space: The authorized representali\le of the designated facility's owner or operator must nole in this space any discrepancy ~et·,... _.
the waste described on the manifest and the wasto aclUally received al the facility. Owners and operators of facilities who cannot resol~·e s1;:i1licar.:
discrepancies w1!hin 15 days receiving the waslo must submit 10 lhe Department a letler with a copy ol the manilesl describing the discrepancy ar,::! a:-:em;I
reconcile iL The 1reatmenl storage. or dlspo~at lacillty mus I enter !he actual weight ~I waste In pounds in the spaces provided if the amount varies any trom :
specified by lhe generalor in item 13 or ii !he oenerntor uses a unit ol mcas11re olhcr than pounds. . .
20. Facility Owner or Operator Certlllcatlon: Print or type the name ol lhe person acccpling.the wasle on behalf ol the owner or operatOr ol !he l3c1!,ty. Tt,;::it person
· must acknowledge acccptanc·o ol tho waste described on the manifest by SIGNING (DY HAND IN INK)and entering the DATE ol receipt.
II' .tc;-;iS.TANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR 01S?OSAL FACILITY OESICNJ.TEOI
R!::' ···•:~ THE: '.\'ASTE OR THE S.C, DHEC MANIFEST SECTH"'."/J AT (803) 734•5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
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South Carolina Department of Health
and Environmental Control ...
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST c o o 9 7 6 o 4 7 1 4
Manifest
Document No.
0 1 3 1
Form A
2. Page 1
of 1
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Streel Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-542(
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in th& shaded areas is not
required by Federal law, but is by State law.
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
4. Generator's Phone 91 9
Smithfield,
934-9711
NC 27577
;jl:1;1rs1:~~~t1!:/!::~~,r1~lt:2;~;f:
:;~:mti~i~~f:~llk1,I1~f~ti~~~~;tts~~l:l!~~]fl
5. Transponer 1 Company Name 6. U.S. EPA ID Number · 11
I--W=il~l:!m!!:s~T:.:r'"'u!.::c~k::i.!.!nl2....C~o~. L......:I~n!.::c:.:• _____ _i.,S=C=D=0..1.!..7.L3=7~0!..l..29c1.=2J29.L!..7~;,!!/g &7 6Jq3333"
7. Transporter 2 Company Name 8. U.S. EPA ID Number
9. Oesignaled Facility Name and Site Address
GSX Services of SC, Inc.
Route I, Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0 3 7 5 9 8
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
d.
a lh..Hl-1 o, 2, z, z, 41-1 )! 1, a ]I, ;;ihih 0·LLJ-I I I I I 1-1 I I I llW
b. LLJ-1 ,J~[l!l\f1!~1!1l!!l~:W:L.Li, t ):l,,,, I ,~~!
is. Special Handling Instructions and Additional Information
GSX Work Order No.: 71824
16. GEMERATOR"S CERTIFICATION: 1 hereby d'eclare that tho contents olthlsconslgnmonlarofullyand accurate1ydescrlbed abova by proper shipping nam• and •r• cla ... itled.
packed. marked, and 1a·beled, and ere In all respects In proper condition for transport by highway according to applicable lnlarnallonat and nallonal govommentreo;ulatlona and
the laws ol lho State of Soult'I Carolina.
11 I am a larga quantity genaralor, I certify that I have a program In place to roduc• lh• wlumo and toxicity of waala genaralod 10 tho de<;rff I have determined to be economk'.alty
practicable and that I have selected tho practicable method of treatment, storage, or dlapoaal currently avallab1a to ma which mlnlml:r.aa tho present and future U"lrNI to human
health and Iha environment: OR, ii I am a small quantity generator, I have made a good lalth eNortto mlnlml:r.e my waste generation and select the beat waste management method
that is available to ma and that I can attord.
ll-l--P-ri-nted_,r_y_p_ed_N_•m_• __ R_O.:.;_.C_E_R_L.:.. . ..:C:.:O:.:A:..:.:T.:s~ __ ...J.s_ig_n_•t-ur_e_.f...::::;~ia.:l...__a,~_.!,~;'.;!.l~~----.J,;M;!o.Ln"'u~;;;.1:i!:L,~
T , . .
Rf-'-::-,='-'--"'----'_:__:_:==='-'-"-'-'-'C:..:...CC.:;;;:..:.c.-,,.,....-,--,,-----,,,...-,,-,.,!<C-~,..,..---,.------....,,..---..,....----------'1
lj
0 Rf'-C:....C.==:::..::..:..:.::..:..:.::..:..:.:===:..:..:.:=c:..:...;c.:;;;:__;;.;;_ __ I<-,.-----------------------------"-'!
1,_i-1---P-rin_t_ed_,_r_y_ped_N_•_m_• ______________ ..1, _________________________ ...1_1-.i....i....&.....1---'1
19. Discrepancy Indication Space
F If 11---------------~ 20. Facility Owner or Operator; Certlf!callon of receipt ol hazardous materials covered by this manifest except as noted In Hem 19. I Printed/Typed Name Signature
EPA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
..
Month Day Yea,•
~ ....
' a I pt,,. •1 !lbs.
b I pbs. d! !Ibo.
Month Day Year
'
GENERAL INFORMATION: Federal Regulations require genP.rators and transporters of hazardous.~0;ste and owr,ers.0J,operatprs,of hazard_Sll!S.Wcl:~:e tr~a.rn,,
,torage. or di$posal licilities to use th': y.s. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 1_0/86)1 and,,il_n.eces~ary, the.conlinuation~sheet U.S. EPA F
8700-22A Aev:9186 (DHEC 1988A) !or both inter-stale and intra-state transportation. Transp·orter·s who transport hazardous,was1e.in10 the.United S:a:es tr ,
another country are responsible for completing the manifest Fcd_erat and State regulations 31so ~eQ~fre gene;a,or~ and transporter~ ol hazardo~s ..... ;s1e-~:-.~•
owners or operators of hazardous waste treatment. storage, or disposal racilities to complete the rollowing i.nlormal_i<?n, 1.
GENERATOR SECTION · -~ , ..
1. Generator's U.S. EPA ID Number~ Manifest Document Number: Enter the generator's US. EPA twelve digit ident1f1ca1ton number and the un1cue live d1g11 I
number assrgned to this manifest by lhe generator begmnmg with 00001.11 your company does not have a U.S!€PAtde'nt1f1c-at10n'Number please con:ac: s•c,i
OHEC at [phone] about obtaining an ldent1f1cat1on number. ·-~ •, .i,. ~, •• '•"!r-.,,,,.,.,. "1' ..... -"l"F • .,. -i I.. ,fwu" .-,•r ;i I'
2; Page 1 of: Enter the total number of pages used 10 complete this manifest, i.e., lhe hrs! page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10186)\ plus
number ol conhnuat1on sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) 1f any.
A.. Stale Manifest Document Number: .Leave blank. ·,,.-~,· :.u:.,--:);!,H<r:::.Pnr.e1,;,~1r•, 1 ··1, .. ~. ,tc.:~:; .,nsol
S: Stale Generalor ldenlrflcallon Number: Leave blank...... ~ · '~ -"0-::0 .-,~ '·""' ,,,.,;~, "): n .... -.,, ., .. ·• · ·"·.r· ':: !r · ·,-,,
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator Who will manage the returned:manifes: lorms.-• • •
~-Generalor's Phorie Number: Enter a telephone number with area code where an authorized .igef'lt Of'Uifi'genera"tOr,..c·a·hn:ie re3Ched•in-:ne even: Ot ~
emergency·including nights, weekends, and holidays. -:0:_0-:; r-.•i_;,..-p:t~:,... -,·~.\r•.'?/" ,,.,, •.• :,, r.~ -•or 'i r •-.;~ •~
5. Transport 1 Company Name: 'Enter the company name ol the lirst transporter who will transport1the waste.r ..
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit idenlilicalion number of the first 1ranspor1er identified in item 5.
C. Slate Transporter's ID Number: Leave blank. ·' , ~ ·: 1i;r1 ,~-:1.--::-.-.n,,
0. Transporter's Phone Number: Enter a teleph0ne number including area code where an authorized agent ol the first transpor1er can be reached in the event of
T.. ~ra~:;:~ee:c;~~~~~~~ ~~g~~~• ~~=~:~~:b~;.~~~~~~~s~~mpa·ny name Oi the seCOridirciiis'PO"rt·e·r· :ho.wir,i:1/a~n:s~ci~·;~e~;;;;;.• 1!.mare than 2 !r;~s;,o-~er;I/
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be lransoor:ir,g the wa .
8 .. U.S. EPA 10 Number:lf applicable, enter the U.S. EPA twelve digil 10 number of the second transporter ident!fied in item 7.
E .. Slate Transporter's IC Number: Leave blank. ,
. F .. Transporter's Phone Number: Enter a 1e1ephOne· numbedncludiri'g area code ~hei-e a'n'a\.ith·oriZeCfagenrorth'e seconcnr.a·nspo.r1er can be reacr.ed in I
event ol an emergency including nights, weekends, and.holidays. . "' , .c.. ,. . _ ,:.•_•i ·:--•.,~r; 1.,w---f. •:~·c: .
9. Designated Facilily Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal lacility desii;;naiea :o receive me
waste listed on this manHest The address must be the Site address, which may differ lrom the ·mailil'fg~a"ddr'es·si':: '."'~ '"!,....e-~ 1'"'~-..... 1J·,,-.-,.. . .,,;s ·~,;1,~ P :-••'
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the desig/1ated trea·1ment, slora~je·, or disposal lacilit-/ iCen:ifie:rin i:em 9 .•
G:. Slate Facility's ID Number: Leave blank. · · · · 1 ,.;,,-.... , • ".~-~ 1'~·~---,~-: .. ~~ ·-·,-,-.-,~ ,,..-,.,. "11f' ·•-·,: . '••:-d .::1· ·· ~
H;. Facility's Phone Number: Entei a telephone numbe·r inCluding area code where an a·uthoi-fzE!(f;i~ie'rlr01 1tie· 13Cility°23ri,.tie rea·ch'"e·d 'in :~:e e ... ent· of ·an
emergency including nighls. weekends, aiid holidays . .a • '."•~ .. , • ·• •-.-•• •
11: U.S; DOT Descrlptlons: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identilied in 49 CFR 171-177.11 ac::::i:icnal sot
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. ., "''• : ('"''' : . ,"' _ .
12.. Containers (no. and type): Enter number ol containers for each waste and the appropri~\t,a~Ff?."!}5'-liq:Q,-lrp[!',J,~~l!J:(~~~~;,:!l11~.~1~~ f;Pe .01 .. cpn1ainefS .....
., • , • ~-1 , ,-.. ~i, , ,~..., ,. .,., TABLE I • " ... ~r. . . • • • ·• • : · •~
OM= Metal drums. barrels, kegs · • · · ·· TT= Cargo tanks (t~nkJ~~-c~~l co,r:-q.~M-~.,.~.~l~.! B'?x,~s1,~_a_0,o~s. ,cases. rcll cHs -~ I·
OW= Wooden drums, barrels, kegs .">:• '", ~ TC= Tank cars .. · CW =·wooden boxes.'cartons. cases
OF= Fiberboard or plastiC drums: barrels. kegs DT = Dump truck CF= Fiber or plastic boxes. car:ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plas::c :.ai;s
13 .. Tolal Ouantily: Enter total quantity of waste deScribed on each line, relative to the unils used in item 14. • .. • . '"""~· , .. !L\i' ....... , •. .,
t4. Unil (weighl/volume): En_ter th_e appropria,tc a"bbrevia,tions from Table II (below) for the unit al m_7.~s~r~; ,,n_.•,f,1.,..,~ •. .",n, ,.,,'~M
., ~. Table II . , .
P = Pounds L = Liters K = Kilograms . T = Tons M = Metric Tons N = Cubic.Meiers , _ Y = Cubic Yards G = Gallcr:s (lieu id only)
I. Waste Number: Enter hazardo~s wasle numbers as specified in South Carolina Hazardous Wasteifan.i9"'e;;;ent Regulation A.61-79.261 Su:;:iar:s C ar:C I
identity the hazardous w3s1e on each line. .· · ·
J. Additional Descriptions for Materials Lisled Above: In the sPaces provided. enter ,he authorization nurnber (from the S.C. DHEC Authonzation Rec:uesl Fo ,)
for each waste slream lis!P.d in section 11 above. Nole: Before any hazardous waste can be accepted for lreatment. storage or disposal in South Carclina. ine
generator must obtain prior authorization lrom the treatment, storage or disposal facility. ~.., .. , ,···:····· · ,,. ·:r.r --,'...;.r~•ni:. ,,,•;c:,;_7 :· .,,. '' ' .. , •· ""I'
K. Handling Codes lor Wastes Listed Above: Leave blank. . --. · · --, · ·· · · • · • :i •
15. Special Handling Instructions and Addilional lnlormalion: Generalofs may use this space to indicate special lranspor1ation. treatment. storage or disp t
inlormation or Bill ol Lading Information. For internalionat shipments. generators must enter in this space the point ol depar1ure (Ci!'/ and s:a1e) !or inose
shipments destined ror treatmenl. slorage. or disposal outside the jurisdiction of lhe United Slates::,,:,:.·-~-· ·,,·•,-1: ":--:-,,. •· ,.-,,,,,,, ,,.,1-·r -,. · •r.1·
16. Generalor Cer1ilication: The generalor must READ,.SIGN (BY HAND IN INK), and DATE lhecer1itication statement. II a mode other than h1gnway is use<:.
word "highway" should be lined out and the appropriate mode(rail, waler.or air) inserted in the space below. II another mode ,n addition :o tr.e h1gnway r.io s
used. enter the appropriate additional mode {e.g ... and rail) in the space below. . , ... ~ .. ,...;_ .·, •)•.:,,,
TRANSPORTER SECTION
11: T!an$por1_er 1 Acknowledgement: . Ei:,tcr. the nam,e of _lh~ per~on_ accepting the waste on behall of the first transporter. _Thal person rr:u_st ac~n:, ... 1el•
accepta~ce ol the waste described on the manifest by signing (BY HANO IN INK) and entering the CATE or receipt.. . . ,.. . , , , , _ . , 1
18. Transporter 2 Acknowledgement: Enter. if applicable, the name ot the person accepting the waste on behalf ol the second transporter. That perscr. r:-::.:s:
acknowledge acceptance al the wasle described on the manliest by SIGNING (BY HAND IN INK) and entering-the.CATE ol·receipt --~ i
FACILITY SECTION . ' I
19. Discrepancy Indication Space: The authorized representative or the designated lacility's_owner or op_erator.must note in I his space any discrec:ancy ~·-::1-...
the waste described on the manifest and lhe wasto aclllally received at the facility, Owners and operators of racilities who cannct resotve s1i;n1ficar.:
discrepancies w11hin 15 days receiving-the waste must sub mil 10 the Department a letter with a copy of lhe ffianilest dE!Scritiii"lg-the discrepancy ar:d ar:em::I
rtco~~ilt it The 1rea1ment ~!~rage, or dl~posat lacillty mus I enter t~e actual weight ~I wasle in poundS In the.spaces provided ir the amount varies any !r~m :
specll1ed by lhe generator 1n item 13 or 1I the generator uses a unit or meas1Jre olher lhan pounds. , . · ·
20. Facility Owner or Operator Cerlilication: Print or lype the nameol the person accepting the wns1eon behatfol the owner or"operator"ot lhe l;;icil,ty. lt'l.'.ll oerson
mus! acl<now1edoe accept.1nc·c of !ho wasto described on lhe manifesl by SIGNING {OY HAND IN INK) and entering the DATE ol receipt.
,, •~s,sT•NCE 1s NEEoeo 1N coMPLeT10N OP mis MANI PEST, CONTACT THE TREATMENT, STORAGE, OR 01s POSAL FAC1L1Tv oes1c;,,ue0 I
Pcf""✓E THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM B:00 am TO 5:00 pm.
f11\o-j
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South Carolina Department of Health
and Environmental Control
-,~ Q
Bureau ol Solid & Ha..z.ardouJ Wu:te Mgt. ~
2600 Bull Sb'eeL Columbia. SC 29201
Phone: [phone]
E PRINT or TYPE (Form desl ned for use on elite 12-llch
UNIFORM HAZARDOUS
WASTE MANIFEST
l Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
,. Generator's Phone 919
5. Transp0r1er 1 Company Name
Smith field,
934-9711
NC 27577
Emergency & Holidays.: (803)73'-5-424 .
Form A roved. 0MB No. 2050-0039 E.xoire:s 9-30-83
2, Pago 1
ol Information in the shaded areas is not
required by Federal law, bu! is by State law.
Willms Truckin Co Inc.
7. Trinspor1er 2 Company Name t"· )
/i r--~~}'4~~+tt./t'"-:;: 1 :,
9. Designated Facilil')' Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10, U.S.'.EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
L
12. Containers 13. Total Quantity l(Unil ,r_w&Stlltuabtir~:
No. Type 'MN-:J ·;~Y?1:r'.-;tLtWii4::~
Hazardous Waste, Solid, nos ORM-E
N 'NA 9189 l D T 2 0 Y
b.
C.
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71826
18. 01!.NERATOR'S CERTIFICATION: I herebydec1■ re th■t !he content• ofthl• con■lgnmenl ■ro fully and ■ccur■lely do•crlbed ■bove by prop.er ■hipping l"l■me ■l"ld ■re claaadted.
p.aclo.ed. m■rl<ed. and 18boled, and are In all respects in proper condition tor Iran sport by highway according to appllc.abla lnlarnaUonal and natlonal government r90uLatlona &lid
ll'le l■w• of tho Stal■ ol Soulh Caroline.
tf I am a large quanhty generator, I certify that I have a program In place to reduce the volume and 10.idcltyol waslaganaralod lo Iha degree I h■ve dalarmlnod to be .conomk:a.lty pr■ct,cable and thal I ha"'• selected the practicable method ol treatmenl, storage, or disposal currenUy av■ltable to me which minimize• the prasenl and lutura ll'lr-1 to human
health and tha anvironmcnl OR, 111 am a small quantltygoneralor, I have mado a good lailh aflor110 minimize myw■sto ganer■tlon end aalocl ttlo bet I wa11■ m■ n ■gemanl .,,.O'ood
that is available to me and lht11 I can allord, ·
Printed/Typed Name ROCER [: COAYS Signature Month Year
a
. Transporter l At.:,mowledgement of Aeceipl of Materials
#,9,:('
Montn Day Year
Printed/Typed Name Signature Monlh Day Year 1.
,;,
~ .. ,,
19. Discrepancy Indication Space 1 ....
• I jib!. CI libs.
b I Jibs. d I Jlti:
20. Facility Owner or Operator; Certification of receipt ol hazardous malerlals covered by lhi, manifesl except as noted In /!em 19.
Prinled/Typed N1m1 Signature Monlh Day YNI
.A. Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
--•" -!-"
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE.MANIFEST
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require genP.ratOrs and transporters of hazardous waste and owners or operators of hazardous was:e !rea:menl
storage. or disposal ficililies lo use the U.S. EPA Form 8700·22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, ii necessary, th& continuation sheet U.S. EPA For
8700•22A Rev.-9186 (DHEC 1988A) loi both inter-slate and intra-state lransPortation. Transporters who transport hazardous waste into the United Stales tro,
another country are responsi6te for completing the manilesl Federal and Siate regulations also require generators and transporters of hazardous ·,.,·aste ar.c
owners or operators of hazardous waste treatment, storage, or dispo~al facilities to complete the following information. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manilesl Document Number: Enter the generalor"s U.S. EPA twelve digit identification number and the unicue live digit
number assigned to !his manilesl by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:ac1 S.1 OHEC at [phone] about obtaining an ldentilication number. ·
2; Page 1 of: Enter the total number of pages used to complete this manilesl, i.e., the nrst page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REV 10/ 86)1 clus t:'I
number of contiiiualion sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) H any. ·
A. Slate Manifest Oocumenl Number: .Leave blank.
B; Slate Generator ldenliftcallon Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of lhe generator who will manage t~e returned mamfes: !arms
4. Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent al the generator can be reached in the even: cl an
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number al the lirsl transporter identified in item 5.
C. Slate Transpor1er·s 10 Number: Leave blank. ·
0. Transporter's Phone Number: 'enter a telephOne number including area code where an authorized agenl ol the first transporter-can be reached in the event of
. . an e~ergency i,:it_luding nights, weekendS. and holidays. · · · · · I -~' ·r..' Transporter 2 Company Name: 11 appllc3ble. enter the c"Ompany Mame Oi the se~O'ri"dir.iiis"P"Oiier wiio wm'tra.'n'spcirt the waste. II more than 2 trans;iorters wi
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transpcr:ing the was: .
8 •• U.S. EPA ID Number:1I applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E.. Slate Transpor1er's ID Number:_ Leave blank.. -· ·· ·, · 1"" ";'---v '' · -· I
F •. T,anspor1er's Phone Number: Enter a tele-phone number including area code where an authorized agent of the second transporter can be reacr.e~ in 11"1
event ol an emergency including nights. weekends, and holidays. · · -· '
9. Designated Facility Name and Sile Address: Enter the company name and site address of the treatm~~t, storage, a~ disposal r~:_i_li,'.Y ~:s.i~n.aie~ :?~.rece1v~11he
waste listed on this manifest The address must be the site address, which may differ from the mailing address. I
10. U.S. EPA 10 Numbtir: Enter !he U.S. EPA twelve digil iden!Hication number ol the designated treatment. storage, or disposal facility idenidie::l 1n_ item 9.
G:. Slate Facility's ID Number: Leave blank.
Hj. Facility's Phone Number: Enter a telephone number including area code where an authorized agent al the facility can be reached in :he ·event of an
emergency'including nights, weeke'nds, and holidays.
1 L U.S: DOT Descriptions: Enter proper shipping name. hazard class and 10 Number (UN/NA) for each waste as idenlified in 49 CF. A 171-1 ii. If aCCi!icnal s::,acl
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ,.. _ ... --..-C' ~ ,r,
12... Conlalners (no. and type): Enter number or contoiners lor each wosle and tho appropriate abbreviation lrom Table I jbelow) lor the type ot containe·rs. · TABLE I , ,. • ~ '
OM= Metal drums. barrels, keg_s TT= Cargo tanks (tank trucks) 9M,.:=:,-M~t~! boxes. cartons, c_a_s~s.,rc-!1,p.::Hs ., .....
OW• Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons, cases
OF• Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ans. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic tiai;;s
13 .. Total Ouantily: Enter total quantity al waste describ8d on each line, relative to the units used in item 14 .. ,.,. "',.., .. ,
T4. Unit (weight/volume): . Enter the appropriate abbreviations ,ram Table II (below) for the unit of measure:
Table II ,
I
P • Pounds L = Liters K = Kilo9rams T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina HazardOus Waste Management Regulation R.61-79.261 Su. b;nr:s C ar.d D ti
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number (from lhe S.C, OHE.C Authoriza11on AeQuest F_or_n:_i)
for each waste stream listP.d in section 11 above. Nole: Bero re any hazardous waste can be accepted for treatmenl storage or disposal in South Carolina. 1ne
generator must obtain prior authorization from the treatment, storage or disposal lacility. -•., ·, -•. ,,,. , .,,
K. Handling Codes for Wasles Listed Above: Leave blank. , · ,; , • ...
1 S. Special Handling lnslrucllons and Addillonal Information: Generators may use this space lo indicate special transportation, treatment. storage or disoos
information or Sill ol Lading Information. For international shipments, generators must enler in lhis space the point or departure (ciry anc! s:ate) lor Inose
shipments destined !or treatment, storage, or disposal outside the jurisdiction of th8 United States. · · ----., . . , -I
16. Generator Certification: The generator must AEA0,·sIGN (BY HAND IN INK), and DATE lhe cer1Hicatfon statement. II a mode other than highway is used. :n
word Nhighway .. should be lined oul and the appropriate modC (rail. water.or air) inserted in the space below. II another mode in addition :o Ir:e hignway r.ioce 1
used, enter the appropriate additional mode (e.g., and rail) in the space below.
TRANSPORTER SECTION .0 • • • •• I
11: Tianspo~er 1 Acknowled9ement: Eriler the name of the person accepting the waste on behall of the first transpor1er. That person rr:ust_ackn9wledi;
acceptance al the waste described on !he manilest by signing (BY HAND IN INK) and entering the DATE al receipt. • · ·
18. Transporter 2 Acknowledgement: Enter, ii applicable, lhe name al the person accepting the waste on behalf ol the second transporter. That perscn r:·H.:s:
acknowledge acceptance of the waste described on !he manilest by SIGNING (BY HAND IN INK) and entering the DATE al receipl --I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representalive ol the designated lacility's owner or operator musf note in this space any discrepancy betwee
!hi waste described on lhe manileal and the waste achially receivod al the facility, Owners and operators or lacililies who cannoI resolve s1;ndicant
discrepancies w1lhin 1 S days receiving !he waste must submit 10 !he Department a lellerwilh a copy of the manifest describing the"discrepancy and a~emots 11
reconcile il The trealmenl storage, or disposal laclllty must enler the acIual weight al waste in pounds in the spaces provided ii lhe amount varies any !rem tr.
specihed by the generator in ilem 13 or ii the generator uses a unit ol meas"rc other lhan pounds. .
20. Facility Owner or Operator Cerlillcalion: Print or type !he name of the person accepting.the waste on behatl ol lhe owner or operator ol the lac1l1ty. Thal person
must aci<nowledge acceptanc·e or tho waste described on lh8 manifest by SIGNING (BY HANO IN INK)' and ente.ring the DATE of receipt
1, Al~tSTANCB IS NEEOEO IN CO~PLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIOtJA,TEO Tl
RECE1'.'~ THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 73<1-5200 WEEKDAYS FROM 8:00 .1m TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa.ste Mgt
2600 Bull Street, Columbia, SC 29201
Phone: (BOO) 734-5200 ·
I
I
I
I
Emergency & Holidays: [phone] rr-E PRINT or TYPE (Form desloned tor use on elite 112-oltchl •••ewrlter)
UNIFORM HAZARDOUS 11. Generator',U.S.EPAIDNo.
WASTE MANIFEST N· C· D· 0· a, 7, ~-0, t., 7,
Form A roved. 0MB No. 2050-0039 E.J:pires 9-30-3!
Man Ila al
01
, 2. Page 1 Oocumenl No, ol lnformalion in lhe shaded a<eas is not
required by Federal law, but is by Stale law.
1 Generator:'s Name and Mailing Address
• Channel Master
P. 0. Box 1416, Smithfield, NC 27577
,. Generator', Phone I 919 l 9 34-9 711
5. Transporter 1 Company Name
Willms Truckin2 Co. Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood. SC 29125
l• ,.,n, n, 1, 1, 1
6. U.S. EPA ID Number 'CJci:;;.'l9·i·.... ·1 in,·.-::-.: ... :., ... __ ,,-.)>/( .. ::, .. ···-. ~.-,;·v, ,.,.,
, s, c, n, o, 7, 1, 7, o. Cir ?i Q · Di!t' · ··• ·,'J>tioM'A+Rn1n~1i•111.1·,,·.,.:; ~~
8. U.S. EPA ID Number ii:?&·.:::·.:..:.❖j''' ... -...... ,. ·a·o:1.:/;· · . ··' :·.: , . .f':';.:..v_,;;_~,,i/J..\ .'! ;
I I I I I I I I I I I I "Fff"''··•,,<,.· ··· "h "1{~'-i.j\-,4=.: .. ,•.~;·.;<.:'.:~•,':...+•!4~+{:(:#/x<~
10. U.S. EPA ID Number
, S, c, D, 0, 7, o, 3, 7, ~
:if i;i~,~t~:!:1G~i1iirl:~l[::z::;:il.;i1.f~tr;:(tt;1t if 2~~)$A1~~·-!~.:
~ a ~ :~ii{;,t::~l~\~~~:r~:~Jq9,4;3=~~~1l%1~
11. U.S. DOT Oescriplion (including Propar Shipping Name, Hazard Class, and ID Number} 12. Conlalners
No. Type
1 3. T olal Quantity 1 •. Unil ~\: ~~.~tt
. . 'M.Nd ,::~i:t::·~:;;,>.:N/J,J:-tt{~
a.
d.
I r I I r ' '
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71827
18. C£NERA TOR'S CERTIFICATION: I hereby declare that the conlents of this conalonmenl are fu11yand accurat81y described abova by prop.tr 1hlpplng nama and ara ct--,fted.
packed. marked, and 1&beled, and are in all respects In proper condition tor transport by highway accordlno to applicable International and natlonal govarnmant r~ulatlon1 al'ld
!!"la t1w1 of Iha Stale ol South Carolina.
Ill am a largo quanllty oanerator, I certify thal I have a prooram In place lo reducathavolumo and loxlcltyol wasleganeratod lo Iha deor-1 have determined to ba econom~lty
practicable and that I have selected 1he pracUcable melhod ol lrealment. storaoe, or dlspoaar currently available to me which minimizes tho present and lut\lra ll"lr-1 to h1,,1man
health and the environment: QR, ii I am a smo1t quantity oonerolor, I have made a good laith oNor1 lo minimize my waslo generation and select the bait wa1ta mana;amant m,e0'10<1
that is svailsble to me and that I can afford. · · I Printed/Typed Name Ro:ceR L COAT~ I Signature ~.,
T 17. Transponer 1 A~Knowledgement ol Receipt ol Materials {/
Month Day Yw
i t'I 9, ,-:i .i,R-,7
~ L::P:r:;~~I ::,:;Y:P:::. ~:l•:/~•~L::::/~,?,;~~,,:~~~~:-e~:--~~::::::::::11s:1:gn:•:tu:,•::A)_;. ;:f:::::~_,.;~;-~~,:;;~;;;:::::::::::::::::::~IM:o:~:"':,~:~::Y~ 1:Y::-':J
R 18. Transporter 2 Acknowledgement of Receipt of Materials
T Printed/Typed Name I ~ignature Month Day Year::~
I r I , I , • ~
l 9. Discrepancy Indication Space r •Ll..1.-u...1-.L
~ b~l..w....1...L.L
pt,,_ C I lib,. <
Jibs. d I I libs.
1-
, I !----------------~ 20. Facility Owner or Operator, Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Ptinled/Typed Name I Slgnalure Monti\ Day YNI
I , I ' I ' PA Form 8700-22 (Rev. 9/88) Previous Editions ore Obsolete (DHEC 1988 (Rev. 10/66)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST 'i
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN· PRESS DOWN HARD ~ ·•· ,, · • ALL COPIES MUST,BE LEGIBLE!,
GENERAL INFORMATION: Federal Regulations requiregeneratOrs and lrnnsporters ol hazardous waste and owners or operators of hazardous wa·~t~ trea:meJ·
s1oraoe. or disposal licililies lo use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, ii necessary, lhe continuation sh~et U.S .. EPA For
8700-22A Rev: 9/86 (OHEC 1988A) ror bolh inter-slate .and intra-st.ite lransportalion. Transporters who transport h;nardous waste into the Uni!ed States lro ,
another country are responsiOte !or completing the manilesl. Federal and Slate regulations also require generators and transporters of hazarCous1was:e a:ia.
owners or operators of hazardous waste treatment, storage, or disposal facilities to complete the following information. · I
GENERATOR SECTION
1. Generator's U.S. EPA 10 Number. Manifest Oocumenl Number:_ Enter the generator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manifest by the generator beginning wilh 00001.11 your company does not have a U.S. EPA ldentirication Number, please con:ac! S.I
OHEC at [phone] about obtaining en ldentilicalion number.
2.:. Page 1 of: Enter the total number of pages used lo complete this manifest, i.e., the lifst page EPA Form 8700-22 Rev. 9/86[DHEC 1988 (P.EV 10/86)1 ~lu_s t,
number or con1iiiuation sheets EPA Form 8700-22 Rev. 9186A (DHEC 1988A) H any. · · -· ,..,. · ,.,..,
A. Stale Manliest Document ·Number: .Leave blank.
B: Stale Generator ldenHflcatlon Number: Leave blank. -I
3. Generator's Name and Mailing Addres,: Enter the name and mailing address of !he generator who will manage the returned manifest forms.
4. Generator's Phoiie Number: Enter a telephone number with a_rea code where an authorized agent al the generator·can'be-reach-ed in the event Ct'3n·
emergency including nights, weekends. and holidays. •.
5. Transport 1 Company Name: Enter the company name al the first transporter who will lransport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transpor1er's JO Number: Leave blank.
O. Transporter's Phone Number: 0Enter a teleph0ne number Including area code where an authorized agent of the first transporter-can be reached in the event of
. . . ·an e~ergency_i,:i~_luding nights, weekends, and holidays... .... . . ... ··-···--. --··· . ' · .' · ' I
· -r..-·rranspoi1iir 2·compiln)' Name:-11 appliCabte·,-en1er the company name or the second transporter who wilf lran'SPOrt th'iW8ste. lr'more th.ln 2 transoorters W
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:ing the was: .
8 •. U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number ol the second transporter idenlilied in item 7.
E.. State Transporter's ID Number:. Le_a'!e ~lank. . ""'·"'' . .., .,.~ ~--=-~· ·-' I
F .. Transporter's Phone Number: Enter a telephone number including area code where_an authorized agent of the second transporter can be reacr.e-: in I
event ol an emergency•including nights. weekends, and holidays. · •• r-• ·<:: ·-.: "'.' ·.•,; ,.. •
9. Designated Facility Name and Site Address: Enler the company name and site address ol the treatment. stqr<;',g~_.~0!51i~P..<:!~a) l<!S,i.li~y ':_1~signat!c :o .;eceive rhe
waste listed on this manilesl The addre::;s must be the site address. which may differ from lhe mailing address. · I
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit Identification number ol the designat.ed trcotment, st0r89C, or disposai lacili!y id.en:ifie'! .n item 9."
G:. State Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter ·a telephone number including area code where an authorized agent of the facility can be reached in :he ·event or an
emergency including nights, weekends. and holidays. ~
11'. U.S; DOT Descriptions: En1er proper shipping name, hazard class and ID Number (UN/NA) !or each waste as identified in 49 CFR 171 •, 77. l! aCCi:icnal soat
is needed. use a U.S. EPA forf!18700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. ", .. ,.. . , .. ,-~ ,. _
12.. Containers {no. and type}: EntE!r number ol containers !or each waste and the appropriate abbreviation lrom Table I (below) lor the t-1pe or containers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases, rcilt cHs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic Oags
13 .. Total Ouanlily: Enter total quanlity of waste describe"d on each line, relative to lhe units used in item 14. I
14. Unit (weighl/volumeJ: Enter the appropriate abbreviations rrom Table II (below) !or the unit ol measure: 1·' ··
Table II
p • Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid onll
I. Wash! Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpa~s C ar:d 0
identity the hazardous waste on each tine.
J. Additional Oncriptions for Materials Listed Above: In the spaces provided, enter the authorization number (lrom the S.C, DHEC Authorization AeQuesl Form)
for each waste stream listf!d in section 11 above. Nole: Belore any hazardous waste can be accepted lor trealmenl. storage or disposal in South Carclina. tne
generator must obta.in prior authorization from !he lreatment, storage or disposal facility. "· ·-··---., · · 1
K. Handling Codes tor Wasles Lisled Above: Leave blank. -
tS. Special Handling lnslrucllons and Additional Information: Generators may use this space to indicate special transportation. treatment storage or disoos
information or Bill of Lading Information. For international shipments. generators must enter in this space the poinl ol departure (city anc: s:atel !or :nose
stiipment5 destined ror treatment. slorage, or disposal outside the jurisdiction of th8 United Slates. · ·. , ! ~. . I
16. Generator Certification: The generator mus! READ,.SIGN (BY HAND IN INK), and DATE the certification statement. If a·mode other than highway is used.:
word '"highway'" should be lined out and the appropriate mode (rail, waler .or air) inserted in the space below, II another mode in additior, to o-,e highway rnoc:e
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION . I 11: Transporter 1 Acknowledgement: Enter the name ol lhe person accepting the waste on behall of the first transporter. That person rr.us: acknowleC
acceptance ol the waste described on the manifesl by signing (BY HAND IN INK) and entering the DATE ol receipt , · · =
t8. Transpor1er 2 Acknowledgement: Enter, if applicable, the name al the person accepting the waste on behalf ol the second transporter. That perscn mus:
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or feceipt . J
FACILITY SECTION , , · .
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator musl note in this space any discrepancy betwe _
the waste described on the manilesl and lhe waslo actually roceivod at Iha facility, Owners and operators ol facilities who cannot resolve. s1i;nifican1
dl1crepanc:ies within 15 days receiving tho waste must submit to the Department a leUer with a copy cl the manliest describing the discrepancy and a:-:~mots I
reconcile ll The treatment. storage. or dlspoaol lacillly mus! enter the actual weight ~I waste In pounds In the spaces provided ii the amount varies any !rem :r:
si,ecilied by the generator in ilcm 13 or ii !he generator uses a unit or mens11re other than pounds. . .
20. Facility Owner or Operator Cerlilicalion: Print or type the name ol the person accepting the wasle on behalf ol 1he 'owner or operntor ol the lac1l11y. ThJ.! ;Jerson
must acll:nowledge acceptance ol tho waste described on tho manifest by SIGNING (DY HAND IN'INK)and entering the DATE of receipt.
,, AS~•STANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT. STORAGE, OR DISPOSAL FACILITY DESIG .. ATEO Tl
RECE•·:<. THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (B03) 734-5200 WEEKOAYS FROM 6:00 am TO 5:00 pm.
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stroo~ Columbia, SC 29201
Phone: [phone]
Emergency & Holiday,: (803)734-5'24
lt..£.UE PRINT or TYPE (Form desinned for use on elfte r,2-pilchl tvnewriler)
UNIFORM HAZARDOUS 11. Generator'sU.S.EPAIDNo.
Form A nroved. 0MB No. 2050-0039 E.tpires 9.30.ga
Menlreet 12. Page 1 . Document No. of
1
lnlormation in the shaded Meas is n01
required by Federal law, but is by Stale law.
j
WASTE MANIFEST N, c, o, O, Q, 7, i;, O, , .. 7, l· '--0,0,1,,,4
1 Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4.Generator'sPhonel· 919 I 934-9711
5. Transporter 1 Company Name
Willms TruckinP Co Inc.
7. Transporter 2 Company Name
9. Designated Facilit)' Name and Site Address
GSX Services of SC, Inc.
6. U.S. EPA ID Number
1 S • C• O• O• 7· ,. 7• ,... Q, 71 Cl
8. U.S. EPA ID Number
I o o o o • • I O I \ I
10-U.S. EPA ID Number
cJ,,;;:ie ·•:•:• ·· a .. -._ .. "--:'':.J).::'._'" .,. '',,7. "~ m a'Pf>oM',i:,.:nno /.7<-7L~~-~~>:.';
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11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number) 12. Containers 13. Total Quantify 14.Unil =·L\Watlltt.nbw~
. No. Type 'MNd '\f\i~':/iff.\VJ~if{'.
L 1'/i" tofl,-i;,~ Hazardous Waste, Solid, nos ORM-E ,1J t;
N 1-.:N:.'.:A~9~l~B'..:9:__ ______________________ ~µ•L· _J•.:1...J'.:'.o_J,_:T..J.-.1•-1•-1•.:2.1,~o..J.-..:Y~..:::l!!':::f::•::P::•~a::•::6:!1Z-J?t.
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15. Special Handling lnstrucfons and Addilionat lnrormalion
GSX Work Order No.: 71828
1tl. Cl[NERA TOR'S CERTI_FICATION: I harabydael•r• Iha! lho CQnlan1s Oflhls eonalgnmanl .,. fully and •eeuratolyda,crlbed abov• by p,o~r •hipping name and a,. cla ..... n-.d,
packed. marked, and labeled. and era In all respects in proper condition tor 1ransport by highway according to appHceble International and national governmenl r.,gutaUon• ar>d
u,e law, of the Stale ol Soulh Carolina. ·
111 am a large Quantity generalor, I certify that I have a program In place lo reduce the volume and loxfcltyol wastagenereled lo the d&gt-1 have determined to be economteally
pracocable and that I have selec1ed the practicable method of treetment. storage, or dl1poaal currently available to me which mlnlml:us Iha preaent and lutura thtMI to human
l'leallh and the environment; OR, 1ft om a smoll quontltygonorolor. I have mado a good lailh effort to minimize my waste generation and select the beal wa,te managamenl methOd
tl'lat iJ availatito 10 me and lhal I con ol!ord.
Printed/Typed Name RO.GER L. COATS I Signature
T 17. Transporter 1 At;Knowledgement of Receipt of Materials U
Month Day Yw
10, c;,l),71,1';7
'.;: f---'-p-,-,-'in;;.ted=,c.T;.:;yp.;,ed __ t.:ia"'m","'--===..::..=======----T"C l..§JSi,-g-nnata-,-u,-•--1...-\J_.::::.....'-. ___________________ M_o_nltl--O-a_y_Y,,,oar-l
I ~~ .""-'"Tl>..""--'\ rw ~ ~ 10,"\•0i')ll!l,-,
R 18. Transporter 2 Acknowledgement ol Receipt of Materials ~
T Printed/Typed Name I Signature Month Day Ye.at
I . I , I ,
19. Discrepancy Indication Space
: •l~..w''-'--'-~
F, b~I..__.__,_,_,_
jibs. C I jibs.
jibs dj l'bs.
l;-1--------------
1 ~ 20. Facility Owner or Operalor; Certirica!lon of receipt ol hazardous malerials covered by lhls manilesl except as noted In llem 19.
Printed/Typed Name I Signature Month Day y..,
I , I , I '
PA Form 8700-22 (Rev. 9/86) Previous Editions nre Obsolete (DHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ~ . · 1
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter} OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST 8~ LE9rBLE!
GENERAL INFOAP..IIATION: Federal Regulations require genP.ratOrsand trnnsporters ol hazardous waste and owners or operators of hazardous waste trea:menl
storage, or disposal licit/ties 10 use the U.S. EPA Form 8700·22 Rev. 9/86 (OHEC 1988 (REV 10/86)] and, if necessary, lhEI continuation sheet U.S. EPA For
8700-22A Aev.-9186 (DHEC 1988A) for" bo1h inlcr-stale and intra-stale trnnsportation, Trnnsporters who lransport hazardous wasle into the United Stat~s rro,
another country are responsiD!e !or completing !he manifest. Federal and Siate regu!alions also require generators and transporters of hazardous ·,o;asie aM
owners er operators of hazardous waste treatment, storage, or disposal raci!ities to complete the following information. I
GENERATOR SECTION
1. Generalor's U.S. EPA 10 Number. Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manilestbythe generator beginning wilh 00001.11 your company does no! have a U.S. EPA Identification Number. please con:acl 5.1 OHEC at [phone] about obtaining an ldenlificalion number. . ,
2;. Page 1 of: Enter the total number of pages used to complete this manHest,i.e .• the liist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (P.EV 1 Ot86)j ~lus th
number ol contiiiuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. ·
A. State Manifest Document Number. .Leave _blank.
e: Slate Generalor ldenliftcallon Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address al the gen.erator who will manage the returned maniles! rorms.
A. Generator's Phoiie Number: Enter a telephone number with a_rea code where an aulhorized agent of the generator can be reached in.me.even: al an
emerg~ncy including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. I
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit idenlilicalio;; nurTlber al the first transporter identified in item 5. ·
C. Slate Transporter's ID Number:. Leave blank: , . ~
O. Transporter's Phone Number: Enter a telephone number including area code Where an authorized agent ol the first transporter.can be reached in the event al
. . an ery:iergency_i~j:luding nights, weekends.and holidays... .... ... ··-··--·-···· ... . ·.· .'. · .•. ··1
• 'T,."-TM!nsporter 2·compan·y Name:-n applicabte;enlE!flhEfc·o"mpanyname of the second transporter who will transport the waste. JI more than 2 trans;,orters w
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be lransoor:ing the was: .
8.. U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
· E .. SI.ate Transporter's ID Number: Leave blank. · · , ~ · = · I
F •. Transporter's Phone N~mber_: E~ter a telephone number i_ncluding area code where_an authorized agent ol the second t~an;p_o~e~e-c~n !Je r~:cr,e: in th
event ol an emergency including nights. weekends, and"hohdays. . 1
· ·
9. Oesignaled Facility Name and Sile Address: Enter_lhe company name and site address al the treatment. storage, o~ disp_osa_l lacili!y d_esignateo :o,receive the
waste listed on this manilesl The address must be the silc address. which may differ from !he mailln.g"' addr;ss.. ' ' -· ' · ··' · · ,· I
10. U.S. EPA ID Number: Enter the U.S. EPA tw8\~e digit Identification number ol the design?.t/~d treot.rnep.t..~~Or3g~.1or dis~osot!~cility ident;!ied 1r'! 1ter:n 9.
G:. State Facility's 10 Number: Leave blank.
H;. Facility's Phone Number: Enter a·teleph0ne nurTib8r including area code where an auihorized ag8nt of the racility can be reached in the event al an
emergency including nights, weekends. and holidays. . · I
11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identilied in 49 CFR 1 71 • 1 ii. ti aCCi:icnal s;iac
is needed, use a U.S. EPA Form 8700-22A Rev_. ~/86 (OHEC 1988A) Continuation Sheet. _ , '"', ,,. ,,._ • ..,,,,,-.,,,.-. ,,,,-.-.~ ., . _., .
12.. Containers {no. and type): Enter number of containers !or each was10 and the appropriate abbroviatioi-flrom Table I {below) lor !he tyD<:? or containe'rs TABLE I -. •. -. ' , •. . ·~
OM= Metal drums, barrels, keg_s TT= Cargo tanks (tank trucks) ~.t-.1 = M~~a) ~o~~~•-S?~9ns._c~as_:s._r;!.~ ,o/1s ..•
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases ··
OF=. Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic ::iags
13 .. Total Ouantily: Enter total Quantity ol waste describe"d on each line, relative to the units used in item 14. ,--.~ •r••·· ,~ (' ... I
T4. Unit (weight/volume): Enter the appropriate abbreviations !ram Table II (below) lor the unit ol measure:
Table II
P • Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid on!I
I. Wasle Number:· Enter hazardous waste numbers as specified in South Carolina Hazardous Wasle Managemenl Regulation R.61-79.261 Su~par:s C ar:d 0
identity the hazardous waste on each line. .
J. Additional Oescriplions tor Materials Listed Above: In the spaces provided, enter lhe aulhoriz.ntion number (lrom the S.C.-DHEC Authoriza1ion AeQuesl Form)
tor each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted lor treatment. storage or disposal in South Car~lina. tne
generator must-obtain prior authorization from the treatment, storage or disposal lacility. .. . •· '
K.. Handling Codes lor Wasles Listed Above: Leave blank. ·
15. Special Handling Instructions and Additional Information: Generators may use this space lo indicate special lranspor1ation, treatment. storage or dispos
information or Bill ol Lading Information. For international shipmcnls, generators must enter in this space the point ol departure (city and s:ate) lor :nose
shipments destined for lrealment. storage, or disposal outside the jurisdiction of lh8 United Slates. · ~ .. . -1
16. Generator Cer1ilicalion: The generator must REA0,·s1GN (BY HAND IN INK), and DATE lhe cerlilicalion statemeht.11 a mode other than highway is used.:
word .. highway" should be lined out and the appropriate mode (rail, water. or air) inserted in the space below. ti another mode in addition 10 u·,e highway r.ioce : . . . • ,· • 1,.,. .s:-; ( •
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION . -I
11: Transporter 1 Acknowledgement: Enter the name of the person acce'pting the waste on behalf of the first transporter. That pe~son mu~': acknowleC
acceptance ol lhe was!e described on the manifest by signing (BY HAND IN INK) and entering the DATE al receipt. · • ,· '
18. Transporter 2 Acknowledgement: Enter, if applicable, the name ol the person accepting the waste on behalf ol the second.transporter. That person mus:
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HANO IN INK) and entering lhe DATE or receipl -,
FACILITY SECTION . ·.
19, Discrepancy Indication Space: The aulhorized represenlative ol lhc designated facility's owner or operator musl note in !his space any discrepancy !:letwee
!ht wute described on the manilosl ond the waela actUul1y recaivod at Iha facility, Ownera ond operators ol facilities who cannot resolve si;n1licant
dl1crepancies within 15 days receiving the waste must submit to the Department a letler with a copyol the manUesl desc·riblng !he dise,f!Paney and ar:emo1s I
reconcile iL The treatment. slorage. or disposal laclllty mus! enter the actual weight ~I wasle In pounds In the spaces provided if the amount varies any rrom :r:
soecil,ed by lhe gene,ator in item 13 or ii the generator uses a unit ol me;1s11re other than pounds. . . .
20. Facility Owner or Operator Certification: Print or type the name ol the person accepting the wasle on behalf ol the owner or oi::ierntor ol the l.:icdity. Th;:it ~er son
must acknowledge acceptance of the wosle described on the manifest by SIGNING (BY HAND IN INK)and enlering the DATE of receipt
,, Al!'1s'rANCI ts Neeoeo IN COMPLSTtON OP THIS MANIFEST, CONTACT THE TREATMENT, STonAOE!, OR OISl'OSAl. PAC1L1rv oesic~u.rao Tl
AECE"','~ THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
' and Environmental Control
Bureau of Solid & Huardous Waste Mgt
2600 Bull Street, Columbia. SC 29201
Phone: [phone]
I
I
i
I
Emergency & Ho!iday5.: {803)734-5-424 If E PRINT or TYPE (Form de,lnned for use on ellle [12-pllchl lvnewrller)
UNIFORM HAZARDOUS 11, Generalor',U.S.EPAIDNo.
WASTE MANIFEST N, c, n, o, q, 7, <. O, ~. 1,
Form A roved. OMS No. 2050-0039 E.xpires 9-30-!.8
Manlfeet 12. Page 1 . Document No. of I• '··0,0<l,3,5 · 1
Information in the shaded a<eas is nol
required by Federal law. but is by State law.
N
E l
0
R
1 Generator's Name and Mailing Address
Channel Master
P, 0. Box 1416, Smithfield, NC 27577
•· Generator·, Phone I 919 ) 9 34-9 711
5. Transporter 1 Company Name
Willms Truckin~ Co.
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc,
6. U.S. EPA ID Number CfSiiioT
, s, c, n, o, 1, 3, 1, n. g, 21 q · oWTi
8. U.S. EPA ID Number i
1 1 1 1 • • • • , t 1 1 FNT ., .. ,,<,,•\,:'•···•es, :s·"rii,,:':;;;:;;;.'.;;\h::1,i/<=·es.:·,~,//•·;c'..-''.;-fi,(i,~.'.(/3:r.-t,r
10. U.S. EPA ID Number
. !~~~:~0 !. B~~ ~~i 25 , S, C, D, 0, 7, 0, ~ 7, I !\ 8 '. 1,~f1:;;;ii1ifr;l~WJi/i1J4,~~~\~6o'12~
11. U.S. DOT Oescriptio.n (incfuding Proper Shipping Name, Hazard Cfass, and JO Number) 12. Containers 13. Total Quantity It Unit ,_.twa:itii~~-
No. Type WIN" :\FiH/·',:'H;:(j~,}~
L Hazardous .Waste, Solid, nos ORM-E
NA 9189 ,· ,I D ,T I o 12 10 y
b.
I ' ' ' ' I '
•.,-,•:, •', • ., •·'v·•• .. A6 <, 1L.....L-'--'-...J' ;{:
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GSX Work Order No.: 71829
,e. Gl!.NERATOR'S CERTIFICATION: I hereby declare that the content, ol thl, con1lgnmentarefullyend accuratelydo,crtbod above by proper 1hlpplng name ar,d uo claaa,fte<S.
pocked, marktK!, and la.beled,and are In ell ro,pect, In propercondlllon lor transpor1 by highway according to applicable Jnternallonal and national government r.gulatlona ar>d
tho laws Ol ll'le SUiia ol South Carolina.
HI am a 1arga ciuanllty generator, I certify that I have e program In place lo reduealhevo1ume and 1oxleltyol waste gariera1ed to Iha da,gr-1 have determlried to be ecOl'\Omblty
prae1ieabte arid that I have ,elected the proet!eable method ol treatmaril slorage, or dlapoaal currently available to ma which mlrilml:r;aa the praa.erit arid lut\Jra lhr-1 to human
haatlh and the envlronmonl; QA, II I am a amnll quanlltygonerotor, I have mado a good lallh effort lo mlnlml:i:o my waste generation and aa1ael Iha bell waata managamenl l'1'>eUiod
aiat la evaileblo to ma and that I eon oflord.
114--,P-rln_,ed_,_r_yp_ed_N_•_m_• __ R_o_.:_c_E_R_L._c_._o_·A·_-!·s-___ ls_;g_n_•l-ur_• _..././7~~µ..__..:,:.__;_ __/-= /1=-"" .~=i:...·· ____ 1.M::01.nlll.a.;OL.ayU£Y.Jw~ -'l{--~. 1-~ ,O,~,ASl~7
T 17. Transporter 1 Ac.:,mowledgemenl ol Receipt ol Materials ..,,,,..--...._ · /7
'r-::7":.:.rln::.::led_::.~:,;;T~::;ped..c•:.:.;:::a~::.::e===~::;~.:..::.:ffi=(::).::..:.:1£.5=::::..--.,.~-:ti"-gn,.,at-,u,_:,e '<"\_--'-'_'....._,,....--r1--,--=--=--=--=--=---_z'\------c(\M:-on-,,~111:----::-{'\D,\_Y_, l~-::\:-7)-i
~ 18. Transporter 2 Acknowledgement ol Receipt of Materials ( / \
T Printed/Typed Name ~ure Monttl Day Year
• I I ' I ' I ' I -+::-,9::-_-:D::-l-,c-,e-p_a_n_cy-l::-n::-dl::-c-a1::-;o-n"'.S::-p-a-ce----------,.;.,--'--------------------------,._..__., ..... _._.._"'1
F a L..I .L.J....L.'-'---'jlt.. c L..I .L.J....L.'-'---'!lbs.
~ bj pbo.dl pt..
'~1---------------~ 20. Facility Owner or Oper110r; Certltlcallon or receipt ol hazardous malerlals covered by this manifest except as noled In llem 19.
Prlnled/Typed Name I Signature Month Oay YNI
I , I , I ,
PA Form 8700-22 {Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)}
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST "' '"I
iMPORTANT: TYPE (on a 12-p;tch (el;te) typewrHer} OR USE FIRM POINT PEN· PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require genP.rators and transporters of hazardous waste and owners.or, operators 6f,hazardous.-~.a.~t~ trea:_menl
storage. or disposal ficilities to use lhe U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)) and, if necessary, the continuation sheet U.S. EPA For
8700-22A Rev.-9/86 (DHEC 1988A) for both inter•slale and intra·sl.itc trnnsportation. Transporters who transport hazardous waste into the United ~!ates lro
another country are responsible !or completing lhe manifest Federal and Slate regulations also require generators and transporters ot hazardous ·.-.·aste a~c
owners or operators or hazardous waste treatment, storage, or disposal facilities to complete the !allowing inlormalion. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to I.his manifest by the generator beginning with 00001 •. 11 your company does not have a U.S. EPA Identification Number. pte\is'e}on:a·c1 S'.]
OHEC at (803) 734•5200 aboul obtaining an ldentilication number. . . ·
2.:. Page 1 ol: Enter the total number of pages used to complete !his manilesl, i.e., the fifst page EPA Form 8700·22 Rev. 9/86 [OHEC 1988 (REV 10/86)] ~lus th
number or contiiiuation sheets EPA Form 8700·22 Rev. 9/86A (DHEC 1988A) H any.
A. Stale Manifest Document Number: .Leave blank. . ~-· -c. ._.1
B.: Slate Generator ldenHflcallon Number: leave blank. · , · "' ·r •·-
3. Generator's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage !he returned manifes: lorms.
4. Generator's Phoiie Number: Enter a telephone number wilh area code where an authorized agent of the·g·enerator can be reached in :he·e..,ent ot'i
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter lhe company name of the first lransporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the lirst transporter identified in item 5.
C. Slate Transpor1er's ID Number: Leave blank. ,.. '" ,. ·• .,si "·~ !c,~
0. Transporter's Phone Number: 0Enter a teleph0ne number including area code where an authorized agent of the first transporter.can be reache-:: in the e ... ent ol
. _. ·-,,,.. an en:ie!ger:,cr.ir:i~luding nights, weekends •. and holidays... _ .... . ... ··-···-.. ·. -··--... _ ·. · .... •'. '. · · -~ · ·· -' · ·-· 1 'I ·-r.. Transporter 2·company Nime:·-·11 ap·plic'able;enterthe company name al the second transporter who will transport.the waste. JI more than 2 transooners wi
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transocr.ing the was: .
8 •. U.S. EPA 10 Number:t! applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E., State Transporter's ID Number:::-Leave b,lank, ,· · , ... w.,c-rc tv1 .. •·· -, • .., , I
F .. Transpor1er's Phone Number: El1ter'a telephone number including area code where an authorized ag"ent ol the second tr'ansporter can t:e reacr:ec in th
event ol an emergency including nights, weekends, 8nd holidays.-· • • r---,r:-•o:-,: r , c-~· n ': .-· -
9. Design a led Facility Name and Sile Address: Enler the company n::imc and sile address ol the lreatmenl, slorage, or disposal facility desic;natec :o rece1 ... e the -• • • , _ ,,. ·!<> -,-,.~ ,, ... ;--• .,, ~na•::,.1 ~•<' '"\( ,,_ · -,.:,~(",· w·•• I(: .:, ·
waste lisled on this manilesl The address must be the site address, which may dilfer f~om'lhe mailing'nddress. · • • ·•
10. U.S. EPA 10 Number: Enter the U.S. EPA twel..,e ·digit identification number ol the designated trca~,:nent, _s!~~~9e'. ~~ ?!s'pos3t iad~ity ·iden:ifieC '':. item 9.
G:. Slate Facility's ID Number: leave blank. ·
H;. Faclllty's Phone Number: Enter a telephone number including area code where an authorized·agenl of the· facilily can be rea:ched in the.;e..,en1 ot an
emergency including nights, weekends, and holidays. · .
11: U.S; DOT Descriptions: Enter proper shipping name, hazard class and 10 Number (UN/NA) loreach waste.••. iden. lilied in. 49 CFR. 171-1 ii. II ac. Ci:icn.a! soacl
is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers {no. and type): Enter number of containers !or each waste and the appropriate abbrcviatiOn.rf'oni' T.a"b11!T.(belo~) ·r()t' the 'tyDe at c'on1a1ners.'
TABLE I . . .
OM • Metal drums, barrels, kegs TT• Cargo tanks (lank trucks)
OW II Wooden drums, barrels, kegs TC= Tank cars
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ans. cases
TP = Tanks ponable CY= Cylinders BA= Burlap, cloth, paper or p!as:1c Oass
CM= Metal boxes, cartons. ·cases. roll otts cW; wao·d;n b~~~s~~c-3rto~S. cases r: ·'.
13 .. Total Ouantily: Enter total quantity of waste describ8d on each line, relative to the units used in item 14 . .,, ••.• •·-o-• .,. ........ ,.. -
T4. Unil {weight/volume): Enter !he appropriate abbreviations from Table II (below) for the unit al measure: :; (
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only}
I. Waste Number: Enter hazardous waste numbers as specified in Soulh Carolina Hazardous Waste Management Regulation R.61 • 79.261 Suboar.s C ar:d D t'
identity the hazardous wasle on each line. '
J. Additional Dncripllon, lor Malerial, Listed Above: In the spaces provided, enter the authorization number(lrom the S.C. DHEC Authorization Reciuest Form
for each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted ror treatment. storage or dispos3:1 in South Carclina. 1ne
generator must obtain prior authorization lrom the lreatment, storage or disposal lacility. . ,.,. I
K. Handling Codes lor Wastes listed Above: Leave blank.
15. Special Handling lnslrucllons and Addillonal Information: Generators may use !his space to indicate special transportation. lre8tment. storage· Or dispos
information or Bill ol Lading Information. For inlernalional shipments, generators must enter in this space the poinl al departure (cit'{ and s:ate) lor tnose
shipments destined tor treatment, storage, or disposal outside the jurisdiction of lhE! United Slates. · .... t
16. Generator Cer1ilicalion: The generator must READ,·s1GN (BY HANO IN INK), and DATE lhecertification Stateme'rit.'H a mode other than hig.>iway is used,:'
word "highway .. should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. II another mode in addition to 11·,e hisnway r:,oc:e
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION . •. . . .. I
11: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behall of the-hrs! transporter. Thal person rr:ust acknowleC
acceptance ol lhe waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt: · ' · ·
TS. Transporter 2 Acknowledgement: Enter, ii applicable, the name al the person accepting the waste on behalf ol the second transponer. That perscn must
acknowledge acceptance al !he waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt . ..,
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative of the designated lacility's owner or operator must note in this space any discrepancy be twee
n,e waste described on the manifest and !he wasle actU.:illy receivod al lhe facility. Owners and operators of facilities who cannot resol ... e s1;n1licant
discrepancies w1thin.15 days receiving the wa.sle must submll to the Oeparlmenl a letter wilh a copy of the manllest describing the discrepancy and ar:emots I
reconcile it. Tl'le ueetment. storage, or disposal laclllly must enter the actu.:il weight ~I wasle In pounds In the spaces p,o..,ided ii 1·he amount ... aries any !rem :r:
specified by ll'le generator in ilom 13 or if the generalor uses a unit ol mcns\lre other than pounds, . .
20. Facility Owner or Operalor Cerllllcallon: Prinl or 1ype lhe name ol lhe person accepting the waste on beholl ol the owner or operator of 1ne f.3c1l11y. Tn:11 person
must aci<nowledge acceptanc·e of lho waste described on lho manifest by SIGNING (BY HAND IN INKf and entering the DATE or receipt
i, ASS<STANCE IS NEEOEO IN COM~LETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR. DISPOSAL FACILITY OESIGW,TEO Tl
RECf'':, THE WASTE OR·THE S.C. DHEC MANIFEST SECTION AT 1603) 734-5200 WEEKDAYS FROM 6:00 am TO s·oo pm.
,,:
I South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desi ned for use on elite 12· itch ewriler
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
Manltest Document No. 0 0 1 3 6
Form A
2. Page 1
of
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Street Columbia, SC 29201
Phone: [phone]
Emergency &.Holiday,: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded areas is not
required by Federal law, but is by State law.
4. !~~r~:r's!~o~e 14~~9 Srn~~~=~;ii' NC
27577 ;~-~~tyfd,[~*~~~t~tf!i(2~t~)t~t$f~~ t-"-'==~=..>-~:....J..----'-"'-'--"-'..0..,.----------------+''+F
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (incfuding Proper Shippfng Name, Hazard Crass, and ID Number}
Hazardous Waste, Solid, nos ORM-E
NA 9189
.,·
15. Special Handling Instructions and Additional Information
.GSX Work Order No.: 71830
12. Containers
No. Type
1 D T 2 0 Y
19. GENERATOR'S CERTIFICATION: I hereby declare that !he contents of this consignment are fully and eccuretelydescrlbed ebove by proper shipping name end are cla.-.ifled,
packed, marked, and laheled, and are In ell respects in proper condition lor transport by highway according to applicable International and national government regulaUona •~
tne taws of the St.ale ol South Carolina.
II I am a large quantity generator, I certify the Ir havo a program In place to reducethevoJumo and toxicity ofwaalegonerated to tho degree I have determined to be economic.ally
practicable and that I have selected tho practicable method ol treatment. storage. or dlspoaal currently available to mo which minimizes the pres.ent and luture tnr-1 lO human
health and the environment; OR, if I am a smull quanllty generator, I have mado a good laith eltor1 to minimize my waste generation and select the beat waate management method
that 11 available to me and lhal I can allord.
Printed/Typed Name Signature Day Year
17. Transporter 1 Ac,;Knowledgement of Receipt ol Materials
Signature
Printed/Typed Name Signature Month Day Year~
..
19. Discrepancy Indication Space
• I jibs. C I pbs.
b I pbs. di pbs.
20. Facility Owner or OperalOr: Certiricallon of receipt ol hazardous malerlals covered by this manifesl except as noled In Item 19.
Prinled/Typed Name Signature Month Day Year
PA Form 8700~22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
iO:f
···~
'!i':'i
;;M
. ,
. !
l '
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12.pilch (elite) typewriter) OR USE FIRM POINT PEN• PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
·GENERAL INFORMATION: Federal Regula!ions require generators and.transporters of hazardous waste and owners or operators or hazardous waste treatmenl
storage. or disposal licilities to use the U.S. EPA Form 8700·22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA For
8700•22A Rev:9/86 (DHEC 1988A) loi bolh inter·state and intra-state transportation. Transporters who transport hazardous waste into the United States fro,
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operators of hazafdous waste treatment, storage, or disposal facilities to complete the following information. I
GENERATOR SECTION
1.
2;.
A.
B:
3.
••
5.
6.
C.
0 .
1:.
8 ..
E.
F ..
9.
10:
G:.
H;.
11·.
12..
Generator's U.S. EPA IO Number -Manilesl Document Number: Enter the generator's U.S. EPA twetve digit identification number and the unicue live digit.
number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA ldenlirication Number. p!E!ase con:act S.1 OHEC at [phone] about obtaining an Identification number.
Page 1 of: Enter the total number of pages used to complete this manirest, i.e., the liist page EPA Form 8700-22 Rev. 9/86{0HEC 1988 (REV 10186)1 plus :h
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
Slate Manifest Document Number: .. Leave blank. · .
State Generator ldentrficatlon Number: Leave blank.
1 I
Generator's Name and Mailing Address: Enter the name and ma,lmg address al the generator who will manage the returned man1fes: forms -t
Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached In the event ot an
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ot the lirst transporter identified in item 5.
Slate Transporter's 10 Number: Leave blank.
Transporter's Phone Number: "enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event ol
an e~ergency. including nights, weekends, and holidays. . . '1; ·, ·; • ,;' ' .. I
Transporter 2 c~·,;,pany Name: II applicable, enler the cOmp~·ny rlame Qi the seCO"~'tiirans·p-orte'r' who wili'1ra·n·spOrl the waste. II more thari 2 trans';:,orters wi
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transpo~ing the wast .
U.S. EPA 10 Number:ff applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
Stale Transpor1er's ID Number: Leave blank. I
Transporter's Phone Number: Enter a telephone number including ar_ea code where an authorized agent of the second transporter can be reacheC in th
event of an emergency including nights, weekends. and holidays.
Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated 10 receive the
waste listed on this manifest The address mu.st be·the site address. which may differ from the mailing address. I
U.S. EPA ID Number: Enler the U.S. EPA twelve digit identification number ol the designated treatment, storage, or disposal facility identified in item 9.
Slate Facility's ID Number: Leave blank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event al an
emergency including nights. weekends, and holidays. · · I
U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number {UN/ NA) lor e_ach was le as idenlilied in 49 CF.A 17 l -1 77. lf addi:ianal s;:iac
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ·
Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) for the rype ol containers.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. canons. cases. roll atfs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons, cases I
OF = Fiberboard or plastic drums. barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plas:ic Oags
13 .. Total Quantity: Enter total quantity of waste describeid on each line, relative to the units used in item 14. I 14. Unit (weight/volume): Enter \he appropriate abbreviations from Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid onlY.I
I. Waste Number: Enter hazardous waste numbers as speciliedin South Carolina Hazardous Waste Management Regulatio. n R.61-79.261 Subpalis C ar,d O t
identify the hazardous waste on each line. . • ·
J. Additional Descriptions !or Materials Listed Above: In the spaces Provided, enter the authorizalion number (from lhe S.C. DHEC Aulhorization Request Form)
lor each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted tor treatment storage or disposal in South CarC"lina. the
generator must obtain prior authorization lrom the treatment. storage or disposal facility. J
K. HandHng Codes !or Wastes Usled Above: Leave blank.
15. Special Handling lnslructions and Additional Information: Generators may use lhis space to indicate special transportation, treatment. storage or dispos
information or Bill of Lading Information. For international shipments. generators must enter in this space the point of departure (city and s:atel !or those
shipments destined for treatment. storage. or disposal outside the jurisdiction al the United States. , . · I
16. Generator Certification: The generator must AEAD,.SIGN (BY HANO IN INK), and DATE thecertification·stattiment.II a lllode other than highway is used. m
word "highway" should be lined out and the appropriate mode (rail, water .or air) inserted in the space below. fl another mode in addition to the highway rnode i
used, enter the appropriate additional mode {e.g.,.and_rail) in the space below.
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: 'Enter the name of the perSon accepting the Waste on behalf of lhe first transporter. That person must acknowledgl
acceptance of the waste described on lhe manifest by signing (BY HAND IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter. if applicable, the name ol the person accepting the waste on behalf al the second transporter. That person must
acknowledge acceptance al the waste described on the manifest by SIGNING {BY HAND IN INK) and entering the DATE ol receipt. I
FACILITY SECTION
19. Discrepancy lndicalion Space: The authorized representative ol the designated lacility's owner or operator must note in this space any discrepancy be twee
the waste described on the manifest.and the waste actUally received at !he facility. Owners and operators ot facilities who cannot resolve signilicant
dl1c,er,ancles w1tt'lln 15 days receiving the waste must submit to the Der,artment a letter with a copy ol the manllesl describing the discrepancy and ar:em~ts I
reconcite il The treatment, slorage, or disposal lecillly must enter the actual weight (!f waste in pounds in the spaces provided ii the amount varies any tram tr.
specified by the generator in item 13 or ii the generator uses a unit of meas11re other than pounds. . .
20. Facility Owner or oi,erator Certilication: Print or type thenameol the person accepting.the waste on behalfol \he owner or operator of the lac1lity. That person
must acknowledge acceptance ol the waste described on the manifest by SIGNING {BY HANO IN INK) and entering the DATE ol receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATEO Tl
.RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Ha.z.ardous Wa..ste Mgt.
2600 Bull Stree~ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: (803)734-5"2( t 'HE PRINT or TYPE (Form designed for use on ellle 112-ollchl "'"ewdler) . Form A oroved. 0MB No. 2050-0039 E.xoires 9-30-88
UNIFORM HAZARDOUS I'· Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N, c, D, 0, 9, 7, i:.. 0, 4, 7,
Manlfe•t
1
, 2. Page 1
, Document No. of 1, ,-.o, 0, 1, 3, 7 1
Information in the shaded areas is not
required by Federal law, but is by State law.
.. 1 Generator's Name and Mailing Address
Channel Master -~t:;;~~-;~,:~~~j!:H:ttf};;:~-~)~t:
:il~l~~tlR~~i~lii:it~ti~11~}~({\~/~;~;tiIVlti~~i·
I = N
E
I ~
0
R I
I
I
I
I
P. 0, Box 1416, Smithfield, NC 27577
( Generator's Phone( 919 I 934-9711
5. Transporter 1 Company Name
Willms Truckine Co.
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
. 6. U.S. EPA ID Number
1 S, C, Dr O, 7, 1, 71 Or q, ?, ~
8. U.S. EPA ID Number
I I I I I I I I I I I
tO. U.S. EPA ID Number
, s, c, D, o, 7, 0, 3, 7, '
11. U.S. COT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity 14.Unil ,_·l'.wafa'~.
No. Type 'M/VIJ. \{('\1>,YN:*;·k~
a. Hazardous Waste, Solid, nos ORM-E
NA 9189 , · ,1 D 1T , , ,2 ,o
b.
I I I 0 I I 0
C.
' ' I . I I I I
d.
I 0 I ' ' ' '
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 71831
1e. GENERATOR'S CERTI_FICATION: I hereby declare lhatthe contents ot lhlscon•lgnm•nt•r• lullyand accuratelyde,crlbod •bov• by prop,u •hipping nam• •nd ara cl ..... fled.
p.cked. marko<I, and labeled, and are in an respects In proper condillon lor lr11nspor1 by highway according to appllcable lntam11Uonat and national gov•rnment r.g"t

■
tiOf'I• ar>d
tna laws ol lhe Stale ol South Carollna.
111 am a large ciu11nllty generator, I certify lhat I have a program In place to reduce the volume and IOJ11lcltyol waste generated lo Iha d09r-1 have determined lo b9 aconomaity
practicable and that I have selected Iha practicable melhod ol trealmenl slorage. or dlspoaal curranlly available to me which minimizes the pr11aenl and !uh.Ir• tnr-1 IO hum.an
heallh and 1h11 environment: OR, II I am a smon quontltyganerotor, I have made a good laith etlor1 to minimize my was1e generation and 1alec1 the be11 wa11a managamanl ~
'lh.al i1 available lo ma and that I can atto,d. ·
Printed/Typed Name .ROGER L COATS . ,. .. . '-~---I Signature -'-,, Month Day Year
16,9', o,, 1,5'-;7
~ ,_11_.-::Tc,r:-a,-ns_,,o,,o=rt_e_r_t,-A7c_,_no_w_led-"-ge_m_e_n_1_o_l_A_e_ce_ic,.p_10_f_M_a_1_er_la_l_s ___ -r:::--:-:-------..:;,.U-,.,------------------:-:-.,..---::---::---
I Oj ~~Pr~i~~~~~~~4~l~~~~N~2Lme_~A~~~~.~~~~~=~---ll~:i=·;~•A ~~~Mll~j/!~~ Q,~~-~---------~~~~~~
Month Day Year ,,....., .,..,,,,,,,1<:-J . ,:;
R ~1...:8::... _T_ra_n...c,po..:.:.n•::..'..:.:. 2A...:c_kn...:o...:w...:l•:..:d.:.g•::..m_•...:n::..l'o::..ll-'-R-'e-'-ce:.;ip...:l..:.o:..I M_•:..'•::..•_i•..:.''----rc-'/"'. / ____ , _____ .,_ ,,.,-;~7'-----------------::----cc-
l -i+_P,,ri_n,_ed_,_r_yp_ed_N_•_m_• ______________ ... 1s_,g_n_._,u_,. _____________________ ...,_.__.._.__ ....... -1
Month Day Yw. ~
I ' I 1 I 1 "~11
19. Discrepancy Indication Spa_ce
F •I
1 il---=-c----..,,.--...,.----b, ............... _._~
;::;: 20. Facility Owner or Operator; Cermicallon of receipl of hazardous malerials covered by this manifest except as noled In l!em 19,
pbs. C I pti.
pbo. d I ptis.
Prinled/Typed Name I Signature Month Day Yoat
I , I ' I '
PA Form 8700-22 (Rev. 9/86) Previous Edlllons nro Obsolete (DHEC 1988 (Rev. 10/86)}
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: 1YPE {on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN· PRESS DOWN HARO ALL COPIES MUST-BE LEGIBLE!.
GENERAL INFORMATION: Federal Regulations require generators and lransporte.rs of hazardous waste and owners or operators of hazardous waste tre~·1menl
storage. or disposal licililies lo use the U.S. EPA Form 8700~22 Rev. 9/86 [OHEC 1988 (REV 10/86)] and. ir necessary, the continuation sheet U.S. EPA For
B700-22A Rev.-9I86 (DHEC 1988A) ror b0olh inter-stale and intra-st.itc lr,1nsportalion. Trnnsporters who lransport hazardous wasle into the United States Ira,
another country are responsible lor completing the manilesl. Federal and Slate regu!alions also require generators and transporters ol hazardous ... aste and
owners or operators of hazardous waste treatment. storage, or disposal facilities lo complete the following information. I
GENERATOR SECTION
Generator's U.S. EPA ID Number -Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manifest by the generator_~egi_nning with 00001. llyour company does not have a U.S. EPA Identification N_umber. please con:act S.1 1.
OHEC at [phone] about obtaining an ldenhl1cat1on number. · ·
2.:. Page 1 ol: Enter the total nu~berof pages used to complete this manirest, Le .• the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] i:;:lus !h
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1968A) ii any.
A. SUie Manifest Document Number: .Leave blank.
Stale Generalor Identification Number: Leave blarik. I a:
3. ••
Generator's Nam~ and Mailing Address: Enter the name and mailing address ol the generator who will manage the returned manifest forms.
Generator's Phone Number: Enter a telephone number with a,rea code where an authorized agent ol the generator can be reached in :ne event cl an
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number or the first lransporter identified in ilem 5. ·I
C. Slate Transporter's 10 Number: Leave blank.
0. Transporter's Phone Number: Enter a lelephOne number includi_ng area code where an authorized agent ol the first transporter.can be reacrie~ in the event cil
an emergency including nights, weekends, and holidays. · · · · ' · I
rran~porter 2 c~·~pany Name:-·Irap"pllcable;enIer the cOmPa~y rlame Oi the seco·n·dirBn'iPOrte'r who wilf tra'n'SpOrt the waste. II more than 2 lrans;:,orters w
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) con_tinuatlon sheet and list the transporters in the order they will be transoor.ing the was! .
U.S. EPA ID Numbed! applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified !n item 7.
State Transporter's ID Number: Leave blank. · . I
F.. Transporter's Phone N~mber: E~ter a telephone number '.ncluding area code where_ an aLlhoriz~d agent ~Ith~ ;e~~~d "tra'nsporter can_ be reac·r.ed in th
event ol an emergency rncludmg nights. weekends, and holidays. · • · ··"' · · · :.·
8 ..
E ..
9. Oesignaled Facility Name and Sile Address: Enter lhe company name and site address of the treatment. storage, or disposal facility designatec :c ·receive the
waste lis1ed on this manilesl The address mus! be the site address, which may dilfer from the mailing"'a'cid"resS: ~-~ ,,,... ~~ ·• · · ~ •
10.
G:.
U.S. EPA 10 Number: Enter the U.S. EPA lwelve digit identification number ol the designated treatment, storage'. or disposal lacility identified ;n item 9. I Slate Facility's 10 Number: Leave blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the even! al an
emergency including nights, weekends, and holidays.
U.S: DOT Descriptions: . Enter i:,roper shipping name, hazard class and ID Number (UN/NA) lor each waste as identified in 49 CFR 171-1 ii. I! aCc::i:icnal s::iacl 11:
12..
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. . . . . . , .,, ,,...,.,.. .,, ,
Conlalners (no, and type): Enter number of containers for each was\e and the appropriate abbroviation from Table I (below) for the type ol containers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (lank trucks) CM=_ Metal ~oxes. cartons, cases. rcll cHs
OW II Wooden drums, barrels, kegs TC= Tilnk cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plas!ic boxes. car:ons. cases
TP = Tanks portable CY:: Cylinders BA= Burlap, cloth, paper or plastic Oags
13 .. Total Quantity: Enter total quantity or waste described on each line, relative to the units used in item 14. • •.. ,, . -.,-..... " -
t.s. Unil (Weight/volume): Enter lhe appropriate abbreviations from Table II (below) for the unit ol measure:
I
I
Table 11
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid onl'
L Wasle Number: Enter hazardous wasle numbers as specilied in Soulh Carolina Hazardous Waste Management Regulation R.61 -79.261 Sub;,alis C ar.d D
identify lhe hazardous waste on each line. ·
J. Addilional Oescriplions tor Materials Llated Above: In the spaces provided, enterlhe authorization number(from the S.C. OHEC Authorization AeQuest Form
for each waste stream listP.d in section 11 above. Nole: Before any hazardous waste can be accepted lor treatment. storage or disposal in SoUth Carclina. tne
generator must obtain prior authorization lrom !he trealment, storage or disposal facility. ' · . I
K. Handling Codes lor Wasles Usled Above: Leave blank.
15. Special Handling Instructions and Addilional lnformalion: Generators may use this space lo indicate special transportation. treatment storage or disooso
information or Bill al Lading lnlormalion. For international shipments, generators must·enter in this space the point ol departure (city and s:aIeJ !or tnose
shipments destined tor treatment. slorage, or disposal outside !he jurisdiction of th8 Uniled Slates. · · . : '· · .. ,-. . " , I
16. Generalor Certilicalion: The generator mus! AEAD,.SIGN (BY HAND IN INK}, and DATE the certification slal~men1.·11 a ~od~ other th~n highway is used.:
word '"highway" should be lined out and lhe appropriate mode (rail. water.or air) inserted in lhe space below. II another mode in addition :o tr.e hignway moc:e. "
used. enter the appropriate additional mode (e.g.,.and rail) in the space below. · · .· · · · ·
TRANSPORTER SECTION . I
17: Transporter 1 Ackno·wledgemenl: Enter !he na_me of the person acc~pting the waste ~n behall ol the lirst trans.porte;,.-That p~rson rr.usI·acknowleC
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE or receipt. • ·
TS. Transporter 2 Acknowledgement: Enter. if applicable, the name ol the person accepting the waste on behalf ol the second Iransporter. That perscn must
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt ·,,
FACILl1Y SECTION .
19. Discrepancy lndical_ion Space: The authorized representative ol the designated facility's owner or operator mus! note in this space any discrepancy betwe _
u,, waste dt1crib1d on !ho manihnl and lht waslo oclUotly rtc:eivod al !he locility, Owners and oporators of facilities who cannot resolve s1;ndicanI
dl1erei:,ar,cies w1Ihin 15 daya receiving the wasle must submll lo the Deparlmenl a letter with a c:opy olthe manifest describing the discrei,ancy and a:-:emou I
rec:oncite it The Ireatment :slorage. or dlsposal lacillly must enter !he actual weight ~I waste ln pounds In lhe spaces provided ii !he amount varies any !rem Ir:
si:;iecified by lhe generator in item 13 or ii the generalor uses a unil of meas11re other lhan pounds. . . · ,
20. Facility Owner or Operator Certillcalion: Prinl or type the name ol the person nccepling.the waste on beh.ill ol the owner or operator or \he l.'.lc1f,t-,,. Th JI ::,er son
must acl(nowledge acceptanc·e ol tho waste described on tho manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
11• AS!i!,1STANCB 1s NEEDED IN COMl'LETION OF TH1s MANIFEST, CONTACT THE TREATMENT, sroRAGE, OR DISPOSAL FACILITY oes1c~u,reo rl
AECE1•.•~ THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 ,,m TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haurdou, Waste M9t
2600 Bull Stree~ Columbia. SC 29201
Phone: (BOJJ 734-5200
Emergency & Holiday~ (803)73-1-5-124
IE.A.SE PRINT or TYPE {Form desianed for use on ellle r12-oitchl tvnewriler)
UNIFORM HAZARDOUS 11. Generator's U.S. EPAID No.
Form A nroved. 0MB No. 2050-0039 Expires 9-30-88
M11nlteet ii 2. Page 1 . Document No. of l lnlormation in the shaded .weas is n01
required by Federal law, but is by State law. WASTE MANIFEST N, c, D, o, g, 7, n, n. 1 .. 1. l· '·-0, 0, 1, 3, 8
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 3, 7, '. 9, & '
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, end 10 Numb6r) 12. Containers
No. Type
a.
13. Total Quantity 1 t Unit · , L': watll Nl.fflbei:½
'MN'J, :::\fr{)::.\?1:,/}J;)?~r:,
1W· i'61t,·9r'~ Hazardous Waste, Solid, ·nos ORM-E ;jl J;
N l--.!:N~A~9'..'.l.::8'..'.9'...· _______________________ -4-.J'L . .J'.:.l..j· .'.:'.D.J•.:.T+.l';..· .l'-1'=.2.l'.'.:'.0+.:.Y-l,:;;"1L:':::f:!1~0:!o~0:!0~6:.1.:.q{i:
I
E t, -~;c'.:.::':-,, .... ~--~,.:.,:.:.;.--4;;
. =::JI I I I . I~<
/i ii\
ol-----------------------'--------------1--L'J1l-j_J•-1-L•J1_L1J•-1---t::·:;!::!:'::::'=;':=':::::'~f!.Jt,..
A c. ·11·1 ~ j I ,-~ l!il,
J~_,... . .!I o I ' I O o I
d.
... .-.~--.,,;; ·-~···'\i,
.(\1 I I I 11(
~--------------==---=---===-=-==-=-=-=l-,L..1 ,J,, •,J_,.,,1!-,..,.l,,,•!-,..,,J,. '-L'.J11...,.J., _ _jj~'.il!:1 =!::::!::::::::::1
.:i~:.1) r~
~~~~~t~~tr~Bitl=
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71832
1--------------------------------------------------I' 111. OENERATOR'S CERTIFICATION: I hereby declare that the contents ot thlscon1ignmentara lully and accuratelyde1cribod abova by prop.er 1hlpplng r,ama al'td ara claaadled,
paclta<I. marked, and 111,"beled, end are In all respects in proper condition lor lranspor1 by highway according to applleabla lnternallonal and nation al govarnment r.-gulat:lon1 al"Od
tf'la 111 ... s of 1h11 State of South Carolina. ·
111 am a large quantity generator, I cer1iry that I hevo • program In place to reducethevo1ume end toxicity of waste genera led to Iha deg roe I heve determined to be economk:alty
prect1cat>le and Iha! I have selected the pr11cUcable method ol lreatmen't. storage, or dlspoaal currently available to me which minimize, tf'le pre Mn! and lutura ui,-110 human
heatlh and the environmcnl: OR. HI am a small Quantity gonoralor, I have me.do a good faith arlort to mlnimlza my wasl8 generation and select uie be1t ... a,ta management method
tf'lat i1 available to me and that I con ollord.
IT-l--Pr-inl_ed_'_Ty-ped_N,_m_•_.:&::.P:::,C::.E __ R __ L~ ___ c __ o:..:A.::J.::-~~--1IS_ig_n,_1u-re __ :::~:::::2:::!. ,,_~'c<:zi.._,;;~~~~:.....--..l;;?u:..11~.J.£.~
R ~1:..7:... ::T:..ra:.n:..s:.po:,;rt:..e:..r :..1,:,A:..c:..'":..O:..w:..led::.:.,9:..em:C.:en:..l.:o:..I :..R:.•<::•::,ip:..l.:o:..I M:::.:al:..e:..ria:.ls:__::--r:::--:-:----,-4-•------:;;------,'-·--,,-7'"'---:-:---::---::---:-:-
' ,L~~~,,~ /, 4., 4/£s \Signa/JY ~ n/ ,4 /2
~ 18. Transporter ,').cknowledgemenl of Receipt of Materials .,,. Ri-:.::~=:::;:::2:.:.==========---,-:,:-----_,,;_---------------.,.,----,-----::---,,--
1
i...., __ P_rin_•_ed_'_T_y_ped_N_•_m_• ______________ __.,l_s_ig_n_•'_"_re _______________________ L....._ .... __._,._..._ r 19. Discrepancy Indication Space
Month Day y..,
,/"\.9. 0, <111,7
/
Month Day Year
,;;-' 9t::7,3',Y,,
Month Oay Year
I·. ' I I ' I
F a .. I .L...1.-'--'-'--'pbs. c .. J ...... __,_,_.__,!to. $ b I !lbs. d I !lbs.
'i1----------------~ 20. Facility Owner or Operator; Certfficallon of recelpl ol hazardous malerials coverod by this manilesl except as noled In llem 19,
Prinled/Typed Name . I Signature
I IPA Form 8700-22 {Rev. _9/86) Previous Editions are Obsolete (DHEC 1988 {Rev. 10/86Jl
Month Day Year
I , I , I ,
·,
'::.!""
~ ..
"" .-::,;
C ·'>01,,1,,o~C,C)~,•
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
,,r ,n. , .. ,. IMPORTANT: TYPE [on a 12-pilch (ei;te) typewdter) OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE.!
GENERAL INFORMATION: Federal Regulations require generatOrs and lrnnsporters of hazardous waste and owners or operators of hazardous waste trea:menl
storage, or disposal licilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 [OHEC t988 (REV 10/86)) and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Rev.-g/86 (OHEC 1988A) loi both inIer-s1ate nnd intra-st.ite lr.insportalion. Trnnsporters who lransport h.izardous waste into the United States Ire,
another country are responsible for completing the manilesl Federal and slate regulations also require generators and transporters of hazarCouS 'wasie a;.;o
owners or operators or hazardous w,aste treatment, storage. or disposal facilities to complete lhe rollowing information. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manifest by the generator beginning with00001. If your company does not have a U.S. EPA Identification Number .. pt ease ~on:~,ct S.1 OHEC at (803) 734-S200 about obtaining an Identification number. · · . ,
2; Pave 1 of: Enter the total number of pages used lo complete this manifesl, I.e., !he lifst page EPA Form 8700·22 Rev. 9/86 [OHEC 1988 (P.EV 10/86ll i:;lus t:i
number cl contirluation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A-SUie Manifest Document Number: Leave blank. -· _ -· -~ ·~-
8: State Generator ldentrflcallon Number: Leave blank. ·
1 ~ ", •• ;ir.~ ' ,c:.-
1 Generator's Nam~ and Mailing Address: Enter the name and ma1hng address of the generator who will manage the returned manifes: lorms "'!' ' ''
4. Generalor's Phone Number: Enter a telephone number w1th area code where an authonzed agent of the generator can be reached in,:rie even:,or an
5.
6. .c.
0.
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name of the rirst transporter who.will lransport the waste. I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilicalion number of the first transporter identified in item S.
Slate Transporter's ID Number:, Leave blank: , . , ,,.. . ,,-,
Transporter's Phone Number: Enter a le le phone number including area code where an authorized agent of the llrst transporter-can be reached in the e ... ent o!
an e,:i:,ergency.ir:i~luding nights, weekends, and holidays... . .... . ... ..-... --. _.,.. ... ·. · . .' · · I
T.. Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will tran.spOrt the waste.11 inor'e than 2 trans;,orters w
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheel and list the lransporters in the order they will be transoor:ing the was:
U.S. EPA ID Number:lf applicable, enter.the U.S. EPA twelve digit 10 number of the second transporter identified in item 7. 8 ..
E.-Stale Transporter's ID Number: Leave blank. · . . . ., · 1 ·~ u·• •,.. ·•.: ,.-• · • 1••:-= I
F .. Transporter's Phone Number: Enter a telephOne number including area code where.an authorized agent ol the second transporter can be reacr:e~ in th
event ot an emergency including nights, weekends, and holidays. · • ' ---r • · -~ • -• •· • -•
9. Oesignaled Facilily Name and Sile Address: Enter the company nume and site address ol the treatment, slorage. or disposal faci!i!y designatec :o r~ce,,.,e the
waste listed on !his manifest The address must be the site address, which may di Her from the mailing addfess:· ·,. · ,... • -I
U.S. EPA 10 Number: Enter the U.S. EPA twelve digil idenlification number ol the designated treatment, storage. or disposal facility identified in. item 9. 10.
G:. Slate Facility's ID Number: Leave blank. ~~
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the e,.,ent ol ah
emergency including nights, weekends, and holidays.
u.s: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) lor each waste as identified in 49 CFA 171-177. I! aCCi:icnal s;,acl
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number of containers !or each waste and tho appropriate abbreviation from Table 1 ·(belo~) lor the type ol containers.
TABLE I
OM zz Metal drums. barrels. kegs TT= Cargo tanks (tan~ trucks)
OW zz Wooden drums. barrels, kegs . TC= Tank cars
_CM= Metal boxes .• ca_rtons. c·ases. rcll ctts
CW= Wo~den box~s. ·dartons.'cas~s
OF zz Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP zz Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic ~ags·
13 .. Total Ouanlily: Enter total quantity ol waste describe'd on each line, relative to the units used in item 14. ~-· ,.
T4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure:
Table II
I
I
P zz Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (!iQuid on))
I. WHle Number: Enter hazardous waslo numbers as specilied in South Carolina Hazardous Waste Management Regula lion R.61-79.261 Sut:par:s C ar,d D
identity the hazardous waste on each line. .
J. Additional Descriptions lor Materials Llsled Above: In lhe spaces provided. enter the authorization number (lrom !he S.C. DHEC Authorization Request For
!or each waste slream listP.d in section 11 above. Note: Before any hazardous waste can be accepted tor treatment. slorage or disposal in South Car~lina. tne
generator mus! obtain prior authorization from the treatment. storage or disposal facility. . · .. I
K. Handling Codes lor Wastes Listed Above: Leave blank. -·
15. Special Handling Instructions and Addillonal lnlormalion: Generators may use !his space to indicate special transportation. treatment. storage-·or dispcs
information or Bill ol Lading Information. For international shipments, generators must enler in this space Ihe point of departure (city and s:ate) for inose
shipments destined for. treatment. storage. or disposal outside the jurisdiction ol lhi! United States. : ' t. "'t') . •.; !. ·:. , .... ,.. I
16. Generator Certilicalion: The generatoimusl READ, SIGN (BY HANO IN INK), and DATE lhecertilication slatement.I1 a mode other than highway is used.:
word "highway" should be lined oul and the approprinle mode (rail, water. or air) inserted in the space below. II another mode in add1tior. :o o-.e highway r.iode
used. enter the appropriate additional mode (e.g .• ,and rail) in the space below.
TRANSPORTER SECTION .
11: Transporter I Acknowledgement: Enter the nnme ol the person accepling lhe waste on behalf ol the first transporter. That person must acknowleCI
acceptance of the waste described on lhe manifest by signing (BY HANO IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, l~e name of the person accepting the waste on behalf of the second transporter. That p!rson r:-:ust
acknowledge accepIance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipl 1·
FACILITY SECTION .
19. D_iscrepancy Indication Space: The authorized representative al the designated lacility's owner or operator mus! note in this space any discrepancy Cetwe_ .
. the was11 described on the manilest ::ind lhe waste ac!Ually receivod al the lacility. Owners and operators of facili1ies who cannot reSol,.,e s1;nirican1
OIIC,.Plf'\C!U w1thIf'\ 15 doya receiving the wosle must submit lo the Department a laflar with o copyol lhe monllesl doacrlbing the disc:re0ancy ana ar.emi,ts I
,.conc,te ll The 1,eatment. storage, or disposal laclllly must enter tho actual weigh! ~I waste In pounds in Iha spaces provided ii the amount ... aries any lrom 1~
specified by lhe generalor in ilem 13 or ii the generator uses a unit ol meas1Jre other than pounds. , .
20. Facility Owner or Operator Cerllllcation: Print or type the name ol the person accepling-lhe waste on behall ol the owner or operiltor ol the lac1l11y. That person
must acknowledge acceptance of tho waste described on the manifest by SIGNING (BY HAND IN INK). and entering the DATE or receipt
,, AS~•STANCE IS NEEDED IN COM~LETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIG,,ATEO Tl
RECE''-'~ THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 nm TO S:00 pm.
I
F
"
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generetor'sU.S. EPAID No.
WASTE MANIFEST N c D o 7 o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
•· Generator's Phone 919
Smith field,
934-9711
NC 27577
l
Form A
2. Page 1
of
Bursau of Solid & Huardous Wa5te Mgt
2600 Bull Stre-e~ Columbia, SC 29201 .
Phone: [phone]
Emergency & Holidays: (603)73'-5-42•
roved. 0MB No. 2050-0039 E.x 'res 9-30-68
lnlormalion in the shaded Meas is no1
required by Federal law, but is by State law.
5. Transporter 1 Company Name 6. U.S. EPA ID Number
S C D O 7 3 7 ' i,:;;;;:;:::;;;.::.:::i::::.=,,,"'""===='"""==~ ;; Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facilit)' Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
B. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S." DOT Description (including Proper Shipping Name, Hazard Class. and ID Number)
L
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling lnslru~tions and Additional Information
GSX Work Order No.: 71833
12. Containers 13. Total Quantity 14. Unil
No. Type 'MN~
l D.T 2 0 Y
1&. Cl!:HEAATOA'S CEATI_FICATION: I horobydoclara thal lho conlonls olthls conalgnmanl are lullyand accurately de1crlbed above by proper 1hlpplng name and are c1■-neo.
pack&d, marked, and labeled, and are in atl respects In proper condition !or transport byhlghwoy according to appHc.able International and national g0vornman1 regulation• aJ"lod
U'\o laws cl tho Sta.to ol South Carolina.
111 am a largo ciu■nt1ty generator, I certify that I have a program In place to reduce the volume and to:idcltyol waslo generaled to Iha degree I have delormlned lo be oeonomlcalty
procticable and that 1 have selected the practicable me\hod cl lroatment. storage. or disposal currently avallabla to mo which minimize• tho prawn! and lutur• u,,_t IC human
heatlh and Iha environment.: OR, HI am a amo.11 Quantity generator, I have mode III good laith eNort lo minimize ITly waste gonoralion and 1elact the boll wa11a rnanagemenl m.aiod
tl'lat Is available to me and that I can afford.
Printed/Typed Name ROGER C COA 5
Signature
19. Discrepancy Indication Space
•~I~~~
b~I~~~
pt>s.
l'b,,
Month Day Yoat
6
Montn oq
Monlh Day Yoat
CI 111:s.
d I pt>s.
~-1
''" . -... ,
~.:
v 20. Facility Owner or Operator; Certirica!lon of receipl ol hazardous materials covered by this manilesl except as noled In lfem 19.
Printed/Typed Name Signature M0111h Day y..,
A Form 8700-22 (Rev. 9/86) Previous Editions are Obsolele (DHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
IMPORTANT: TYPE (on a 12-pitch (eme) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generatOr~ and trnnsporters ofhnzardous waste and owners or operators al hazardous waste trea"tmenl
storage, or disposal ficilities to use 1he U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 {REV 10/86)1 and, ii necessary, tha continuation sheet U.S. EPA For
8700-22A Rev:9/86 (OHEC 1988A) lei both inlcr-slnte nnd inlra-stnle transporlation. Trnnsr,orlers who transport hazardous waste into the United Slates lro,
another country are responsible !or completing lhe manilesl Federal and State rcgulalions also require genc!ators and transporters or hazarCous ....-aste anel
owners or operators ol hazardous waste treatment. storage, or disposal raci!ities to complete the following information. -.
GENERATOR SECTION
1. Generator's U.S. EPA ID Number·-Manilest Document Number: Enter the 9enerator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:act S.1 OHEC al [phone] about obtaining an lden!llication number.·
2;. Page 1 of: Enter the total number of pages used to complete this manifest, i.e., !he riist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10186)] i:lus th
number of contiiiuation sheets EPA Form 8700-22 Rev. 9/B6A (OHEC 1988A) ii any. ·
A. State Manllesl Ooeumenl Number. .Leave blank.
B: State Generalor ldenlifleallon Number: Leave blank. 1
• •
3. Generalor's Name and Mailing Address: Enter the name and ma1l1ng address of the generator who will manage lhe returned maniles: lorms
4. Generalor's Photle Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached 1n :r.e even: cf an
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. -
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the lirst transporter identified in item 5. I 5.
6. . c.
0.
Slate Transporter's 10 Number: Leave blank .
Transpor1er's Phone Number: 'enter a te1ePh0ne number inCluding area code where an authorized agent olthe first transporter.can _be reached in tr,e event ol
aneir,ergencyincludingnighls,weekends.andholidays. . • .. ·· ·. ·' ~-' '·'1 •. ~• -·•·c1 r.. Transporter 2 Co-mpaliy Name: -.II applicable, enter the cOmP3~Y name o; the seC:Ori.dir.iris"Porter wiio wm'tra:n·sp0r1 the waste. I! more than 2 1ranS;,or1ers w
be used. use a U.S. EPA Form B700~22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transpo~ir.g the wast
U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. a ..
E .. Slate Transporter's ID Number: Leave blank. · 1
F .. Transporter's Phone Number: Enter a telephone number including area code where.an authorized agent of the second Iran sporter can be reached in th
event ol an emergency including nighls, weekends, and holidays. ·-
9. Designated Facility Name and Sile Address: Enter the company name and site address or !he treatment, storage, or disposal lacility desic;natec :o receive the
waste listed on this manifest The address must be the site address. which may diller lrom the mailing address. -~ ·
10;
G:.
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol lhe designated treatment, storage, or disposal raci!ity identdieo 1n. 11em 9. I Stale Facility's ID Number: Leave blank. ·
H;. Faclllly's Phone Number: ·Enter a telephone number including area code where an authorized agenl ol lhe facility can be reached ir. :r,e event of an
emergency including nights, weekends, and holidays. ·
U.S: DOT Descriptions: Enter proper shipping name, hazard class and.ID Number(UN/NA) for each waste as identilied in 49 CFR 171 -177.11 aCCi:icna! spacl
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. . _ . ,
11:
12.. Containers (no. and type): Enter number al containers lor each waste and the appropriale abbrovialion lrom Table I (below) for the type ol containers.
' . TABLE I .
OM = Metal drums. barrels, kegs TT = Cargo lanks (tank trucks) CM = Metal boxes. cartons. cases. rcll ctts
OW II Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF = Fiber or plastic boxes, cartons. cases
I
TP ::r Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 •. Total Ouantily: Enter total quantity ol waste describe"d on each tine, relative lo !he units used in item 14.
Unit {weight/volume): Enter the appropriate abbreviations tram Table II (below) !or !he unit ol measure: 14. I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liauid onl,
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Sut:par.s C ar.c D
identity the hazardous waste on each line.
J. Additional Oesc,iptions lo, Materials Listed AboYe: In the spaces provided, enter the aU1horization number (!tom the S.C. OHEC Authoriza1ion Reauest Form
tor each was1e slream listP.d in seclion 11 above. Nole: Belo re any hazardous was le can be accepted lor lreatment, storage or disposal in South Carclina, tne
generator must obtain prior authorization from lhe lreatment. storage or disposal facility. '
K. Handling Codes for Wasles Lisled Above: Leave blank.
15. Special Handling Instructions and Additional lnlormalion: Generators may use this space lo indicate special lransportation, treatment. storage or dispos
inlormation or Bill ol Lading Information. For international shipments, generators must enter in this space lhe point ol departure (ciry and s:ate) !or inose
shipments destined for treatment, storage, or disposal oulside lhe jurisdiction ol 1he United States, · I
16. Generator Certilicalion: The generator must READ •. SIGN (BY HANO IN INK), and DATE the certilication statement. II a mode other than highway is useCl.:
word Nhighway .. should be lined oul and the appropriate mode (rail, water.or air) inserted in lhe space below. If another mode in addition to tt':e nignway rnoc:e
used. enter the appropriate additional mode (e.g .•. and rait) in the space J?elow.
TRANSPORTER SECTION •
17: Transporter 1 Acknowledgement: • Enter the hame of the'person acceptirig the waste on beh_atl ol l
0
he first transporter. That person rr.ust acknowtec:!
acceptance of the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE of receipt.
18. T,ansporter 2 Acknowledgemenl: Enter, if applicable, the name of the person accepting the waste on behall of the second transporter. That perscn mus:
acknowledge acceptance of the waste described on the manilest by SIGNING (BY HAND IN INK) and entering the DATE or receipt J
FACILITY SECTION
19. Discrepancy Indication Space: The authorized rcpresenlalive al the designated facility's owner or operator mus! note in this space any discrepancy betwe_
tti1 waslo described on lhe manifest and the wa&lo ac!Ually receivod at !he facility. Owners and oporators al facilities who cannct resolve s1;ndicar:t
cllscrei,aneies w11t•11n 15 days receiving !he waste must submll to the Oepertmenta leller wlth a copyol the manllestdeseribing the discrepancy and •~•mots I
reconcile iL The lrea.tment, Stf?rage. or disposal lacillty mus! enter the aclua1 weight ~f waste in pounds in the spaces proyided ii the amount varies any !rorn tr:
specilied by lhe generator in ilem 13 or ii the generator uses a unil of measiJre other than pounds. , .
20. Facility Owner or Operator Cerllllcation: Prinl or lype lhe name ol the person accepting.the was1e on behall ol the owner or operator ol !he lac1l11y. Tti.11 ::ierson
must acknowledge a.cceptanc·e ol the waste described on tho manifest by SIGNING (BY HAND IN INK}° and entering lhe DATE or receipt
i, AS~•5TANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT, STORAGE. OR DISPOSAL FACILITY DEStGliATEO Tl
RECE••:~ THE WASTE OR THE S.C, OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haz.ardous Wa.ste Mgt
2600 Bull Stree~ Columbia., SC 29201
Phone: [phone]
Emergency & Holiday>: (603)734-5-424 WE PR I ITT or TYPE !Form desloned for use on elile 112-pifchl lvoewriler)
UNIFORM HAZARDOUS 11. Generafor'sU.S.EPAIDNo.
WASTE MANIFEST N, c, D, O, q, 7, 6, o, , .. 7,
Form A
Manlleal
1
12. Page 1 • Document No. of 1, , .• Q.Q-1,4,0 1
nroved. 0MB No. 2050-0039 Expires 9-30-88
Information in the shaded a<eas is nol
required by Federal law, but is by State law.
•
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generato~sPhonef 919' 934-9711
5. Transpo11er 1 Company Name 6. U.S. EPA ID Number
i~~;,~~~~:c'~tit{~~~~t!Ht~iSi
!lil!~~t~;ti\~~i~~:ttt.11~~~: ;J~!~;~1l¾f~4-~
'CJ;Stlte'•; ., .. ,: •. [) :!V:/",F··:L/i: ·,,<i.-:...::.,;{::\,~\·:~\:: , •
Willms Truckino Co Inc. , s, c, n, o, 7, ,. 7• ,... CJr " ci Dfi •· • · ·,l'hoM!i':.:•an, 1,7&. 72'\"\.'\.,'<c'.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood. SC 29125
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) ~ 2. Containers
No. Type
13. Total Quantity U. Unil • L"WUIINlrubei'M'.
. WtN~ \({i;\./=·,S,/\i~;}~·Jt~
Hazardous Waste, Solid,· nos ORM-E :\j1'j'bt11'9,'it .,; ii' ..
~ l-..!N~A~9:_;_18::.9::..._ ________________________ _j._1•·:.· .i•,:l•+D.J'L:T..j...J'LL'l.'.'2:..L ,O:'...j._Y,:_+-i1!.!'::f:::l::D::l::D;!::1 6::;;I *1.:j:·
I ~1-b-. ------------------------------l-J.'-1'~-1'--lf---l'L'LL'L'-l--+:~l!.!:=··=·=··=-;='=··•=,-·=-!J:~~}
R ,., , ' .if ~ t.t I I •~
• I
I
I
I
I
I I I I I I I . ,! ... ..' ... !~
d.
I I I I I I '
15. Special Handling Instructions and Addilionat lnformalion
GSX Work Order No.: 71834
141 •. Ql[N!RATOR'S CERTIFICATION: I herebydeel•re lh•tthe conlenlll olthl• eon•lonmenl •r• fully •nd •ecur•tely deaerlbed •bove by prop.er a hipping n•m• end •r• ela..,ned.
P•Cked, marked. and laheled.•nd ere In atl respecls In proper condllion lor tran11portbyhlghway according to appllc.blo lnlorn•llon•I •nd natlonal governmenl re,oulatlon• •rod
U'le ••-• ol the State of Soulh t;arotlna.
111 am a large ciuanhty goneralor, I certlty lht1I I h11ve a program In piece lo r&duce the volume and lo1dclty of waste generated lo lhe d~r-I h•v• determined lo be .conomlcally
prac11cable and !hat I h11Y11 selected !he practfcable mathod ol lrealmenl. storage, or dlspoaal currenUy available to me which minimize, the pre111nt and lutvre lhr-1 to h1,1man
healll'I and the environ men!; QR, ii I am a small quontltygenerotor. I have mado a good teilh eftort lo mlnlmtte myw11ste gen11r11tlon 11nd sslect th• be al-••'• managsm•nt '"'91:!"ooCl
that is aYailab1e to me and the\ I can allo,d. l Printed/Typed Name RO,QER ~ COATS I Signature .
Month Day Year
,r.0,0,31,i>n
Rr1_7_.~T~ra_n_s~po~n_e_r_1_A_c_,n_o_w_led-"g_em_;.en_1_o_l_R_ec~e~ip~t~o~IM,..al~cr_la_ls ___ -,,:,-_____ ..:;.C/ ___ ·_· _____________________ c--i
IA 1 -:--::Pr-in-ted-1-Ty_p~.,,· ~tj'lmL~'-.i.-'~'~ AnJ. ~~,;;:::t_-~-~~~ff, ,,.,:Z:.l IS-ig_n_atu-"r•~· 1 ~ ,~/~ 1~ ,1~ 11~:::::..~<:::;::1~2:-~-~:::~,f/_'.::... ___ ~M~o'6._(t!I.J:D~•~y~Year(Lj ,., I J t t ·, ( ./'7 / .)tC ,1-""s'I /A/,~ "'1, ,6',::;:. ;'; ,
18. Transporter 2L cknowledgement of'Ffeceipt of Malerials L--' Rl-',-C;_:,:==:.::.:============--~-----------==--------------------l
'
T-+--P-n-·n-ted-lT-y-ped_N_•_m_, ______________ J..ISi-gn_•_•u_r_e _____________________ .,1,M_o..t~-1!1-.... ,D •• •_Y .... ly..t:"'--4
19. Discrepancy Indication Space f a ,_I "-'-'-'-'--'pt.. c ,_! .L..J.-'-'-'--'!lbs.
~ b I i'bo. d I !lbL
,1-e,,--,,-,.,-c---=----,,-=---,--~ 20. Faciriry Owner or Operator, C11r1ilication or receipt or hazardous materials covered by lhi3 manifest e.-.:cepl u noted In Item 19.
Printed/Typed Name I Signature
IPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10186)1
MOOl!I
I , I
Day Year
' I I
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST''·ic
p .,.
IMPORTANT: TYPE {on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!·
GENERAL INFORMATION: Federal Regulations require genP.ratOrs and transporters of hazardous waste and owners or operators of hazardous waste trea:menl
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)) and, if necessary, the continuation sheet U.S.1EPA.For
8700-22A Rev: 9186 (DHEC 1988A) foi both inter-state and intra-slate trnnsportalion. Transporters who transport hazardous waste into the United States Ire
another country are responsible !or completing the manifest Federal and Slate regulations also require generators and transporters at hazardous ·.-.as!e aM
owners or operators ol hazardous waste treatment. storage, or disposal facilities to complete the following inlormalion. I GENERATOR SECTION
Generator's U.S. EPA ID .Number. Manifest Documenl Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to !his manilestby lhe generator beginning with 00001.11 yourcompanydoes not have a U.S. EPA Identification Number. p!ease con~act S.C.
, .
OHEC at [phone] about obtaining an ldentilication number. . · · · · 1
•
1 I
2.:. Page 1 of: Ent~r the total number of pages used lo complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P.EV 10186)1 ~lus th
number or continuation :sheets EPA Form 8700-22.Aev. 9/86A (DHEC 1988A) if any.
A. Slate Manifest Do~umenl Number: .Leave blank. . . .
B: Slate Generator ldenliflcallon Number: Leave blank. · · · ., ' · · ·1
3. Generalor's Name and Mailfng Address: Enter the name and mailing address of the generator who will manage the returned maniles: rorms. •;'
,. Generalor's Photle Number: Enter a telephone number with a_rea code where an authorized agent o! the generator can be reached in :r,e even: cf a ,
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol lhe first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the lirsl transporter identilied in item 5.
C. state Transporter's ID Number: leave blank,
0. Transporter's Phone Number: 0Enter a teleph0ne number including area code where an authorized agent cl the first transpor1Efr c·an b·e reacne-: in the event cl
an er,:iergency_iry~_luding nights, weekends, and holidays... . ..... . ... ..-•···--. -···· .. .. ·. · . .". · ' I
T.. · Transporter 2 COmpiny Name: II applicable, enter the company name al the second transporter who will transpOrt the waste.11 more than 2 transooners w
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transpor:ing the wast
U.S. EPA ID Number;tl applicable, enter the U.S. EPA twelve digit ID number of !he second transporter identified in item 7. 8 ..
E .. Slate Transporter's ID Number: Leave blank. · -~ ' r.··:; ~ · ,1. ~ I
F .. Tr,1nsporter's Phone Number: Enter a telephone number including area code where_an authorized agent ol the second transporter can be reached in th
event ol an emergency including nights. weekends, and holidays.
9. Designated Facility Name and Sile Address:· Enter the company name and sile address of the treatment, storage. or di~p_osar !~ci!ity <Jesignatea :o_rece1ve the
waste lisled on this manifest The address must be the site address, which may di lier rrom lhe mailing address. ,
10.
G:.
U.S. EPA 10 Number: Enter the U.S. EPA lwelve digit identilication number ol the designated treatment, storage, or disposal raC1lity iden:1fiea 1ri 1!em 9. I
Slate Facility's ID Number: leave blank. · · ·
H;. Faclllly's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the-event or an
emergency including nights, weekends. and holidays.
U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) lor each waste as identified in 49 CFR 171 • 1 ii. I! aC:ci:icr.al S;.)acl
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers {no. and type}: · Enter number of containers tor each waste and the appropriate abbreviation lrom Table I (belO~·, rO~ the type of containerS.''"'
· TABLE I ._ ,·
OM c Metal drums, barrels, keg.s TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. c·ases. rcll c_tts
OW c Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic ~ags
13 .. Total Ouantily: En1er total quantity of waste describe"d on each line, relative 10 lhe units used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations rrom Table II (below} ror the unil of measure: I
Table II
P = Pounds l = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liQuid ~:inly)
I. Wasle Number: Enter hazardous waste numbers as speciliedin South Carolina Hazardous Waste Management Regulation R.61-79.261 Sut:::iar-:s C ar.c DJ
identity the hazardous waste on each line. ·
J. Additional Descriptions for Malerials Llsled Above: In !he spaces provided, enter the aulhorizotion number (from lhe S.C. DHEC Aulhorization Reciuest For
tor each wasle stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted !or lrealmenl. storage or disposal in Sou1n Carc:-lina. lhe
generator must obtain prior authorization rrom lhe treatment, storage or disposal lacility. . . . ~ ., -, ,,, • 1
K. Handling Codes for Wastes listed Above: leave blank. :. ·
15. Special Handling lnshuclfons and Additional lnlormalion: Generators may use !his space 10 indicate special transportation. treatment. storage or di spas
information or Bill ol Lading lnrormation. For international shipments, generators must enler in lhis,sp_ace the point al departure {city anc s:aie) !or tnose
shipments destined for treatment, storage, or disposal outside the jurisdiction ol thE! United Stales. ,.i ; • /, l ~ . · · .. , • .. I
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK}, and DATE thecertilication statement. II a mode other than nighway is used, t
word "highway"' should be lined out and the appropri~te mode (rail, water. or air) inserted in the space below. II another mode in additior, :o 11·.e hic;nway r.ioce
used, enter the appropriate additional mode (e.g.,_and rail) in the space below.
TRANSPORTER SECTION ' .
11: Transporter 1 Acknowledgement: Enter the name al the person accepling lhe waste on behalf or the first transporter. That person rr.usi acknowJecf
acceptance of the waste described on the manilest by signing \BY HAND IN INK) and entering !he DATE al receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name of the person accepting the waste on behalf ol the second transporter. Thal person mus:
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE or receipt· I
FACILITY SECTION
19. Discrepancy lndicalion Space: The authorized represenlative ol the designated facility's owner or operator must note in this space any discrepancy betwe_
u,e waslo dueribed on lho manilHI ond lhe wula ach.ially recaivod al Iha laci1ity. Owners and operalors of facilities who cannct resolve si;ndican!
crlscrepanc!es w,thin ,~ doys receiving lhe waste mus! submit to the Oepartmenta letter with n copy ol the monllestdescrlblng lhe diserepane·y and •~•m:ns I
reconcile it. The treatment. storage, or dlsposol lacHUy mus! enter the actual weight (!f waate In pounds in lhe a paces provided ii Iha amounl varies any !rom tr: ..
specihed by the generator in ilem 13 or ii !he generator uses a uni! ol mcas11re olher than pounds. . .
20. Facility Owner or Operator Cerlilicalion: Print or type the name ol the person accepting.the waste on behall ol the owner or operator of the lac1h1y. Th.:it :,er son
must aclo::nowtedge acceptanc·e ol tho waste described on the manilest by SIGNING (BY HAND IN INK)° and entering the DATE cl receipt
i, AS~•STANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIG>l•TEO 1
RECE''·'" THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 ,,m TO 5:00 pm.
I. South Carolina Department of Health
· and Environmental Control
Bureau ol Solid & Ha.z.ardous Wa,te Mgt
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
Emergency & Holidays.: (803)734-5-42(
{Form des! ned lor use on ellle 12· itch ewriler Form A roved. 0MB No. 2050-0039 E.x:Dires 9.30.ga
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D O 7
1 Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield,
,. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
NC 27577
6. U.S. EPA ID Number
S C D O 7
Manliest 2. Page 1
Document No. of 0 0 1 4
Information in the shaded a<HS is not
required by Federal law, but is by State law.
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
•oute, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Class, and ID Number)
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71835
12. Containers 13. Total Quantity tt Unil :ew&itii'~
No. Type 'Mfllr;J. \J:='if<;.: .. ,;f\t'.-;}?,;,
1 D T 2 0 Y
115. Cl!:HERA TOR"S CERTI_FICATION: I hereby declare that !he con Ian ls ol!hls conal<;lnmanl are fully and accurately described ebove by proper ehlpping n ■m• and are claN,tft~.
packed. marked. and labeled.and are In all respecls in proper condition forlransport by highway according to appllca.ble lnlemallonal and national government rit9ulatlon1 al"'d
tl'le laws ol tl'la Slate ol South Carolina.
II I am a large Quantity genorolor, I certify that I havo a program In place to reduce the volume and toxlcltyol wastagenen1ted lo the d&9r-1 have determined 10 be oconomk:alty
practicable and that I have selacled Iha practicable method ol lroolmont. storaga, or dlspoul currently avnlteble to me which minimizes the present and lutvra ll'UMI to human
l'laaltl'I and Iha environment: OR. II I am o smnll quonlltygonarolor, I hove mada a good lailh etlort to mlnlmb:o my waste generation and 1atecl the bell wa11a management ""'8tnod
that is available to me and lhal I can ollo,d.
Printed/ yped Name Month Day Ye.at
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
'I Jibs. C I I I pm.
b I I pt,,. d I J· I pbs.
20. Fac:iliry Owner or OperalOr; Cer1ific:atlon of receipt or hazardous materials covered by lhls manifest except as noled In llem 19.
Printed/Typed Name Signature Montn Day y..,
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
I. l .•~,;-,,.
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
IMPORTANT: TYPE (on a 12-pilch (elite) lypewriler] OR USE FIRM POINT PEN. PRESS DOWN HARD
, -i·I
ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and lmnsporters al hazardous waste and owners or operators of hazardous waste treatmenl
storage. or disposal ficitilies 10 use the U.S. EPA Form 8700·22 Rev. 9186 (DHEC 1988 (REV 10/86)] and, if necessary, th~ continuation sheet U.S. EPA For·
8700•22A Rev:9/86 (OHEC 1988A) for bo1h inter-state and intra•stnte Irnnsportation. Trnnsportcrs who transport hazardous waste into the United Sta:e~tro
another country are responsible !or completing the manilesl Federal and State regulations also require generators and transporters al hazardous .-.·ast·e a:~c
owners or operators al hazardous waste treatment. storage, or disposal facilities lo complete the following inf?rm~tion. I GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unic:ue live dii;it
number assigned to this manifest by the generator beQinning with 00001.11 your company does not have a U.S. EPA ldentilication Number. please con:act S.C.
OHEC at (803) 734 ... 52oo·about obtaining an Identification number. I
2.: Page 1 ol: Ent~r the total number of pages used to complete this manifest, i.e., the first page EPA Form 8700·22 Rev. 9/86 [DHEC 1988 (REV 10/86)1 ~lus th
number ol continuation :sheets EPA Form 8700·22 Rev. 9/86A (DHEC 1988A) II any.
A. Slllt• Manliest Document Number: .Leave blank. ·
B: State Generator Identification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned maniles: forms.
4. Generator's Phor\e Number: Enter a lelephone number ~Hh area code where an authorized agent of the generator can be reached in the event ol a
emergency including nights. weekends, and holidays. · ' · ·
5. Transport 1 Company Name: Enter the company name of the lirst transporter who will transport the waste. I 6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification nulTiber ol the first transporter identilied in item 5,
C. Slale Transporter's 10 Number: Leave blank.
0. Transporter's Phone Number:
0
Enter a telephClne number including area code where an authorized agent of the lirst transporter.can be reache~ in tr.e event ot
an ery:,ergency_ir:i~luding·nights, weekends. and holidays... .... ... ··-···-·· . -·· ... .. ·. · .· · .·. I
T.. ·rransporter 2 Company Name:-·11·applicable, enter the company name of the second transporter who w_ill transport the wa~te. II more !han 2 trans;::iorters wi
be~sed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in lhe order they will be transoor:ir,g the was:
a.. U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digil ID number al the second transporter identified in item 7.
E .. State Transporter's ID Number: Leave blank. '' ---·'" · -I
F.:' .. : Transporter's Phone N~mbcr~ E~ter a telephone number i.ncluding area code where an authorized agent of the second tr~ns_~o~.:r c~~ be r~~cr.e:_ in tM
1 · event ol an emergency 1nc!udmg mg his, weekends, and hohdays. ·
9. Design a led Facility Name and Sile Address: Enter lhe company name and site address of the treatmer:i!, storage, or,disposal faci!ity 9esigna\~c,:o_rec~1ve the
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve.digit identification number ol the designated treatment, storage. or disposal lacility identilied 1n 1Iem 9. waste listed on !his manilesl The address must be the site address. which may di lier from the mailing address. I
G:. State Facility's 10 Number: Leave btank. · · · · '
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized· age.nt of the facility can be reached in :r.e· even·! or ary
emergency including nights, weekends, and holidays.
11: ~.s: DOT Descriptions: Enter_proper shipping name. hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 171 • 1 i7.II aC:::i:icnal s:iacl
I:s needed. use a U.S. EPA Form 87QQ.22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ~ . , . ~ .
12.. Containers (no. and type): Enter number or containers for each waste and !he appropriate abbreviatiorffrom Table I (below) for the typg o! containers.
TABLE I '
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. rc,II ctls I
ow= Wooden drums. barrels, kegs TC= Tank cars cw ;;v..foOde'n bOxe·s. cJrtOns, Cases'
OF= Fiberboard or plastic drums. barrels,. kegs OT= Dump truck CF= Fiber or plastic boxes. car:ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic :)a;s
11. Total Quantity: Enter total Quantity ol waste described on eac~ line, relative to the units used in item 14. 1 ~ I
t4. Unit (weighl/volume): Enter the appropriate abbreviations !ram Table II {below) !or the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
1. Wnle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management RegulatiOn A.61 • 79.261 Sub;:iar:s Car.~ DJ
identity the hazardous wa:sle on each line. · .
J. Additional Oucriplfons lor Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Aulhom:aIion ReQuest For
for each waste stream listP.d in section 11 above. Mole: Belore any hazardous waste can be accepted for treatment storage or disposal in South Careolina. the
generator must obtain prior authorization from the treatment. storage or disposal facility. · · -I
K. Handling Codes lor Wasles Listed Above: Leave blank. ,·
15. Special Handling lnslructions and Addilional Information: Generators may use this space to indicate special transportation. lreatment. storage or dispos
information or Bill of Lading lnlorma\ion. For in!crnational shipments, generators must enter in this space the point al departure (city anc s:ate) tor :nose
shipments destined lor treatment, storage, or disposal outside the jurisdiction of th8 United Slates. · . ,. t
16. Generator Certificalion: The generator must AEA0,·s1GN (BY HANO IN INK). .ind DATE the certification statement:11 ~;,,ode ~1he;'1han highway is used.";
word .. highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below.II another mode in 1ddilior. to u·:e hignway r:ioC!e
used. enter the appropriate additional mode {e.g.,.and rail) in the space below. · • ·
TRANSPORTER. SECTION . ' · . •
11: Transporter 1 Acknowledgement: EntCr lhe n1ame of the person iccepling the waste on behalf or the lirst t~ansporter . .That person 1:;ust acknowleCI
acceplance ol lhe was le described on lhe manifest by signing (BY HAND IN INK) and entering lhe DATE ol receipt ' .
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalf of the second transporter. iha: perscn r.,wsi
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt J
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative al the designated lacility"s owner or operator must note in this space any discrepancy betwe _
U'le wuI1 ct11crib1d on lho manilHI and lh8 wa1le ac1Uat1y received at the facility, Owners and oporalorG ol facilities who cann·oI resolve s,;nilicani
dl1crepanc1es within 15 dnya receiving the waste must submit 10 the Department a teller with a copy cl the manifest describing the dl1cre0ancy and ar:trn011 I
11co~~it1 iL The Ireelment, ~!~rage, or dlsposol lacUlty mus I enter the actual weight~• wasle i~ pounds in. the spaces provided ii the amount varies ~ny !ram :r:
si:iec1!1ed by lhe generator In item 13 or U the generator uses a uni! of measi.,re other than pounds. .
20. F aclllty Owner or Operalor Certification: Prinl or type the name ol!he person accepling-lhe waste on be hall ol the owner or operator ol the rac1f1ty. That person
must aclc.nowledge acceptance or tho wasle described on the manifest by SIGNING (BY HANO IN INK)and entering the DATE ol receipL
1' AS~!STANCB IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR OIS?OSAL FACILITY CEStG~a.TEO Tl
RECE'1"': THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 ;1m TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
E PRIHT or TYPE (Form desi ned for use on elite 12-itch ewriter
UNIFORM HAZARDOUS 1. Generetor'sU.S.EPAIDNo.
WASTE MANIFEST N c D o
l Generator's Narne and Mailing Address
Channel Master
P, 0. Box 1416,
,. Generato(s Phone 919
Smithfield,
934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, I Box 255
Pinewood SC 29125
NC 27577
10. U.S. EPA ID Numbei
S C D O 7 0
Form A
2. Page 1
of
Bureau of Solld & Huardous Waste Mgt.
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
Emergency & Holidays.: (803)73'-5"'24
roved. 0MB No. 2050-0039 E.tDires 9-30-88
Information in the shaded areas is nor
required by Federal law, but is by Stale law._
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, snd ID Number} 12. Containers
No. Type
13. Total Quantify 14. Unit •L1Wa:stii~~~-
'MNd ;j{:,,_.;·~c>:~/~~,f\~%~
L
Hazardous Waste, Solid, nos ORM-E
NA 9189
GSX Work Order No.: 71836
1 D T 2 0 y
111. OENEAATOA'S CERTIFICATION: I h•r•by dec1■ re that !he conlents Oflhla con1lgnmenl ■r■ lullyand accur■toly d•■crlbed ■bova by prop,■r ■hipping name ■nd ara c.1..,.;11.c,.
packed, m■rked, ■nd lo·b■led, ■nd are in all raspecla in proper condition tor tran,portbyhlghway according lo appHc.blo lntern ■ tlon■I ond national govarnm■ntraou1at1on1 and
tne raws ol th ■ SU.le of South Carolina.
It I am a la,ge quantity generator, I certity that I have a program In place lo reduce the volume and loxlcltyol wasle generated to the dog,_ I have determined to be-economic.ally
practicable and that I have selected the praclicabte method ol lrealment storage, or disposal currently available lo me which mlnlml1e1 the pre-.ent and lutur■ PJ"\rMI to human
heallh and Iha environmont:OR, 1ft am e small quantity gonoralor, I hove mado a good laith errort to minimize my waste generation and select tho bet! watt■ management ~thod
that is available to me and that I can allord.
Printed/Typed Name RO.GER L. COATS Signature
ement of Receipt of Materials
/ ot-t Signature
0
ement ol Receipt ol Malerials
ame Signature Mont!> Day y..,
19. Discrepancy Indication Space
• I l't.. ' I libs.
b I pt.. di l'bo.
20. Facility Owner or Operator; Certilication of ,eceipt of hazardous materials covered by thi3 manifesl except a, noted In Item 19.
Printed/Typed Name Signature Mont!> Day Year
PA Form 8700•22 (Rev. 9/86) Previous Editions ore Obsolete (OHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generatOrsand transporters of hazardous waste and owners?' operators o! hazardous waste trea:mel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Aev.-9186 (DHEC 1988A) for' both inler-state and intra-stale transportation. Transporters who transport h,nardous waste into the United States lro
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters at hazarcoUs ·,...·~ste i3:-:c
owners or operators or hazardous waste treatment, storage, or disposal laci!ities to complete the following information. . . I GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the un1cue live digit
number assigned to this manilesl by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:act S.C.
OHEC at [phone] about obtaining.an Identification number. I
Page 1 ol: Ent~r the total nu.mber al pages used to complete lhis manirest, i.e., !he riist page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10186)! ~!us:.
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A. Slate Manifest Document Number: .Leave blank;
e:
3.
5.
State Generalor ldenliflca!lon Number: · Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address or the generator who will .lTlanage the returned manifest rorms.
Generator's Pholle Number: Enter a telephone number with a_rea code where an authorized agent ol the generator can be reached in tlie event or a
emergency including nights. weekends, and holidays.
Transport 1 Company Name: Enter the company name of lhe first transporter who will transport the waste.
6. U.S. EPA 10 Number: En!er the U.S. EPA twelve digit identification number al the lirst transporter identilied in item 5. I C. Sla1e Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent ol the first transporter.can be reacne:::! in the event ot
an e~ergency_ i,:i\:_luding nights, weekends, and holidays... . .... . ... .,_,..,_ ... _,,.. .. . ·. · .· . · ', · I
T. Transporter 2 Company Name: II applicable, enter the company name al the second transporter who will tran.spOrl the waste. II more than 2 trans;:,orters w
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the cider they will be transoor:ing the was:
e ..
E..
U.S. EPA ID Number:ll applicable. enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7.
State Transpor1er's ID Number: ... Lc_ave blank. _ , ... rn)I•---,,,6 c:-;-i::' ~~ ,,,11-= =<-·.: ;,_ t
F .. Transpor1er's Phone Number: Enter a telephone number including area code where.an authorized agenl al the second transporter can be reacr.ed int
9.
10.
G:.
H;.
11:
12..
event of an emergency including nighls, weekends, and-holidays. · , -.._, t r:"'•o•-=~ • r-·.· ,..r:-r·-.,
Oesignaled Facility Name and Sile Address: Enter the company name and site address al the treatment.·storage, or disposal racility designatea :o receive the
waste li5ted on this manileSl The address niust b8'1he sitC i'.lddrcss. which may dilfer lrom•'th'e ma"i1fn'g"a'ddress:•<: M r>M•<'IN~ t'\f ... ~?;1J~\(°'OJ. , .. ;,,~•';! ,, ..
U.S. EPA ID Number: Enter the U.S. EPA twelve digit i~enlilication number ol the designated treaim~n't, ·s~orage: O'r·diSpoSa't'fciCilit)'-ide'ntdiec::1 ,n. 1\em 9. I
State Facility's ID Number: Leave blank. • · • • · " · · · · .. · ·
Facility's Phone Number: Enter a lelephone number including area code where an authorized agent of !he faC:ility can'tie'reclch·ea in'the'·event_ol an
einergency including nights, weekends, and holidays. ·-~ · ·
~.s: OOT Descriplions: Enter prope.r ship.ping name, hazard class and ID.Num_ber (UN/NA) !or each waste as identir.ied in. 49 CFR. 1.71 • 1 77.1! aC::::i:icnal s~at
Is needed. use a U.S. EPA Form 8700-22.~ Rev. 9/8_6 (D~EC 1988A) Conl1nua11on Sheet. .: . : _·!\ 1,,r,171-1,,•:1i•t'n 0,,rl"rJ·' .•,,ii, 1 .. " _, .,..
Containers (no. and type): EQler numb.er of co_ntainers !or each waste and the appropriat1;, abbre'i},~.t-io_n /'~<:>'!1Ja~!! .t (~!'t~~). f~.~ th~, type o! COftain~;s.
TABLE I ...,
OM= Metal drums. barrels, keg~ TT= Cargo tanks (tank lr!JCks) CM =,.r:,,,,;~~! ~q~~~-,.c.2,0011~ .. ~a.~~s.,r9!!p41s :h;r ·-1
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs DT = Dump !ruck CF= Fiber or plastic boxes. ca~ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or pfast1c ~ags
13 .. Total Quantity: Enler total quanlity of waste describe'd on each line, relative to the units used in item 14. -"·'"'' .... ,,.,.~, o•(, •. ,,.,,n m~n" ,. I
T4. Unit {weight/volume): Enter lhe appropriale abbreviations from Table 11 (below) ror the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Sub;:iar:s C ar:c DJ
identity the hazardous waste on each line.
J. Addillonal Descriptions for Materials Listed Above: In the spaces provided, enter the authorization -:,umber {lrom the S.C. OHEC ~uthorizati'?.".l. ~~gues1 F,o.r .•
for each waste stream listed in section 11 above. Nole: Belore any hazardous wasle can be accepted lor treatmenl storage or disposal in South Carclina, tne
generator must obtain prior authorization from the lreatment. storage or disposal facility. . ... , . ... . " • .,,, 1r~ •p:. • • ••
K. Handling Codes tor Wasles Lis led Above: Leave blank. , , .,.. -,
15. Special Handling Instructions and Addillonal lnformalion: Generators may use this space to indicate special transportation, !reatmenl. storage or d1spcs
information or Bill or Lading lnlormalion. For international shipments, generators must enter in this space the pain! ol departure (city and s:are) !or tnose
shipments destined !or treatment, storage. or disposal outside lhe jurisdiction of the United States. · . • .,, . . . 1 . • I
16. Generator Certification: The generator must READ,·s,GN (BY HANO IN INK), and OAT~ lhe certification Statert'lent. If 3, mo.de Other tha'n.hignway is used.:'
word Hhighway" should be lined out and the appropriate mode (rail, water, or air) inserted in the space below. ti another mod_e in additio_r. :o tr-:e hignway r.ioce
used. enter the appropriate addi,lional mode (e.g.,.arid rail) in the sPace below. · ~ , . · · ., ' ·· .. '
~ANSPO~TER,SECTION ~ ) . : .· I__ . ( I ., \ \". .... •• j' ' .' : : \ ~--, .. , ., ' • . ,;:·,. I
1. 11:· Transportel' 1 Acknowledgement: Enter the ·name ol the person\ac~epling lhe waste on behalf of the first tran·sPorter. That ~erso~·rr;~st a~knowled
acceptance of the waste described on the·manilest by signing (BY HAN(? IN INK) and entering the DATE ol receipt. · ·, • , · ·• ' -: ·
18. Transporter 2 Acknowledgement: Enter. H applicable, the name of the person accepting the waste on behalf ol the second transporter. That person rni..:st
acknowledge accep!ance of the waste described on the manircst by SIGNING (BY HAND IN INK) and entering the DATE ol'receipt · · · ~,-·
FACILITY SECTION . I
19. Discrepancy lndicalion Space: The authorized represenlalive ol the designated facility's owner or operator must note in this space an)' discreoancy t,etwe
the waste described on !he manilest ond the waste actUally receivod al the lacility, Owners and operators of facilities who cannct resolve s1;n1licant
c111cr1p1r,cIes wllt'ltn 1! days receiving the waste must submit to the Deportment a letlerwilh o copy of the monilestdescribing 1he.di1crepancy'and •~•mc1s I
reconcile il The treatment storage, or disposal laciHty must enter the actu.il weight ~I waste in pounds In the spaces provided if the amount var,es any l_rom :h
specified by lhe generator in item 1J or ii the generntor uses a unit or meas1Jre other than pounds. . . •
20. Facility Owner or Operator Cerlillcalion: Prinl or lype !he name ol lhe person accepting.the wasle on behalf or the owner or operator al the tac1l,1y. Th,1I :,er son
must acl<now!edge acceptanc·e al. lhe waste described on lhe manifest by SIGNING (BY HAND IN INK)° and entering lhe DATE or receipt.
"•s~rsTANCE Is NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE. OR DISPOSAL FACrurv 0EsIc.11ueo Tl
AECf1••~ THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm_
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous W.u~ Mgt.
2600 Bull Street. Columbia. SC 29201
Phone: (S.00) 734-5200
E PRINT or TYPE (form desi ewrlter
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
N C D O 7 0 1
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
4. Generator's Phone 919
5. Transporter l Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transpcrter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. COT Description (including Proper Shipping Name, Hazard Cfass. and ID Number)
L
C.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
GSX Work Order No.: 71837
Emergency &. Holidays: (803)73-4-5"'24
Form A rovod. 0MB No. 2050-0039 E.rpire:s 9-30-M
2. Page 1
of Information in the shaded aoas is no1
required by Federal law, bul is by State law.
12. Containers 13. Total Quantity 14.Unil ;_"L\W&itii~
No. Type WtN~ \ffN:(\?f;/~fJ}f!
l D T 2 0 Y
1 II. GENERA.TOR'S CERTIFICATION: I horobydoclaro lhot lho conlonts of this conalgnmont ■re fully and accurately doscrlbod aboYe by prop,ar •hipping name and are cia ... ned.
packod, markod, and 18boled,and aro In at1 rospocta In proper condllion for1ranspor1 by highway according lo appllc.abla lnlornatlonal and natlonal government regulation a and
u,e taws 01 the sui.u, ol South Carolina.
111 am a largo Quantity genoralor, I certify thot 1 ha Yo a program In place to roduco tho volume and 1oxlcltyofwastogonoratod lo tho do,gr-I have dotermlne-d lo be econom6c.ally
prac11cablo and thal I havo selected tho practicable method of t,ootment. storage, or dlapoaal currenlly aYollablo to mo which minimizes tho pro a.ant and future thrNI to h1,1men
hea11h and tho onvi,onmcnt.: OR, 111 am a small QUOnlltygonorolor, t hovo mado a good toilh oHor1 to mlnlmlz:o mywaslo gonora\Jon and 1a1ect tho be•I wall• management me1hOd
that ls available to mo and that I con afford. ·
Printed/Typed Name Signature Month Yoat
0
l 7. Transpor1er 1 At;Knowledgemenl ol Receipt ol Materials
Printed/Typed Name ~ r, ·-f .,_
Signature Monttl Day Yoat
Pnnted/Typed Name Signature Month Cay Yw
19. Discrepancy Indication Space
• I Jibs. C I !lbs.
b! Jibs. d I pto.
20. Facility Owner or Operator; Certiflcallon of rec:elpl ol hazardous materials coYered by this manifesl excepl as noted In Item 19.
Prinled/Typed Name Signature Mot1tn Day YNI
PA Form 8700-22 (Rev. 9/86) Previous Edlllons are Obsolole fDHEC 1988 (Rev. 10/86))
"
IMPORTANT:
,I •~. , ., "' I~ i,~ ;' .• , 1. ~i
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFO~M HAZARDOUS WASTE.MANIFEST . . ··.ir. J
TYPE [on a 12-pitch (elite) lypewriter) OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEGIBL !
GENERAL INFORMATION: Federal Regulations require generators and lrnnsporters ol hazardous waste and owners or operators of hazardous was:e treatmel
storage. or disposal licililies to use the·U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, if necessary, thf:l continuation sheet U.S. EPA For
8700-22A Rev:9186 {DHEC t988A) loi bo1h inter-slate and inlra-st.JIC transporlation. Trnnsr,ortcrs who transport hazardous waste into the United States Ira
an0Iher counlry are responsible !or completing the manilesl Federal and Siate regulations also require generators and transporters al hazarCous ·,..·aste ar:c
owners or operators ol hazardous waste treatment. storage, or disposal facilities lo complete the following information.
GENERATOR SECTION I
1. Generator's U.S. EPA 10 Number. Manifesl Document Number: Enter the generator's U.S. EPA twelve digit idenlification number and the unicue live digit
number assigned to this ma_nifest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number. please contact S.1 OHEC at [phone] about obtaining an Identification number. ~
2.:. Page 1 of: Enter the total number of pages used to complete this manirest, i.e., !he liist page EPA Form 8700-22 Rev. 9/86(DHEC 1988 {REV 10l86)j ~lust,
number of contifluation sheets EPA Form 8700-22 Rev. 9/SGA.(DHEC 1988A) ii any.
A. Slate Manifest Document Number. .Leave blank. . . .
e; State Generalor ldenliflcallon Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address ol lhe generator who will manage the returned manifest !arms. ·
~-Generator's Phone Number: Enter a telephone number with a_rea code where an authorized agent ol the generator can be reached in the even: cl a
emergency including nights, weekends. and holidays. ~ · 10
•
5. Transport 1 Company Name: Enter the company name of the rirst transporter who will transport the waste.
6.
C.
0.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first lransporter identiried in item 5.
Slate Transporter's ID Number: Leave blank.
Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent of the first transporter-can be reacriec in t:-:e event ol
an emergency including nights, weekends, and holidays.. . . . · · · · · I
T. Tr.1n~porte~ 2 c~-~pany Name: II applicable, enter the c·omP;~y name Oi the se~o·~'dtrans·porter who wili' tra'nsp0i1 the waste. If more than 2 !rans;JOrters w
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:ing the was:
U.S. EPA 10 Number:lf applicable. enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7. 8 ..
E .. Slale Transporter's ID Number: Leave blank. • ., ... ,.,..~ ~., ,. ,-t
F .. Transporter's Phone Number: Enter a telephone number including area code where_an authorized agent of the second transpor.er can Ce reacr.e-= int
event of an emergency including nights, weekends, and holidays. · -
9. Designaled Facility Name and Sile Address: Enter the company name and site address of the treatment, storage. or disposal facility desic;natec :o receive the
wasle listed on this manifest The address must be the site address, which may differ from the mailing address. · ,~ · ~-· · ·~ ,
10.
G:.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit Identification number or the designated treatment, stor.ige, or disposal racility identified ,n 11em 9. I
Stale Facility's ID Number: Leave blank. · ·
H;. Faclli1y's Phone Number: Enter a telephone number including area code where an authorized agent of lhe facility can be reached in :he event or an
emergency including nights, weekends, and holidays.
U.S: DOT Descriptions: Enter proper shipping name. hazard class and ID Number (UN/NA) ror each waste as identiried in 49 9FR 171-1 77.11 aCci:icnal s::ial
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
1L
12... Containers (no. and type): Enter number or containers ror each waste and the appropriate abbroviatio~ from'Tablc I (b;iow) for the type a't con1ainers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. ca~es. rcl_l ctls
OW= Wooden drums. barrels, ke.gs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. ~arrE!ts~ keg$ ' , OT= Dump truck CF= Fiber or plastic boxes. car.ans. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or ptas:1c t.a~s
13 .. Total Quantity: Enter total quantity ol waste describl?d on each line, relative to the uni.ts used in item 14.
t-4. Uni! (weight/volume): Enter the appropriate abbreviations from Table ll (below) for the unit of measure:
I
I
Table II
P = Pounds · L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Su~par:s C ar.c DJ
identity !he hazardous waste on each line.
J. Addilional Descriptions !or Malerials Listed Above: In the spaces provided, enter the aulhorization number(lrom the S.C. DHEC Authorita1ion Rec:uest For
for each waste stream listP.d in section·, 1 above. Nole: Before any hazardous waste can be accepted lor treatment storage or disposal in South Carclina. tne
generator must ob!ain prior authorization lrom the treatment, storage or disposal racility. -· I
K. Handling Codes lor Wastes Listed Above: Leave blank. , , . ,
15. Special Handling lnstrucllons and Addillonal Information: Generators may use this space lo indicate special transportation. treatment. storage or dispos
information or Bill or Lading Information. For international shipments, generators must enter in this space lhe point of departure (City and s:ate) !or :nose
shipments destined !or treatment. storage, or disposal outside the jurisdiction of the United Slates. ,· ; . I
16. Generator Certilicalion: The generator must REAO,'SIGN (BY HAND IN INK), and DATE the certificatio~ Statement. II a ITlode other than highway is used.:
word Mhighway°' should be lined out and lhe appropriate mode (rail, water, or air) inserted in the space below. II another mode in addition to tr-.e hignway mace
used, enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION , .
17: Transporter 1 Acknowledgeme~I: Enter the name or the person accePting the waste on behalf ol'lhe first trans~orter. That person l'r:ust acknowledl
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering lhe DATE or receipt. ·" ·
18. Transporter 2 Acknowledgemenl: Enter. ii applicable, the name ol the person accepting the wasle on behall or the second transporter. That perscn r.-:us:
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative of the designated facility's owner or operator must note in this space any discrepancy be!we _
the waste described on !he manifest and Iha waste actually received al the facility. Owners and operators of facilities who cannot resolve s1;n1licant
discrepancies within 15 days receiving lhe waste must sub mil lo the Department a leller with a copy of lhe manifest describing the discrepancy and a~em::ts I
reconcile iL The IreaImen1. storage. or dlspoanl laclllly must enter the actual weigh! f:!I woste In pound• In the spaces pro..,lded if the amount varies any trcm :r-:
si:,ecified by the generalor in item 13 or II the generator uses a unit ol meas1.1re other than pounds. . .
20. Facility Owner or Operator Certillcalion: Prinl or type the name ol lhe person accepting the waste on beholl of lhe owner or operator of the l.:1c1t1Iy. Th.:1! ::,er son
must aci<nowledge acceptanc·e of the waste described on lho manifest by SIGNING (BY HAND IN INK}"and entering the DATE of receipt
"•s~1STANCe rs NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY oes,m,.rec 1
AEC,1••, THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (B03) 734-5200 WEEKDAYS FROM B:00 nm TO 5:00 pm. ·
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt.
2600 Bull $tree~ Columbia., SC 29201
Phone: (Bro) 73-4-5200
UNIFORM HAZARDOUS 1. Generetor'sU.S.EPAIDNo.
WASTE MANIFEST N c D o o
3. Generalor's Name and Mailing Address
Channel Master
,P. 0. Box 1416, Smithfield, NC 27577
,. Generato(s Phone [phone]
5. Transporter 1 Company Name
Willms Truck in Co Inc.
7. Transporter 2 Company Name
Menllesl Document No. 0 0 1 4
Emergency & Holidays: (803)73'-5"'24
Form A roved. 0MB No. 2050-00:39 E, ·res 9-30-68
2. Page 1
of Information in the shaded Meas is no1
required by Federal law, but is by State law.
!t~l~=i~:::~i.hf.i!~~i~j~~
:r~llt~~f ~.~~;1:.0~~:;fSt¥;~f~~~l1~
9. Oes!gnaled Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shlppfng Name, Hazard crass, and ID Number}
Hazardous Waste; Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormallon
GSX Work Order No.: 71838
12. Containers 13. Total Quantity 1◄. Uni :.~)'!'.~-~
No. Type · Wr.NrJ ;'~\/1~f;•>1h~~.,;;-.t(~,
1 D T 2 0 Y
,n'il" ,oji,~
\11E ,a ,a 16 •'If
1 e. CEN!RA TOR'S C ERTI_FICA TION: I hereby decl•re th•t the conlents ol thl• con•lgnment ere lully •nd eccurel91y de•crlbod •bove by pros,.r •hipping name and a,e ~fled.
packed. marked, and labeled, and are In all re1pecl1 In proper condition lor lran1por1 by hlghw•y ■ccordlng to appUeable lntern ■llon■1 and naUon■I governmaru r■9ul•Uona af'd
v,e 1■w1 ol tha Stale ol Soulh Carolina.
, 111 am ■ large quantity generator, I certify lhet I have a program In place toreducethavotume and to:idcltyolwasle generetod to Iha d~r-I have determined to be econo,.,leally
practicable and lh■t I have selected the practicable method ol treatment. 1torage, or dl1posal currently avaUable to me which mlnimlz.H the present and lutura ltUMI to human
)~ haallh and the anviionmcnt: OR, ill am a amotl quanlltygenerator, I have made a good failh aNorl lo minimize mywasta generation and select the bell wa1ta management ""9thod
that 11 available to me and Iha! I can atford. ·
Printed/Typed Name Signature Year
17. Transporter 1 At.:,mowledgemenl ol Receipt ol Malerials
ri edlTyped Name /.
.___JP\'
Printed/Typed Name Signature Monlh Cay Year
19. Discrepancy Indication Space
• I l'bs. CI ltbs.
b I Jib,. d I Jibs.
20. Facility Owner or Operator, Certification of receipt ol hazardous malerlals covered by this manifest except as nored in Item 19.
Prinled/Typed Name Slgna1ure Monlh Day Year
PA Form 8700-22 (Rev. 9/86) Previous Edltlons are Obs_olete (OHEC 1988 (Rev. 10/86)1
,· .. '
!', .... )·_+J,, .. l.:,/,',\
STATE OF ~OUTH CAROLINA INSTR~'cr10NS FOR UNIFOR.M HAZARDOUS WASTE MANIFEST • I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEGIBL~
GENERAL INFORMATION: Federal Regulations requiregeneratOrs and transporters ol hazardous wasleand ownersoroperatorS of hazardous waste trea1menl
:storage, or disposal licililies to use the U.S. EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)) and, ir necessary, lhE! continuation sheet U.S. EPA For
8700-22A Rev:9/86 {OHEC t988A) lor' b·o1h inter-stale and intra-state trt1nsportalion. Transporters who transport hnzardous wosle into the United States fro
an01her country are responsiOle !or completing the manilesl. Federal and S!a!e regulations also require generators and transporters of hazardous waste anel
owners or operators ol hazardous waste treatn:1ent. storage. ~r disposal facilities to complete the following information. I GENERATOR SECTION ,.
2:
Generator's U.S. EPA 10 Number• Manifest Oocum~nl.Number: Enter the generalor's U.S. EPA twelve digit identification number and the unicue tive ~ig1t
number assigned to this manifest by the generator beginning with 00001. ti your company does not have a U.S. EPA Identification Numt;ier. please con:act S.C.
OHEC at (803) 734·5200 about obtaining an Identification number. · . ■
Page 1 of: Ent~r the total number of pages used to complete this manifest, i.e., the nrst page EPA Form 8700-22 Rev, 9/86 [OHEC 1988 (P.EI/ 10/86)] i:lus t11
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A. Stale Manifest Document Number: .Leave blank.
B:
3. ••
5.
6. . c.
St.ale Generalor ldentiflcallon Number: Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage !he returned manilest forms.
Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the even: of a
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number or the first transporter identified in item 5. I Stale Transporter's ID Number: Leave blank .
0. Transporter's Phone Number: ·Enler a te1eph0ne number including area code where an authorized agent of the first transporter.can be reached in the event of
an el!lerger:icy_ir:ii:.luding nights, weekends, and holidays... . .... . . ... ---···--·-···· .... · · . .'. · ' I T.. Ttansporter 2 Company Name: II applicable. enter the company name of the second transport.er who wilf lran.sp0r1 the waste. If more than 2 trans;:,orters w
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in th'e order they will be transoor:ing the was:
8 ..
E..
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number al the second transporter identilied in item 7.
State Transporter's to Number: Leave blaryk. --, ,, --.... ~-' A ~--c:-·;..,:·· I
F .. Transporter's Phone Number: Enter a telephone number including area code where_an authorized agent of the second transporter can be reacl":e~ in th
event of an emergency including nights. weekends, and holidays, ,. .. ,, · • · r: -
9.
10.
G:.
. H;.
11:
Designaled Facilily Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal facility designatec :o receive the
waste listed on this manifest The address must be the Sile address, which may differ from the mailing address. · ·.., · · · · •
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit Identification number ol the designated treatment. storage, or disposal racility identilied ,n_ item 9 I
State Facility's ID Number: Leave blank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in :r.e event or an
emergency including nights, weekends, and holidays,
U.S: DOT Oescriptio.ns: Enter proper shipping name, hazard class and ID Number (UN/NA) !or each waste a.s identified in 49 CFR 171 -1 n.11 aCci:icr.aJ s;:ial
is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number of containers tor each waste and the appropriate abbreviaiion from Table i°'(belo,;.,,) for lh·e-~1Pe o'r c.o.nta1ne'~s.
TABLE I .
OM= Metal drums, barrels, kegs TT= Cargo tanks (lank trucks) CM= Metal ~,oxes._carton~. cas~s. roll ctls I
OW= Wooden drums. barrels, ke.gs TC= Tank cars CW= Wooden boxes, cartons. cases
OF= Fiberboard or plastic drums, barrels, ke~s OT= Dump truck CF= Fiber or plastic boxes. car.ans. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or piastre !:Jags
13 .. Total Ouantily: Enter lotal quantity of waste describe'd on each line, relative to lhe units used In item 14 ... '.). .. ~--..,_ •e• •-,;,-, ,.,--,i-I
T4. Unit (weight/volume): Enter the appropriate abbreviations from Table II {below) !or the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Subpar:s C ar.d DI
identity the hazardous waste on each line. · ·
J. Addilional Descriplions tor Malerials Listed Above: In the spaces provided. enter the authorization number (from the S.C. OHEC Authoriza1ion Reciuest F. or
for each waste stream listed in section 11 .ibove. Nole: Belore any hazardous waste can be accepted lor treatment storage or disposal in Soutn Carc-lin·a. tne
generator must obtain prior authorization from the treatment, storage or disposal facility. .,. . ~, . '"
K. Handling Codes for Wasles Listed Above: Leave blank. -. I
15. Special Handling Instructions and Additional Information: Generalors may use this space lo indicate special tranSportation, lreatment. storage or dispos
information or Sill al Lading lnrormation. For international shipments, generators must enter in this space the point al departure (city and s:ate) !or tnose
shipments. destined lor treatment. storage, or disposal outside the jurisdiction or the United States, · .• • . . _ ,. , .,
16. Generator Certification: The generator must READ,.SIGN (BY HANO IN INK), and DATE the certification statement. !(a mode other tha'n ... highwaYis used. :I
word Hhighway" should be lined out and lhe approprinte mode (rail. water.or air) inserted in lhe space below, II another mode in addition to tt·,e ~ignway r:ioce
used. enter lhe appropriate additional mode (e.g.,_and rail) in the space below.
~t~,~:~P:TrtEe~ ~~~!~~~redgemJnt: Enter the name ol,!he person accepting the waste on behall of _the first transponer, That person rr:ust acknowrecl
acceptance of the waste described on the manilest by signing (BY HANO IN INK) and entering the DATE ol receipt. . · . ~ --, • •
18. Transporter 2 Acknowledgement: Enter, ir applicable, the name of the person accepting the waste on behalf or the second transporter. That person mus:
acknowledge aCceptance at the waste described on the manifest by SIGNING (BY HANO IN INK) and entering lhe DATE or receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative of the designaled facility's owner or operator must note in this space any discreoancy Cetwe
the waste described on the manifest and lhe waste actUally received al the facility. Owners and operators ol facilities who cannot resolve s1;nific:an1
a11crepanc!u within 1 ~ doya receiving tho wnslo must submit 19 tho Dopartmentn lefter with n copy al the manifest describing the discrepancy and a~em::,tsl
reconcile it The treatment, storage, or disposal facility must enter the actual weight ~l waste in pounds in lhe spaces provided ii the amount varies any !rem :r:
specified by !he generator in item 13 or ii \he generator uses a unit ol measure other than pounds. . .
20. Facility Owner or Operalor Certification: Prinl or type lhe name of the person accepting-the waste on behall ol the owner or operator ol the locll,:y. Tho! ;:,er son
must acknowledge acceptanc·e ol lhe waste described on lhe manifest by SIGNING (BY HANO IN INK)° and enlering the DATE of receipt.
i,r AS~•STANCe IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OES1CNATEO 1
AECE1\'':: THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Haz.ardous Wa,te Mgt.
2600 Bull Stroot. Columbia, SC 29201
Phone: {SOJ) 73-4.5200
LEASE PRINT or TYPE {Form desl ned tor use on ellle 12· itch ewriler
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Ge-neralor's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N C D O 7 0
sP, 0. Box 1416, Smithfield, NC 27577
,. Generator's Pho~e 919 9 34-9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
1
Manifest Document No. o o· 1 4 5
Form A
2. Paga 1
ol
Emergency & Holidays; (803)73-4-5424
roved. 0MB No. 2050-0009 E, ·res 9-30-68
lnlormalion in the shaded areas is nol
required by Federal law, but is by State law.
~~~~";~':'~~~:!.fiti!t~~~'
;-~~~}~i~~[{%~~~f~it~~$~~~fi~~J)
·"\Mf:#~~:..::'>i!.:;..,/i ::f :;;t;f;~~t-<.xr~~:
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number -fi~j~~~i;1~1r1 ;);1~~11}~;\rtt~~~:~i~1r1,1. ·~
:fJ,tfli:t~:liiil~~J!:t~t:~g5~~-4:~~~~t~ S C D O 7 0
~ 1. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers
No. Type
L ... • . "Hazardous Waste, Solid, nos ORM-E
NA 9189 1 D T
±~~,~~~~:i;:''
L ltM.1-IO ,2 ,7 ,7,41-11, 1,0,
b. l..::..L.J-! 1 !-!
15. Special Handling Instructions and Addilional Information·
·.\. GSX-Work Order No.: 71839
18. GENE.RA TOR'S CERTIFICATION: I herebydeclareth•tthe Contents otthls consignment ere lu11yand accurately described above by proper ahlpplng name and arecla•adled.
packed. marked. and la°belod, and are In all respects ln proper condlllon tor tran1port by ~lghway according to appllcab1o International and natlonal governmen1 r99uladons •N:I
u,e law1 ol tha SI.ala of Soulh Carotlna. .
HI am a large quantity generalor, I certify that I have a program In ptaco to reduce the volume and toidclty of waste generated to the degree I have de111rmlned to be aconomk:&Jty
praCticable and that I have Hlectad Iha practicable method of trealmenl slorago, or dlapou.l currenUy available to ma which mlnlmli:ea U1e praMnt and future trirMI IO human ::.t health and the environment: OR, 111 am a small quanUtygonoralor,1 have mode a good failh ottortto minimize mywuto generation and select the beat wasta management~
:.: tt'let ls available lo mo and !hat I can arlord,
Printed/Typed Name ROGER L COATS ,~ -.__
l 7. Transpor1er 1 At.:1<now!edgement of Receipt of Materials
Printed/Typed Name
/,.,,., ""IIZ ,' (} ,u
Printed/Typed Name
19. Discrepancy Indication Space
Signature
Signature
Signature
20. Facility Owner or Operal0r; Certification of recelpl of hazardous malerlals covered by this manifest except as noled In llem 19.
Printed/Typed Name Signature
PA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete [OHEC 1988 (Rev. 10/86})
Month Day Year
Month Day Year
• I !lbs. C I !lbs.
bl !lbs. d I !lbs.
Mooth O.y YNI
: ,1
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MU~T BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require genera!Ors and transporters ol hazardous waste and owners or operators ol hazardous waste trea1menl
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 {OHEC 1988 (REV 10/86)1 and, if necessary, tM continuation sheet U.S. EPA For
8700-22A Aev:9186 (DHEC 1988A) tof bo1h inter-state and intra-stale transportation. Trnnspor1crs who transpor1 hazardous wi1ste into the United States lro
another country are responsiCle !or completing the manifest Federal and State regulations also require generators and transporters al hazarcous ·.-.·as:e a:-:c
owners or operators of hazardous waste treatment. storage. or disposal facilities to complete the !allowing information. . , I
GENERATOR SECTION .
1. Generator's U.S. EPA ID Number -Manifest Documenl Number: Enter the genera!or"s U.S. EPA twelve digit identification number and !he urn cue live digit
number assigned to this manifest by lhe generator beginning with 00001. U your company does not have a U.S. EPA ldenlilication Number. please con:ac1
1
S.C.
OHEC at [phone] about obtaining an identification number. I
2;. Page 1 ol: Ent~r the total number of pages used lo complete this manifest, i.e., the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P,EV 10l86)j plus :h
number or continualion sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) H any. .
A. Slate Manifest Document Number: .Leave blank.
State Generator ldenlificallon Number: leave blank. I B;
3.
5.
6, . c.
0,
Generator's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage the returned man if es: lorms.
Generator's Phor\e Number: Enter a telephone number wilh area code where an authorized agent of the generator can be reached in :t",e even: cf a
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter lhe company name or the first transporter who will transport the waste. I'
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the lirst transporter identified in item 5.
Slate Transporter's ID Number: Leave blank .
Transporter's Phone Number: 0Enter a telephOne number including area code where an authorized agent ol the lirsl transportf:?r-can be reacheC'. in the event o!
an erryergerycy_ i~!=_luding nights, weekends, and holidays... . .. .. ... .··---•"-... -·--· .... . .. ·. .' .:. I r.. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. ti more than 2 lrans;:iorters w
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:ir.g the was:
8 •. U.S. EPA ID Number:lf applicable, enter !he U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. St.ale Transporter's 10 Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area cod~ where_an authorized ~g'"ent'Ofth~ S~~Q~C(transporter can t:e reacr.ed in It
event of an emergency including nights. weekends. and holidays. -·• -· · •· · -•
9. Oesignaled Facilily Name and Sile Address: Enter the company name and site address al the lreatment, storage. or disposal facility designatec :o receive rr",e
wasle listed on this manifest The address must be !he site address. which may differ from the mailing a'cldres's'. ·· .... ·
U.S. EPA JD Number: En!er the U.S. EPA twelve digit iden!ilica!ion number or the designated lreat~e~t. s!ora'ge'._ or disposal_lacili!y iCentdieo ,n item 9. I
Stale Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized age'nt ol the~ faC:iHty can tie' reiched in :i-,e event al an
emergency including nights, weekends, and holidays.
U.S: OCT Descriptions: Enter proper shipping name, hazard class and ID Number (UN'tNA) for each waste as identified in 49 CFR 171-1 ii. II aCCi:icnal s;:,at
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) C_ontinualion Sheet. •,, :. ,r,rn.-·, _, . . _ ..
12... Containers (no. and type): Enter number ol containers lor each waste and the appropriale abbreviation lrom1Tablc I (below) for the type ol containers.
nBLEI . -·
OM 1:11 Metal drums. barrels, kegs TT = Cargo tanks (tank trucks)
OW II Wooden drums. barrels, kegs TC= Tank cars
CM= Metal boxes. cartons, cases. rcll cHs cW = Woo'd~'n-,b~x~S. c-;r1~ns. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ans. ca5es
TP .. Tanks portable CY= Cylinders BA= Burlap. cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste describe'd on each line, relative to lhe units used In item 14.
14. Unit {weighl/volume): Enter the appropriate abbreviations lrom Table II (below) !or the unit of measure:
Table II
I
I
P = Pounds L = liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)·
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Subpar:s C ar.d 01
identity the hazardous wasle on each line.
J. Additional Descriptions lor Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Aulhorization ReQuHI For
for each waste stream lislP.d in section 11 above. Note: Before.any hazardous waste can be accepted tor lreatme,nt. storage or disposal i'n Soulh Carclina. tne
generator must obtain prior authorization lrom !he treatment, storage or disposal facility. . .. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
l 5. Special Handling Instructions and Additional Information: Generators may use this space lo indicate special transportation. treatment. storage or di'soo
information or Bill o_l lading Information. For international shipments, generators must enter in this space the point al departure (city and s:ate) tor tnose
shipments destined !or treatment, storage. or disposal outside the jurisdiction or the United States. · . . • . • . . _ •
16. Generator Certification: The generator must AEAD,.SIGN (BY HAND IN INK), and DATE the certification statement If a mode other than hignwaYis used. :I
word Nhighway .. should be lined out and !he appropriate mode (rail. water .or air) inserted in the space below. II another mode in addition to tt".e highway r:,oce
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION . . ., . .
· 11: Transporter 1 Acknowledgement Enler the name of the person accepting the waste on behalf of the first transporter. That person rr.us: acknowl~C,
acceptance al !he waste described on the manifest by signing (BY HAND IN INK) and entering the DATE al receipt. , -•, ,
18. Transporter 2 Acknowledgement: Enter. ii applicable, the name al the person accepting the waste on behall ol the secoiid transporter. That person mus:
acknowledge acceptance of !he waste described on the manilest by SIGNING (BY HAND IN INK)_and entering the DATE al receipt
FACILITY SECTION ' ' ' ' I
19. Discrepancy lndicalion Space: The authorized rcpresenta!ive ol the designated facility's owner or opera!or must note in this space any discrepancy betwe
the waste described on the manifest and lhe waste actl.Jally received al !he facility, Owners and operators of facilities who cannot resolve s1~n1lican1
Clisc,epancies within 15 days receiving the waste must submit to the Oepartmenl a letter with a copy of the manifest describing the"discrepanc·t ar,d a:-:er.i~:,·
reconcile it The lreatment. storage.or disposal lacltlly must enter the actual weight (!fwasle in pounds in the spaces provided ii !he amount -.,aries any !rom:
specified by the generator in item 13 or ii the genera!or uses a unit al me.ts1.1re other than pounds. . .
20. Facility Owner or Operator Cerlillcalion: Print or lype !he name of the person accepting.the waste on behalf ol the owner or operator al !he I.Jctldy. Th.JI :,er son
must acil.nowledge acceptanc'e of tho waste described on the manifest by SIGNING {BY HANO IN INK}° and entering the DATE or receipt
1, AS~1STANCe IS NEEDED IN COMPLeTION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAG' E, OR DISPOSAL FACILITY OESIQ~Oi.TEO 1
RECE'"I:: THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 nm TO 5:00 pm.
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Huardous Waste M¢
2600 Bull Streel Columbia. SC 29201
Phone: (80J)734-5200
E PRII/T or lYPE (Form desl ned for use on elite 12-itch
. UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
_Channel Master
P. O. Box 1416, Smithfield, NC 27577
,. GeneratofsPhone 919 934-9711
S. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
· GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper S~lpplng Name, Hazard Class,' and ID Number}
L Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71840
Form A
2. Page 1
ol
Emergency & Holidays: (803)734-:.124
roved. 0MB No. 2050-0039 E.x ·res 9-30-88
Information In lhe shaded ateas is not
required by Federal law, but is by State law.
. ,.-.~--=,-=~btt~+:,•i:;..~·•·-.--~ ... ~~-!~~~
,jft;Wi~filitil[t1f:¼1~/tr:t~-~~i~~lm ~
~lj~,lii.ilit~t~~ltJ83:/1l~~Wstiti
12. Containers 13. Total Quantity U.Urtit ;~;'.!"Ullt~:i;.'t
No. Type · WIN~ ;;~(;};j.,:•-'.3-]s:/~J;'}'.'\~
I D T 2 0 Y
:ntt ,o;i,'9';}
~1•E1Q1Q161,f; ;~-t~~,.~--~~, .. ~
:~.I 1 I I I~
, I. Ql[Nl!AA TOR'S CERTIFICATION: I herebY declare that the conlent• ol thl• con•lgnment are fully end ■ccurai.1)1 do•crlbod above by proP4r ehlpplng namo and a,a cl--...fled.
• packed, marked, and 111."beled,and are ln 1111 respacta In proporcondlllon lor transport by highway according toappUcabla lnlarnatlonal and national govarnmantre,guladon• and
ma laws ot Iha SI.ala ol South Carolina.
If I am a luge quanlrty generator, I certify that I havo a program In place lo reduce the volume and 101tlclty of waste generated to Iha deg,_ I have datormlnod to M economlcaNy
practicatJle and that I have selected tho practlcablo method or trea1monl, storage, or dh1poaal currently available to mo which mlnlml:r.01 ltlo proMnt and lutur• ltlrMt to num.an
h•alth and tho environment; OR, 111 am a smoll quanlltygonorator, I have made a good faith etror1to minimize mywasta goner•tlon and 1elact the bo11 w .. tt manag•ment~
tt\al Is available to ma and !hat I can allord.
Printed/Typed Name RO.GER L. COATS Signature Cay y..,
Signature
~
Printed/Typed Name Signature Month Day y..,
19. Discrepancy Indication Space
• I pbs. C I llhl
b I pbs. d I llhl
20. Facility Owner or Operator; Cer1ificilfion of receipt or hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Day YNI
PA Form 8700·22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
··-··----.
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WA°STE MANIFEST ••
IMPORTANT: TYPE [on a 12-pitch [elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD
I
ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generatO,sand transporters of hazardous waste and owners or operators al hazardous waste treatmel
storage. or disposal ficililies to use the U.S. EPA Form 8700·22.Aev. 9/86 [DHEC 1988 (REV 10/86)] and, ii necessary, the continuation sheet U.S. EPA For
B700•22A Rev:9186 (OHEC 1988A) foi bo!h intcr•stnlc and intra•sI.itc tr;in5port.ition. Trnnsportcrs who transport hazardous waste into the United States fro.
another country are responsible !or completing the manilest. Federal and State regulations also require generators and transporters al hazarCous waste ar.c
owners or operators ol hazardous waste treatment. storage, or disposal facilities to complete the lollowing inlorma!ion. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number. Maniresl Document Number: Enter the generator's U.S. EPA twelve digit identilicatfon number and th~e uniCue !iv~ digit
number assigned to this manifest by the generator beginning with 00001. ti your company does not have a U.S. EPA ldentilication Number. please con:ac1 S.1 OHEC at (803) 734•5200 about obtaining an ldentilication number. . .
2;. Page 1 ol: Enter the total number of pages used to complete this manifest, i.e., the lifst page EPA Form 8700·22 Rev. 9/86 [DHEC 1988 (P.EV 10/86)1 ~lus l,
number ol contiiiualion sheets EPA Form 8700·22 Rev. 9186A (DHEC 1988A) ii any.
A. Slate Manifest Document Number. .Leave blank. . .
B: Slate Generator Identification Number: Leave blank. · · · J
3. Generator's Name and Mailing Address: Enter the name and mailing address al the generator who will manage the returned manifes: !arms.
4. Generator's Phorie Number: Enter a telephone number with a.rea code where an authorized agent of the generator can be reached in tr.e event cl
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will lronsport the waste,
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identilication number of the first transporter identilied in item 5. I C. Slate Transporter's ID Number: Leave blank.
0. Transpor1er's Phone Number: Enter a teleph0ne number incll.Jding area code where an authorized agent of the first transporter can be reache-::: in the event o!
an emergency including nights, weekends. and holidays. . _ _ _ · · · . · ;I
T.. rran~por1er 2 c~·mpany Name: 11 applicable, enter the cOmp~~y name Oi the seC:'~~'dt,ans·por1·er who witi' tra'n·spOrt the waste. If more than 2 !rans~orters
be used. use a U.S. ~PA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheet and Hsi the transporters in lhe order they will be transpcr:ir.g the was
8 .. U.S. EPA 10 Number:1I applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. Stale Transporler's ID Number: Leave blank. · ·-~ · · v·-I
F .. Transpor1er's Phone Number: Enter a telephone number including area code where.an authorized agent of the secc~d lransporter can be reach;': int
event ol an emergency including nights, weekends. and holidays. ,1 • •
9. Designated Facilily Name and Sile Address: Enter lhe company nnme and site address of the treatment. storage, or disposal !aCilfcYiii:":.ignatec :o receive the
waste listed on this manilest The address musl be the sile address, which may di lier rrom the mailing address. • • ~ I
10. U.S. EPA 10 Number: Enter the,U.S. EPA twelve digit identilication number of the designated lreatment,_s:orage, or disposal lacllizy ident1!iee! 1n ,tem 9.
G:. Slate Facility's ID Number: Leave blank. ·
H;. Faclllly's Phone Number: Enter. a telephone number including area code where an authorized agent of the facility can be reached in the event ol an
emergency including nights, weekends, and holidays. · · ·
1 L U.S; DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) !or each waste as identified in 49 CFR 171 •,ii.II aCCi:icnal s:,al
is needed. use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number or containers ror each w3sle and the appropriate c!bbreviation rrom Table I (bel'aw) lor \he type or containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. c·ases. rel! ctts
OW= Wooden drums, barrels, ke.gs TC= Tank cars ·cw~ Wooden boxes. c'3rtons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car.ens. cases
TP = Tanks·portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity ol waste described on each line, relative to the units used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) !or the unit ol measure:
Table 11
I
I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (!iQuid only)
I, Wasle Number: Enter h3zardous waste numbers as specified in South Caroliila Hazardous Wasle Managemenl Regulation R.61 • 79.261 Sut:;:;iar.s C ar:d 01
identity the hazardous waste on each line.
J. Addition al Descripllons for Malerials Listed Above: In the spaces provided, enter !he authorizolion nurnber (from !he S.C, OHEC Authorization Rec:iues! For
for each waste stream list~d in secllon 11 above. Note: Before any hazardous waste can be accepled lortreatmenl storage or disposal in South Carc1ina. 1ne
ge.nerator must ob!ain prior authorization from the treatment, storage or disposal facility. .
K. Handling Codes lor Wasles Listed Above: Leave blank. ·
. 15. Special Handling lnstrucllons and Additional lnlormalion: Generators may use this space fo indicale special transportation. treatment. storage or dis po
information or Sill or Lading fnlormalion. For inlernational shipments. generators must enter in this space the point of departure (ciry anc s:ate) for tnose
shipments destined !or.treatment. storage. or disposal outside the jurisdiction o/ the United Stales. ·
16. Generator Cer1ilication: The generator must READ,.S!GN (BY HAND IN INK), and DATE lhe certification statement. II a mode other than highway is used. •I
word "highway" should be lined out and lhe appropriate mode (rail, water.or air) inserted in the space below. II another mode in addilior, to tr.e hignway r:ioce
used. enter the appropriate additional mode (e.g., and rail) in the space below.
TRANSPORTER SECTION n: TransPorter 1 Acknowledgement: Enter the name or the person accePting the waste on behalf of lhe first transporter. That person'rr.ust acknowleCI
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE or receipt.
18. Transpor1er 2 Acknowledgemenl: Enter, ii apPlicable, the name al the person accepting the waste on behatl or the second transporter. That perscn r:-.us:
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt I
FACILITY SECTION
19. Discrepancy lndicalion Space: The authorized rcpresentalive ol the designated facility's owner or operator must note in this space any discrepancy betwe.
lhl wasle described on lhe manife11 ond Iha waste actUally receivod al the lacility, Owners and operators of facilities who cannot resolve s1;ndicant
c:111ct1o•ncles w1lhIn 15 day1 receiving tho waste mu1I submll lo tho.Oopa.r1monl a loltor with o copy of tho monllo1l describing the di1crepaincy and a:-:em:::,tsl
reconcile IL Tlie ueatment sto~age. or disposal laclllty musl enter the aclualwelght ~• waste In pounds In the spaces provided ii the amount varies any r,om 1r-:
si:iecilied by the generator in item 13 or ii lhe gener.Jtor uses a unit ol meas11re olher than pounds. .. .
20. Facility Owner or Operalor Certification: Print or type the n.Jmeol the person accepling-lhe waste on behaH ol the owner or operator ol the l.lc!l,:y. Th.ll :,erson
musl aci<.nowledge acceptanc·e ol lho waste described on the manifest by SIGNING (BY HANO IN INKfand entering the DATE ol receipt 1, AS!\rSTANCE IS NEEOEO 1N COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILliY OESIG~O,TEO 1
RECE'"-'~ THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734•5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of.Health
1· and Environmental Control
UNIFORM HAZARDOUS 1. Generalor'aU,S,EPAIDNo.
WASTE MANIFEST N c D o 7
l Generator's Name and Mailing Address
Channel Master
,P. 0. Box 1416, Smithfield, NC 27577
,. Generato(s Phone [phone] ·
5. Transporter 1 Company Name
Willms Truckin co· Inc,
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
CSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
ol
Bureau ol Solid & _Huardous Waste Mgt.
2600 Bull Street, Columbia.. SC 29201
.Phone: (803) 73.<-52()0
Emergency & Holid_ay,: (803)73-4-s-42'
roved. OMS No. 2050-0039 Ei: ·,es 9-30-Sll
lnlormalion in the shaded a,eas is nol
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Clas.s, and ID Number} 12. Containers 13. Total Quantity U.Unit :rWa:itaM.rnblf'M:
No. Type YNVrJ \?:'/~;L:-.,;::J..:Ajii:,'.~ ..
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling lnslructions and Addillonal lnlormallon
GSX Work Order No.: 71890
1 D T 2 0 Y
L Ql[Nl!:AATOR"S CERTIFICATION: I hereby declare that the content• ot thl• con■lgnment are fully end eccuralely de1crlbed above by proper ■hipping name and are ct.-fted.
packed, marked, and l11.beled, and are In all respects In proper condition tor tranapor1 by highway according to applleabla International and national govemmen1 ra,oulation• a1'd
U'la laws of the Stale ol South Carolina. . .
tf I am a large quantity gana,alor, I certify th al I have a pr0<;1ram In place to reduce the volume and 1011lclty of waste gan■r■IN to Iha d~rM I ha,_.. determined lo tMI .COftOm6cany
practicable and 1t,a1 I have aelected the practlcabla method of treatment. 110,age, or dlapo .. l currently available to me which mlnlml:r.aa th■ pr■Nnt and lutura l:hrNI IO human
health and Iha environment: OR, II I am a small quanlltyganaralor,I have made a good failh enortto.mlnlmlze my waste Qenaratlon and H1acl Iha brat! wu1a rnanaga~t method
1'\al Is available 10 ma and thal I can afford. · · -·
Printed/Typed Name RO.GERL COATS Signature Month O.y
D
17. Transporter 1 At;1mowledgement ol Receipt of Materials
Printed/Typed Name
-:5,: o.-.>
Signalure Monlh O.y Yw
,,,,__, 918i7
18. Transporter 2 Acknowledgem8nt of Receipt of Materials
Printed/Typed Name Slgnatura Monlh Day Yw
19. Discrepancy Indication Space
• I ·r !Ibo. C I libs.
bl libs. d I (Ibo.
20. Facility Owner or Operator, Certmc,tlon of receipt or hazardous materlals covered by this manifest except as noted In Item 19.
,,1nttd iTyptd Nam a Slgnalura Monlh Day YNI
.A Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 1'0/86)1
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM.HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewdte,J OR USE FIRM POINT PEN~ PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE'
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatm1
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev .. 9/86 {DHEC 1988 (A.EV 10/.86)] and, if necessary, tht:t continuation sheet U·.S. EPA Fe .
8700-22A Rt?v.-9/86 (OHEC 1988A) tor" bo1h iriter-state and inlr.i-stalc tranSportJtion. Transporters who transport hazardous waste into the United Sta:es Ire ..
another country are ·,esponsiCle !or completing the manifest Federal .ind State regu13tiqns also require generatorS and transporters or hazardous w.iste ar.c
::::::~::e~a~:;l:INhazardous .waste treatment. storage. o, disposal lacililies to complele the lollowing inlo,malion. . I
·1. Generator's U.S. EPA ID Number. Manifest Document Number: Enter the generator's U.S. EPA twelve digit identiflcation number and the umcue live d1g11
number assigned to this manifest by the generator beginni_ng with 00001.11 your company does not have a U.S. EPA ldentilication Number, please con:ac: S.C.
OHEC at [phone] about obtaining an Identification number. · I
2:. Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/SS)] ~l:.:s ·
number ol continuation sheets EPA Form 8700-22 Rev. 9/BGA (DHEC 1988A) H any.
~ State Manifest Document Number: .Leave blank. ·
State Generator ldenlrflcatlon Number: Leave blank. · · · 1 · a:
3.
••
5.
Generator's Naffl~ and Mailing Address: Enter lh~ name and mailing ~ddress of the generator ·wtio will mana9e the returned manifest lorms.
Generalor's Phone Number: -Enter a lelephone number with area code where an authorized agent of the generator can be" reached in :he even: cl an
emergency i_ncluding nights, weekends, and h·olidays. · · '
Transpor11 Company Name: Enter the company.name of the first transporte.r who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilicalion number ol the lirsl transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
O. Transporter's Phone Number: 0Enter a teleph~ne number including area·code where an authorized agent ol the first transporter can be reached in tr,e e·.ren1 o!
r.. ~i;.::;:~e;c;~~~~~~~ ~~9;:~· ~~=~~~~:b~;~~~~~~::-~mP~~Y name Oi the sec-;;·~dir8M-p()rtef Who wiii"t;r~:~.s~O~-,h~ waste. II more thari 2 trans:,oners I
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be fransoor.ing the wa .
B ..
E
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number ol the second transporter identified in ilem 7.
State Transporter's ID Number: Leave blank. · I
F .. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the second transporter can be reacr.e': in
9.
10.
G:.
11:
12..
13 ..
14.
event of an emergency including nights, weekends, and holidays. ·
Designaled Facility Name and Sile Address: Enter the compan·y name and site address ol the treatment, storage, or disposal facility designatec :c receive :J-,e
waste listed on this manifes·l The address must be 1he sile ·address, which may differ from the mailirig address. I
U.S. EPA ID Number: Enter the U.S. EPA· tw~lve digit identification number ol the desig0atcd treatment. storage, 9r disposal facility iden11fiec:J in 1:ern 9.
Slate Facility's ID Number: Leave blank. . · . .
Facility's Phone Number: Enter a telephone number Including area code where an authorized agent of !he _lacilily can be reached in :r.e e·.rer.t ot an
emergency including nigh1S, weekends, and holidays. · · · I
U.S: DOT Descriplions: Enter proper shipping name, hazard class and ID Number(UN/NA) for ~aCh waste as identified in 49 CFR 171 •1 ii. I! ac:i:icr.al s::i·
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. ·
Containers (no. and type): Enter number ol containers lor each waste and the appropriale abbreviation rrom Table I (below) lor the type or c::::nta1ners. nBu1 ·
OM= Metal drums. barrels, kegs TT= c;;argo tanks (lank truck_s) CM= Metal boxes. cartons. cases. roll cHs·
OW II Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
DF • Fiberboard or plastic drums, borrels, kegs OT=. Dump truck CF = Fiber or plastic boxes. canons. cases
I
TP = Tanks portable CY ~_Cylinders BA= Burlap, cloth. paper or plas:1c ba;s
Total Quantity: Enler total quantity of waste describe"d on each line, relative to the·unils used in item 14.
Unit (weight/volume): En1er the appropriate abbreviations from Table II (below) !or the unit ol measure: . . Table II . I
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Managemenl Rcgula!ion A.61 • 79.261 Subpa~s c· and
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N =:= Cubic Meters Y = Cubic Yards G = Gallons (lic~id cil)
identify lhe hazardous waslc on each line. ·
J. Additional Descriptions lor Male rials Li sled Above: In !he spaces pro~ided, enler the authorizalion number (lrom !he S.C. DHEC Authomat1on Rec:ues11F orm)
for each waste stream lis!P.d in section 11 above. Note: Before anY hazardous waste can be accepted !or treatment storage or disposal in Soulh Carclina. tne
generator must obtain prior authorization lrom the treatment. storage or disposal facility. II
K. Handling Codes !or Wastes Listed Above: Leave blank. · · ·
1 S. Special Handling Instructions and Additional fnlormalion: Generators may use this space lo indicate special transpor1alion, treatment. storage or Cisp .... cat
information or Bill of Lading lnlormation. For international .shipments, generators must enter in lhis space the point ol departure (city and state) !er tnose
shipmenlS destined lor uealment, storage, or disposal outside the jurisdiction of the United Stales. · _-I
16. Generator Certificalion: The generalor must READ, SIGN (BY HAND IN INK), and DATE !he certilicatiOn statement.Ha mode other than highway is usec.
word "'highway" should be lined out and the appropria1e mode (rail, water .or air) inserted In the space below. ti another mode in addition 10 1t•,e highway rnoc: ,
used. enter the appropriate additional mode (e·.g.,,and_rail) in the space below.
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behall of the first transporter.
acceptance.al \h~ waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt. ·
~hat person must ·ackno-,,.lel
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name al the person accepting the waste on behall ol the second transporter. Thal perscr, r..us:
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE al receipt I
FACILITY SECTION ·
19. Discrepancy Indication Space: The authorized representalive ol lhe designated facility's owner or op~rator must note in !his space any discrepancy 00:1· ... _.
the waste described on !he manifest and the waste actUaHy received al the facility. Owners and operators ol lacilities who cannol resolve s1i;rid1can:
discrepancies w1lhin 15 days receiving the waste must submil to lhe Department a lefler with a copy of lhe manifesl describing the discrepancy and a r.er.iotl
rtconcile it The 1rea1ment. storage, or dlapoaol loclHly muat onler the actual weloht ~I waste In pounds In the spaces provided ii lhe amount varies any from r
si:,ecilied by the generalor in item 13 or II the generalor uses a uni! ol meas1.1re olher than pounds. . .
20. Facility Owner or Operator Certification: Print or type the name of the person accepting the wusle on beh.ill of !he owner or operator 01·1he !acility. Tl1.Jt ~er son
mus! acknowledge acceptanc·e of the wasl_e described on the manifest by SIGNING (BY·HAND IN INK)° and entering the DATE or receipt 1 .IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACll.lTY OES1Gu<,:Q
REC "THE '.'/ASTE DR THE S.C. OHEC MANIFEST SECTION AT [phone] WEE.KDAYS FROM 8:00 am TO 5:00 pm.
South Carolina Department of.Health
and Environmental Control
. . .
E PRIHT or TYPE . (Form de~I ned f~r us~ on elite 12-·· 11c~ eWriler
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
3. Generator's Name and Mailing Address
Channel Master
N C D 0
P. O. Box 1416, Smithfield, NC 27577
,. Generators Phone [phone].
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
Menlleat Document No.
0 0 1
9. Oesigna!ed Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
S C D O 7 0
2. Pago 1
of
Bureau of Solid & Hu.ardous Wute Mgt.
. 2600 Bull S>eo\ Columb;a. SC 29201
Phone: [phone]
Em.orgoncy &. HoHdays; (803)734-~2•
roved. 0MB No. 2050-0009 E, ·res 9-30-8.!
Information in the shad9d atlas is not
required by Federal law, but is by State law.
11. U.S. DOT Description (in~luding ~roper Shipping Name,· Hazard Class, and ID Number) 12. Containers 13. Total Quantity 1'. Unit , l'.Wa:iti• ....,_.if
Wt/Vd. '.'.'.fr\;:;>~:.;}i)i~tt
Hazardous Waste, .solid, nos ORM-E
.NA 9189
b ..
C.
GSX Work Order No.: 71891
No. Type
I D T 2 0 Y
11. OENEAATOA'S CERTIFICATION: I hereby declare t1,a11he con1ent•olthlacon•lonmentere lullyend accuratelydaacrl~ ■bo"e by prop., •hipping name and are c.1-..fled,
packed, marked, and 1abeled, and are In all respecls In proper condition tor lran•porl by highway according to applfcable lntemaUonal and national go"emmen1 ,--.,ulation• ■"4
t,ie I•""• ol o,e S1a1e ol Soutf'I CaroUna. ·
HI am • large quan1ity ganer1111or, I certify th11t I ha"• a program In place to reduc, the volume and toxicity of wa•le generated to tha d--.,,-1 have delermlnad 10 be, aconomk:aNy
preclicable and that l ha"• selected !he practicable method ol treatment. storage, or dlspoaat currently avallable lo me which mlnlmlzet tho preMnl and ruture tnrMI IO human
health and !he en"lronment OR, Ill am• small quanUtygonerator, I have made a good lalth ettor1 lo minimize fflywaste generation and Hlec:t tho bolt wHlO management tn9U"od
lhal la •"ailable to me and thal I can attord. ·
Printed /Typed Name 0 ERL COATS Signature
17. Transporter l A<.:J(nowledgement ol Receipt of Materials
Printed/Typed Name
18. Transporter 2 Ac
Printed/Typed Name Signature Month Cay Year
19. Discrepancy Indication Space
a I 111o. C I libs.
bl jibs. d I libs.
20. Facility Owner or Operator, Certificallon of receipl ol hazardous materials covered by this manifest except as noled In Item 19.
Printed/Typed Neme Signature Monltl Cay. YNI
PA Form 6700•22 (Rev. 9/86) Previous E~ltions are Obsolele [OHEC 1988 (Rev. 10/86)1
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE {on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require genP.rators and transporters of h·azardous waste and owners or operate.rs of hazardous was:e trea:mel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Aev."9/86 [DHEC 1988 (REV 10/.86)1 and, ii necessary, th~ cOntinuation sheet U..S. EPA For
8700-22A Rev:9/86 (OHEC 1988A) lo~ both intcr-sta18 and intra-state 1rnnspor1at1on. Transporters who transport hazardous waste into the United Sta:es tro
another country are responsiOle for completing the manilesl Federal 3nd Stille regulations also require generatorS and transpoi-ters ol hazardous was!e a.~.c
owners or operators ol hazardous waste treatment, storage, or disposal facilities to complete the following inrormation.. · •.
GENERATOR SECTION
1. Generalor's U.S. EPA ID Number a ~anlfest OoCuml!nt Number: Enter the generator's U.S. EPA twelve digil id.entilication number and the u~icue tive digit
number assigned to this manliest by thegenerator'beginning with 00001. llyour company does not have a U.S. EPA Identification Number. please con:a_c: S.1 OHEC at [phone] about obtaining an Identification number. · · .
2.:. Page 1 of: Enter the total number ol pages used to complete this manifest, Le., the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P.EV 10186)] ~lus :r-:
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. ·
A. State Manifest Oocumenl_Number. .Leave blank. . . .
B: Slate Generator ldentiftcallon Number: Leave blar)k.. . -· . . • · '
3. Generator's Name and Mailing Address: Enter the name and mailing ~ddress of the generator who will manage the returned mani!es! forms.
,. Generator's Phoiie Number: Enter a telephone number wit~ area code where an autho~ized agent of the generator can be reached in :he ever:: ct a
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company.name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identHication number ol the first transporter identified in item 5. I
C. Slate Transporter's ID Number: Le3ve blank. · . o. Tr.ans porter's Phone Number: 0Enter a telephOne number including are8·code Whe.re an authorized agent of the first transporter can be reached in 1r.e e·,ent of
.: • 1 an1 en:,~rgency_ir:i~Juding nights, weekends, and holidays ... ·, ...... . ··-· · . ··-·--· . -···-. . ':' · :·. : ·. · · I ·"·r.. "rranspOi-tei-2 Company Name: II ap.p!lcable, enter the company name al the secon_d transporte"f Who will transport !hf:! waste. II more !hari 2 transi)o~ers w
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 {OHEC 1988A) continuation sheet and list the transporters in the order they will be transpor.ir:g the was! ..
8 •. U.S. EPA ID Number:ll applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in i~em 7.
E .. SI.ale Transporter's 10 Number: Leave blank. · 1 ·
F .. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol the sec~nd transporter can be reacr.ed int
event ol an emergency including nights, weekends, and holidays.
9. Oesignaled Facilily Name and Sile Address: Enter the compan·y name and site address of the treatment, storage, or disposal facility designatec :o receive tt-,e
waste lisled on this manifest The address musl be the site address. which may differ from the mailirig address. · I
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage, 9r disposal facility iden:ifie:J 1n 1:em 9.
G: State Facility's 10 Number: Leave blank.
· H;. Facility's Phone Number: Enter a telephone number Including area code where an aulhorized agent ol the facility can be reached in :r.e e·,ent o! an
emergency including nightS, weekends, and holidays. · · · I
11·. U.S; DOT Descriptions: Ent.er proper shipping name, hazard class and ID Number(UN/NA) for each waste as identified in 49 CFR, 71-1 ii. If ac:i:icr.al s::ia
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. ·
12.. Containers (no. and type): Enter number ol conlainers for each waste and the appropriate abbreviation lrom Table I {below) for the r-I;:e of c::n:a1ners
TABLE I
OM :c: Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons, cases. roll'ctts·
OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF• Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP,. Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plas:1c :ai;s
13 .. Total Quantity: Enter total quantity ol waste describe"d on each line'. relative to the units used in item 14.
t4. Unit (weight/volume): Enter the appropriate abbreviations (rom Table II (below) !or the unit of measure:
Table II .
I
I
F' = F'ounds L = Liters K = Kilograms T = Tons M = Metric Tons · N =: Cubic Meters Y = Cubic Yards · G = Gallons (lic::uid cntl
I. Wast_e Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Su. t::,a~s C ar.d D
idenhty lhe hazardous wasle on each line. · ·. ·
J. Addilional Oescriplions lor Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. OHEC Author1zat1on ReQuest Form)
for each waste stream tist~d in section 11 above. Nole: Before any hazardous waste can be accepted lor treatmenL slorag'e or disposal in South Car_c-lina. ine
generator must obtain prior authorization from the treatment. storage or disposal fricility. · . I
K. Handling Codes tor Wasles Listed Above: Leave blank. · · -
15. Special Handling lnslrucllons and Addilional Information: Generalors may use th_is space to indicate special 1ranspor1ation, lreatment. storage or dispcs
information or Bill ol Lading Information. For international shipments, generalors must enter in this space the point of departure (City and s:a:el !er :nose
. shipmenl3 destined lor treatment, storage, or disposal outside the jurisdiction ol the United States. · · • , . . I
16. Generator Certilicalion: The generator must READ, SIGN (BY HANO IN INK), and DATE thecertilicatiOn statement. II a mode other than highway is used.:
word .. highway" should be lined out and the approprii!te mode (rail, water.or air) inserted in the space bel(?w, If anoth.er mode in adddion to the highway moc:e,
used, enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION . I
17: Transport~r 1 Acknowledgement: Enter the name of the person accepting the waste on behalf ol the first transporter. That person must ackno·..,leC
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt. · .
18. Transporter 2 Acknowledgement.: Enter, if applicable. lhe name of the person accepting the waste on behalf of the second transporter. Thal perscr. r..us:
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE_of receipt I
FACILITY SECTION .
, 9. Discrepancy Indication Space: The authorized representative of the d·esignated facility's owner or ope;ator must note in !his space any discrepanc'f o~twe_
the waste described on th8 manirest and the waste actUatly received at the facility. Owners and operators of facilities who cannot resolve s1i;~il1can1
discrepancies within 1 S days receiving the waste must submit to the Department a letter with a copy of the manifest describing the discrepancy ar:d a:-:er.'l::;tl
reconcile it The treatmeni storage, ordlsposol loc!Hly must cnler lhe ectuol welohl ~f waste In pounds in lhe spaces provided ii the amount varies any trom:
specified by lhe generator in item 1:J or ii the generalor uses a unit ol measi.,re other than pounds. . .
20. Facility Owner or Operator Certlllcalion: Print or type lhe name ol 1he person accepling the waste on behall ol the owner or operator ol the I.Jcilt1:;. Th JI :.,er son
musl acknowledge acceptanc·e of the waste described on lhe manirest by SIGNING (BY·HANO IN INKf and entering lhe DATE ol receipt
IF AS~•~TANCE !S NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR. DISPOSAL FAC"ITY OES•G'"•=O I
R~C c THE WASTE on THE s.c. DHEC MANIFEST SECTION AT (803) 73,.5200 WEEKDAYS FROM 8:00 nm TO s·oo nm. .
I
, -'C··=,...,~ -i\
IL~~~-•.-..: "!
South Carolina Department of Health
and Environmental Control
LEASE PRIHT or TYPE (Form des! ned for use on elite 12-Itch ewrller
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N c D 7
l. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor's Phone [phone]
5. Transporter l Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name·
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box.255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Paga 1
of
Bureau or Solid & Haz.ardous Wute M;t
2600 Bull Streel Columbia. SC 29201
Phone: [phone]
Emergency & Holiday>: (803)73-1-5'24
roved. 0MB No. 2050·0039 Ex 'res 9-30-88
Information in the shaded ateas is not
required by Federal law, but is by State law.
11. U.S. DOT Description (including' Proper Shipping Name, Hazari Class, and ID Numb6r} 12. Containers 13. Total Quantity U.UM l'.W&IIII.....,;·~
No. Type 'M/VrJ :f:'i::/·!!}/(_i-[,ih
L
b.
C.
d. .
Hazardous
NA 9189
. .
Waste, Solid,. nos ORM_-E
.!.'Additional ~ !cir MalerialQ Usied )J,6y,j
::10~, -.. -:~\ .. \t>fi~~\;/::'.I~ii:i$fL~Utf1MIJ\~ifit
L lt.ili.j-10121717141.:..111 l 10121·
b. LLJ-1 1-1 L, .. . ,.,,._:;;,,,:-:•,:,.
15. Special Handling lnslructions and Addilional Information
GSX Work Order No.: 71892
l D T 2 0 y
l II. GENERATOR'S CERTIFICATION: I hereby declare Iha! the conlenl• or this con1lgnment are fully and accurai.ly de1crlbed above by proper 1hlpplng name and ara cla ... n■cs.
packed. marked, and 1a·b111ed, and are In at! respecta In proper condition lor transport by highway according to applicable lnternatlonal and n1t1onal government re,gulatlona &Ni
the laws ol 11,a State ol Soulh Carollna.
HI am a larQe quan!Uy generator, I certify that I have II program In place !0reducethavolume and toxlcltyofwailaganeratad lo the de,grM I ha.,. determined to~ aconofflk:atty
practicable and thal I have Hlected Iha practicable mathod of treatment. storage, or dlapoaal curranlly avallable lo ma which mlnlmlt■ a the pr■Nnt and future 11\rMt to ru,man
ha a Ith and Iha anvironment OR, 111 am II smoll quantity generator, I have mado a good lalth effort to mlnlml.r.o my waste generation and aaleet the beat wula management methOd
that is available to me '!-"d thal I con ellord. ·
Printed/Typed Name RO.GER L. COATS Signature Zi--Month Day y..,
0
(>
Prinled/Typed Name Signature Month Cay y..,
19. Discrepancy Indication Space
I I jibs. .e I llbl
b I jibs. d I jibs.
20. Facility Owner or OperalOr; Certification ol receipt of hazardous malerlals covered by this manifesl except as noted In.Item 19.
Prinled/Typed Name Signature Month Day y..,
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete {OHEC 1888 (Rev. 10/86))
IMPORTANT:
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZAROOUS WASTE MANIFEST I
TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEGIBL .
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators al hazardous waste treatml
storage, or disposal licililies 10 use lhe U.S. EPA Form 8700-22 Aev.'9186 (DHEC 1988 (R,EV 10/.86)] and, if necessary, the continu~tion sheet U·.S. EPA F
e700-22A Aev:9/86 (DHEC 1988A) loi both inler-statf? and in!ra-stale tranSportation: Transporters who transport hazardous waste into the United S:a:es Ir ....
another country are responsible for completing lhe manifest Federal and State·regu18tions also require generator$ and transpor1ers al hazardous ... -aste ar:c
owners or operators or hazardous w~ste treatment, storage, or disposal facilities to complete the following information. I
GENERATOR SECTION
1. Generator's U.S. EPA 10 Number p Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unic;ue five digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:ac! S.C.
OHEC at (803) 734p5200 about obtaining an identification number. . · I
2;. Page 1 ol: Enter the total number of pages used to complete this mani_fest, i.e .• the fiist page EPA For_m 8700-22 Rev. 9/86 [OHEC 1988 (P.EV 10l86)j ~lus ·
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A. Stale Manliest Document.Number. .Leave blank. .
a: Slate Generator _ldentifleallon Number: Leave blar:ik.' · . · · · I
3. · Generator's Name and Mailing Address: Enter !he name and mailing address of lhe generator who Will manage the returned manifes: forms.
,. Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in :ne even: er "
emergenC:y including nights, weekends, and h·olidays. · · ·
5. Transport 1 Company Name: Enter the company name or the first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the rirst transporter identified in item 5.
C. Slate Transporter'.s ID Number: Leave blank.
0. Transporter's Phone Number: 0Enter a telephOne number including area·code where an authorized agent of the lirsl transporter can be reacheO: in the e· ... er.t of
T.. ~ra~:;:~ee~c;~~!;~i~~ ~~g!:~· ~~=;~~:=b~;~~:~~~~:.·omP~~Yname Oi~he se~~·;dt,an;-pc)rterwho wil
1
i't'r~:~sPo~-,h~ waste. II more thari 2 t~ans~ortersll.
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation shE!etand list the transporters in the order they will be transoor:ing the wa .
8 .• U.S. EPA 10 Number:II applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. Slate T,ansporter's ID Number: Leave blank. I
F .. Transporter's Phone N~~ber_: E~ter a.telephone number i_ncluding ar~a code where an authorized agent of the second transporter can be reacne-: in
event cl an emergency including nights. weekends. and holidays. . · . .
9. Designated Facilily Name 3nd Sile Address:· Enter the compan'y name and site address ol the treatment, storage. or disposal laci!ity desic.::;natea to receive n'",e
waste listed on this manilesl The address must be the site address. which maY differ from the mailing address. · I
10. U.S. EPA ID Number: Ente_r the U.S. EPAtw~lve digil identirication number.or the desig~ated treatment, storage. 9r disposal lacllity 1d~n:il1e:11n 1:em 9.
G: Stale Facility's ID t'umber: Leave blank. . · · · · ·
· H;. Facllily's Phone Number: Enter a telephone number including area code where an authorized agent ol the facitily can be reached in· :ne e·,e.r.1 of an
emergency including nights, weekends. and holidays. • ·
, i: U.S: DOT Descriptions: Enter proper.shipping name, hazard class and ID Number (UN/NA) lor each waste as identified in 49 CFA 171 • 1 i7. I! aCCi:icr.al s:,f
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet
12.. Containers (no. and type): Enter number of containers ror each waste and the appropriate abbreviation from Table I (below) lor the ripe or con:a1ners
~B~I . .
OM= Metal drums, barrels, kegs TT= Cargo tanks {lank truck_s) CM= Metal boxes. cartons. cases. roll c·tts·
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF• Fiberboard or plastic drums. barrels, kegs OT"' Dump truck CF = Fiber or plastic boxes. canons. cases
I
TP = Tanks portable CY= .Cylinders BA= Burlap, cloth. paper or plastic bags
Total Quantity: Enter Iota! quantity ol waste described on each line. relative to the units used in item 14.
14. Unit (weighl/volume): En!er the appropriate abbreviations from Table II {below) !or lhe unit ol measure:
. Table II .
13 .. I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons · N =:: Cubic Meters Y = Cubic Yards G = Gallons (lieu id cit I
I. Wasle Number: En!er hazardous waste numbers as specified in South Carolina Hazardous Wasle Managemenl Aegulation R.61 • 79.261 Sut:pa~s C ar.d
idenlity the hazardous waslt? on cactl line. . · •
J. Additional Descriptions for Materials Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Aulhomation Request F o I
for each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted lor treatment. storage or disposal in Soutri Carclina. trie
generator mus! obtain prior authorization tram the treatment. s!orage or disposal facility. . I
K. Handling Codes for Wastes Usled Above: Leave blank. · ·
15. Special Handling lnslructlons and Addilional lnlormalion: Generalors may use this space to indicate special transportation, treatment. storage or disp.. I
information or Bill or Lading Information. For international shipments, generators must enter in this space the point ol departure (ciiy anc state) !er :nose
shipments destined !or treatment, storage, or disposal outside the jurisdiction of !he United Stales. · I
16. Generator Certification: The generator must READ,.SIGN (BY HAND IN INK), and DATE the cer'tificalio'n statement. II a mode other than highway is usec e
word "highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. II another mode in addition lo tl"',e hignway mo ,S
used. enter the appropriate additional1mode (~.g.,_and_ rail) in the space below.
TRANSPORTER SECTION ' , ' • · , .\ 1 · • .•
11: Trans-porter 1 Acknowledgement: Enter th'e name al the person accepti~g the waste on behall of the first transporter. _That person must ackno ..... le e
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt. ·
18. T,anspor1er 2 Acknowledgement: Enter, if applicable. the name ol the person accepting the waste on behalf ol the second transporter. That perscr. r:-.us:
acknowledge acceptance ol the waste described on the manifest by SIGNING {BY HAND IN INK) and entering lhe DATE ol receipt I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative of the designated racility's owner or operalor must note in this space any discrepanc·, b-=t·..., __ n
the waste described on the manifest and tho waste actually received al the lacility. Owners and operators of facilities who cJnnot resol1,1e s11;n1f,car.:
discrepancies within 15 days receiving the waste must submit to lhe Departmenl a let!er with a copy ol the manilest describing the discrepancy ar.a ar:em;:ilo
reconcile iL The 1reaIment storage, or dlsposol laclllty musl enter the actual weight (?I wasle In pounds in the spaces provided if !he amount varies any /ror.i r
specified by the g_enerator in ilcm 13 or !I !he generator uses a unit ot meas!Jrc olher than pounds. . .
20. Facility Owner or Operator Cerlilication: Print or type the name ol the person accepting the waste on behnll .of the owner or oper.:itor of the IJcil1t·;. TtiJ! ::ierson
must a_cknowled~e ~,cepliin,·e 01 lhe Wa5le described on lhe manifest by SIGNING (BY HAND IN INK) and enterin9 the DATE al receipt ·
I~ M,tBTANC~ IS frnrnrn IN COMPLETION OF T►IIS MANlr-EST, CONTACT THE TREATMaNT, STOnA(lfi, on OIS~OSAL ~ACI\.IH Cn~l0"•1rnt
,;;cr ·c THE '.'/ASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
South Carolina Department of Health
·and· Environmental Control
E PRINT or TYPE {Form des! ned for use on elite 12· itch wriler
UNIFORM HAZARDOUS
WASTE MANIFEST
3. G~erator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
4; Generator's Phone [phone]
5. Transporter 1 Company·Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
1
M11nlle•t Document No. 0 0 1 5 0
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l.Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
SCD070
Form A
2. Page 1
ol
Bureau or Solid & Hazardous Waste ~gt.
2600 Bull Street, Columbia, SC 29201
Phone: [phone]
Emergency & Holiday!: (603)734-~24
roved. 0MB No. 2050-0039 E.t ·res 9-30-a.!I
Information in the shaded a,eu is nee
required by Federal law, but is by State law.
11. U.S. DOT. Description (including Proper S~iPpl~g f!ame, Hazard Clas.5, and ID Num~r) •12. Containers 13:Total Quantity ~t Unit L\W&itil....,.;"f
No. Type WIN~ :+:·:,f (;--,:'tr_l:,),.··l~~
a. Hazardous
NA 9189
Waste, Solid, nos ORM-E .. :
l D T 2 0 y
15. Special Handling lnstrucfons and Additional lnlormalion
GSX Work Order No. : . 71893
ie. G!NltAATOA'S CERTIFICATION: I hereby declartl that ihe contents olthl• con•lgnment •re luilyand eccuratelydHcrl~ above by prop,ar •hlPplng name and ere cl--..fted.
packed, marked.and 111."beled,and !l'" In all respects in proper condition for tran1portbyhlghway according to applicable lnterna_llonet and_natlonal govemment r99ulat1on1 a/'ld
the laws ot lhe S~I• or Soult! Caronna, · · · ·
111 am a large quanlity genera1or, I cer1lty thiit I have e program In place to reduce the volume and 1oxlclfy ofwastegene,ala,d to the deg,_ I h■-dalermlna-d to tMo econom'cally
practicable and that I hava selected the pracUcabto method of treatment. storage, or dl1poul currently available to ma which mJnlmlu• the praNnt and future tf',rMI 10 h1.1man
health and the environment: OR, II I am a smo11 quontlty generolor,I have mado a good faith effort to minimize my waste generation and select the be1I w•1te management meU"lod
that 11 availat>le 10 ma and that I can allord,
Printed/Typed Name Signature Month Year
COATS
I Receipt of Materials
Prinled/Typed Name Slgnalure Monlh Day Year
, 9. Discrepancy Indication Space
I ,._._,.__,_.,__,_ ..... Pbs. C 1 ............................... Pbs.
bl pbt. di jllll
20. ,1cUl_ly Own1, or Opo,.tor: Cor11fleellon or receipt or heurdou, m1tortalI covered by 1h11 monlloI1 oxcept as noted In ltom 19.
Prinled/Typed Neme Signature Monlh Oay YNI
PA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDqus WASTE MANIFEST I
IMPORTANT: TYPE {on a 12-p;tch (elHe) typewrHerJ OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST_,BE LEGIBLE! ' ·..,,)
GENERAL INFORMATION: Federal Regulations require genP.rators and transporters of h·azardous waste and owners or operators of hazardous waste trea:meJ
storage, or disposal licililies to use the U.S. EPA Form 8700-22 Aev."9/86 [OHE_C 1988 (REV 10/,86)1 and, ii necessary, thEi cOnlinuation sheet U..S.·EPA For
8700-22A Rev: 9166 (DHEC 1988A) fof b0olh inter-state and intra-state lr.inSportation: Trnnsportcrs.who transport hazardous waste into the United States !ro.
another country are responsible !or completing the manilesl Federal 3nd State regu18tions also require generatorS and transporters al hazardous waste a.~,d
owners or operators ol hazardous waste treatment. storage. or disposal facilities lo complete the following inlormation. • .
GENERATOR SECTION , .
1. Generalor's U.S. EPA ID Number -Man11es1 DoCument Numbe;: Enter the generator's U.S. EPA twelve digit identification number and the unic;ue five digit
number assigned to this manifest by the generator beginning with 00001. If your company does not have·a U.S. EPA ldentilication Number. please cor::a_c: S.C.
OHEC at [phone] about obtaining an Identification number. · · . . · · · I
2;, Page 1 ol: Enter the total number of pages.used to complete this manifest, i.e .• th·e liist page EPA For_m 8700-22 Rev. 9/86 (OHEC 1988 (REV 10186)1 ~lws ::-
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) ii any.
A. State Manifest Oocumenl_Numbei": .Leave blank.
e: State Generalor ldenliflcallon Number: Leave blank.• · · · -· I
3. Generator's Nal'T\~ and Mailing Address: Enter th~ name and mailing ~d~ress of the generator ·who will manage the returne~ ~anifes: lorms.
4. Generator's Phone Number: -Enter a telephone number with area code where an authorized agent of the generator can be reached in :rie even: al an
emergency including nights, weekends. and h'olidays. · ·
5. Transport 1 Company Name: Enter the company_name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: El'}ter the U.S. EPA twelve ~igit identification number ol the lirst transporter identified in item 5. I C. Slate Transpor1er's 10 Number: Leave blank.
D. Transpor1er's Phone Number: 0Enter a teleph0ne number including area·code where an authorized agent of the lirsl transporter can be reache~ in the e·,er:t 01
•. T.. ~':a~:;:~e;c;~~~~~i~~ ~~g;:~· ~~:;;~~=b~;.~~~~~~~:-omPBny f,am~ Oi~~e sec-;;·ndtrans·pc;rterWhowil/1lr~:~·s~6~-th~ waSte. If more thari 2 lransporters w •..
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation shE!et and l_ist the transporters in the order they wlll be transoor:.ir:g :he was: __
8 .. U.S. EPA ID Number:11 applicable, enter the U.S. EPA·twelve digit ID number ol the second transporter identified in item 7.
E.. Stale Transpor1er's ID Number: Leave blank. · · I
F .. Transporter's Phone Nu~ber: Enter a telephone number including area code where an authorized agent of the second transpor1er can be reacr:e: int.
event ol an emergency including nights, weekends. and holidays. ·
9. Designated Facility Name and Sile Address: Enter th~ compan·y name and site address ol the treatment, storage. or disposal facility designatec :o r~ce1ve :r-,e
waste listed on this manifest The address must be the site address. which may differ from the mailing address. I
10. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number al the desig~aled treatment, storage. <?r disposal laci!ity identdiec 1n item 9.
G: Stale Facility's ID Number: Leave blank.
· H;. · Facility's Phone Number: Enter a telephone number including area code where an aulhorized agent al lhe facility can be reached in :r.e e·,ent al an
emergency including nigh1S, weekends, and holidays. · · · · I
11~ U.S: OCT Descriptions: Ent_er proper shipping name, hazard class and ID Number{UN/NA) for each waste as identified in 49 CFR 171-1 ii. If aC:::i:iC~al s;:,a
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12..:. Containers (rio. and type): Enter number ol conlainers lot each waste and the appropriate abbreviation lrom Table I (below) for" the type al containers. ne~1 ·
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases, roll cHs'
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons._cases
OF• Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. can.ens. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic :ai;s
1:1 .. Total Ouantily: Enter total quantity of waste described on each line; relative to the units used In item ~4.
Unit (weighl/volume): Enter the appropriate abbreviations f_rom Table II (below) for the unil ol measure: 14.
I
I
Table II
P = Pounds L = Liters · K = Kilograms T _= Tons M = Metric Tons N =::-Cubic Meiers Y:;: Cubic Yards G :;: Gallons {licuid cnll
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Sut:;,ar.s Car.~ D
identity the hazardous waste on each line. · . -,
J. Additional Descriptions tor Malerlals Listed Above: In !he spaces provided. enter the authorization number (lrom the S.C. OHEC Aulhor1zation Request Form)
for each waste stream listed in section 11 above. Niole: Be lore any hazardous waste can be accepted !or treatment slorage or disposal in South Carclina. ine
generator must obtain prior authorization from the treatment, storage or disposal facility. . · . -,
K. Handling Codes for Wastes Lisled Above: Leave blank. . · · · . · · . · ,s. Special Handling Instructions and Additional lnlormalion: Generators may use this space 10 indicate special transportation, treatment. s1orage or dispcsa
information or Bill ol Lading Information. For international _shipments, generators must enler in this space the point ol departure (City and s:a1e) ror :nos~_
. shipments destined !or treatment. storage, or disposal outside the jurisdiction or the United Stales. ·. · I
16. Generator Cer1illcalion: The generator must READ,.SIGN (BY HAND IN INK), and DATE lhe certifiCaliOn statement.Ha mode other 1han highway is usec.:
word '"highway" should be lined out and the appropriate mode (rail. waler. or air) inserted in the space below. II another ~ode in addition to the high•••:ay r:ioce,
used, enter the appropriate additional mode (e.g.,_and. rail) in the space below.
TRANSPORTER SECTION ' . • . . 'I
11: Transpor1er 1 Acknowledgement: Ente~r the name al the person accepting the waste on behall of the first lranspor1er. That person rnu·si ·ackno ... 1ec
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE al receipt. ·.
18. Transpor1er 2 Acknowledgemenl: Enter. if applicable, the name ol the person accepting the waste on behalf al the second transporter. That perscr: ~us:
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative al the designated racility's owner or operator must nole in this space any discrepanc·1 ~-:1.....-e w
the waste described· on \he mnnilcst and tho waste actUaHy received at the facility. Owners and oporalors of facilities who c.1nnct resol,.,.·e s1~1,i11car.:_
discrepancies within 15 days receiving the waste must submit to the Department a letter with a co Py ol the manifest describing lhe discrepancy ar,d a~er.i::;tsl
reconcile il The ueatmenl storage, or dlsposol loclllly must onler the actual weloht ~f waste In pounds in lhe space, provided ii the amount varies any tr:irn-:r
s0ecilied by the generator in item 13 or If the generalor uses a unit ol mcnst.1re other than pounds. . .
20. Facility Owner or Operalor Cerlillcalion: Print or type the nome of the person accepting.the Yo'.aste on behalf ol the owner or operator ol.the· IJctli1·1. Tflat per~on
must acknowledge acceptanc·e ol lhe waste described on the manifest by SIGNING (BY·HAND IN INKf and entering the DATE ol receipt · 1 ·
i, ASS•STANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATM,1/T, STORAGE, OR DISPOSAL FACILITY CES'Gr,a,eo
F:C -~ .iHE '.'/ASTE On THE S.C. OHEC ~.1A.NIFEST SECTION AT {803) 734-5200 we~·KOAY:· · '• ·; ""f) .,m TO 5:00 pm.
I ~~\
-~
South Carolina Department of Health
and Environmental Control
E PRINT or TYPE (Form desl ned for use on ellle 12-itch ewriler
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
10. U.S. EPA ID Number
Form A
2: Page 1
of
Bureau ol Solid & Ha.urdous Wa.ste Mgt.
2600 Bull Sil'~~ Columbia, SC 29201
Phone: [phone]
Eme.rgency & Holidayi: (803)73-1-5(2,
i-oved. 0MB No. 2050-0039 E.x ·,es 9-30-88
Information in the shaded .areas is no1
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Na.me, Haza;d Class. and ID Number) 12. Containers 13. Total Quantity 14. Un~ f Wat9 ~'-~\
No. Type · . WrJVd. \~f'/<:i,,;;:,?)) ... ·l~
L Hazardous Waste, Solid, nos ORM-E
NA 9189
1~. Special Handling Instructions and Additional lnfor'11allon
GSX Work Order No.: 71894'.
l D T 2 0 Y
, e. QENERA TOR'S CERTI.FICATION: I ·hereby declare th al the content• ol thl1 consignment •r• rully •nd accur•i.ly d11crlbed 1bov1 by pro~, 1hlpplng name end •r• cle ... n.a,
pa,cked, marked, and l11b11led,and are in all respects In proper condlllon for tran1por1 by highway according to app11cable International and nattonal govern men! re,guleoon, &/'Id
u..e la,.,, of th• Sia.le of South Carolina.
If I am a large quantity gene,ator, I certify thal I have a program In place lo roducethevolume endto.11:leltyol wa1legen1ralod to the de',;lr-1 haV9 detarmlned to be economa11y
practicable and !hat I have a elected the pracllcable method ol tre·a1ment. alorage, or dlspoaal currenlly avalteble lo ma which minimize a the pre-nt end lutu,1 It\,_, to hu-n
healU', and lhe environment.: OR. II I am a"amotl quonlitygoneralor, I have made n good lalth eHor1 to minimize mywaslo generation and 11toct Iha boaJ wall• managamenl meoiod
that is available lo mo and that I can allord. ·
Printed/Typed Name RO.GER L COATS
Signature Year
Printed/Typed Name Slgnalure Month Oay Year
19. Discrepancy Indication Space
I I libs. CI libs.
b I Jibs. d I Jibo.
20. Facility Owner or Operator; Certiricalion of receipt ol hazardous malerials covered by this manifest except as noted In Item 19.
PrinledtTyped Nama Signature Monlh Day Yw
iPA Form 8700-22 (Rev. 9/86) Previous Edlllons are Obsolele (DHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (ente) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generatOrs and lrnnsporters of h·azardous waste and owners or operat~:irs of hazardous was:e trea:mel
storage. or disposal ricilities to use the U.S. EPA Form 8700-22 Aev.-~l/86 (DHEC.1988 {REV 10/.86)] and. if necessary, the continuation sheet U'.S. EPA For
S700-22A Aev.-9I86 (DHEC 1988A) for both inter-state and intra-stale transportation. Transporters who transport hazardous waste into the United States !re
another country are respon~iOle ·,or completing the manilesl Federal and State regu18tions also require gene"ratorS and transpor1ers or hazardous waste a.~.c
owners or operators of hazardous waste treatmenl .. slorage, or disposal lacililies to complete the lol!owing information. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number. Manifest DoCumenl Number: Enter the generator's U.S. EPA twelve digit identillcalion number and :he ur.icue live c!i,;it
number assigned to this manifest by the generator beginning with 00001.11 your company does not have·~ U.S. EPA ldenlilication Number. please cor::ac: S.C.
OHEC at (803) 734•5200 about obtaining an Identification number. · · · I
2.:. Page 1 ol: Enter the total number of pages used to complete this manl_lesl, i.e., the lifst page EPA Form 8700·22 Rev. 9/86 [DHEC 1988 {P.EV, 0186)] ~l:..:s: ·
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any. ·
A. State Manllesl Document.Number: .Leave blank. .
B: Stale Generator ldenliflcallon Number: Leave blar,k. • · · · · · · · I
3. Generator's Nanie and Mailing Address: Enter the name and mailing ~ddress ol the generato_r who will manage the returne~ manifest lorms. .
,. Genera!Or's Phoiie Number: Enter a telephone number with area code where an authorized agent ol. the generator can be reached in :ne ever.: cf ,
emergency including nights, weekendS, and h·olidays. · •. · · · · · I 5. · Transport 1 Company Name: Enter the company.name of the first transporter who wilt transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA Melve digit identification number of the first lranspo.rter identified in it.em 5.
C. Slale Transporter's ID Number: Leave blank. · ··
0. Transporter's Phone Number: 0Enter a te1eph0ne number including area·code where an authorized agent.of the first transporter can be reached in the e·.-ent or
an emergency. including nights, weekends, and holidays. · ' '· ·, · : ·' · 1·
T.. Tran~porter 2 c~·~pany Name: II applicable, enlerthe cOmpa;;y name Oithesec·~;~iral1s"POrte'r'Wiio will't'ra'n'spOrt th~ waste. If more thari 2 lrans;,orters .
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and hst the transporters m the order they wall be transoor:1r.g the "Nas •.
8 .. U.S. EPA ID Number:11 applicable, enter the U.S. EPA Melve digit 10 number of !he second transporter identified in item 7.
E .. State Transporter's ID Number: Leave.blank. · · · I
F .. Transporter's Phone N~mber'. E~ter a telephone number i_nctuding area code where an authorized agenl ol the second transpor1er can be reac~e~ in_ t,
even! ol an emergency including nights, weekends, and holidays. · ·
9. Designated Facilily Name and Sile Address: Enter the companY name and site address ol the treatmenl, storage, or disposal lacility desiGnateo to receive tr,e
waste listed on this manifest The address must be the site address. which may differ from the mailing address. · •.
10. U.S. EPA ID Number: Enter lhe U.S. EPA tw?lve digit identification number ol the desig~ated treatmenl. storage. qr disposal racility ident11ie:: 1n 1:er:1 9.
G: State Facility's ID Number: Leave blank. . · . :
· H;. Facllily's Phone Number: Enter a telephone number including area code where an authorized agent of the lacility can be reached in :r.e e·,er.: or an
emergency including ni_ghtS, weekends, arid holidays. · / · I
11·. U.S. DOT Descriptions: Ent_er proper shipping name, hazard class and ID Numb-er (UN/NA) ror each waste as identified in 49 CFR 171 • 1 77. I! ac::::i:icr.al s:ia
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ~
12.. Containers {no. and type): Enler numbi?r ol conlainers !or each waste and the appropriale abbreviation from Table I (below) lor the r-1pe of c:::n1a1ners
TABLE I .
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll c:-ts·
·ow• Wooden drums, barrels, kegs TC·= Tank cars · CW= Wooden boxes. cartons. cases I
OF• Fiberboard or plastic drums, b ... a'rrels. kegs OT= Dump truck . CF= Fiber or plastic boxes. c:an.ons. cases
TP = Tanks portable . \~~ · CY= Cylinders BA= Burlap, cloth, paper.or plastic ::a;s
13 .. Tolal Ouanlily: Enter tolal quan1ity~(~sle described on each line; relative 10 the-units used in item 14. I
14. Uni! (weighl/volume): Enter the appr0'8~iate abbr~viations I.rem Table II (below) for the unH of measu;e: · ·f . !able II · '.. .
P = Pounds L = Liters K =·Kilogr"ams T = Tons M = Metric Tons · N =:= Cubic Meters Y = Cubic Yards G = Gallons (li4uid cnil
I. Was le Num_ber: Enter hazardous waste llumbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Sub::iar:s· C ar.c D
idenlify the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number(lrom the S.C. DHEC Authonzation Request For
!or each waste stream liSlP.d in section 11 above. t-k>le: Belore a°ny hazardous waste can be acc·epted lor treatment slorage or disposal in South Carci"ina. me
generator must obtain prior.authorization from the treatment, storage (?r disposal facility. . I
K. Handling Codes !or Wastes Listed Above: Leave blank. · · ·
1 S. Special Handling lnslructlons and Additlonal Information: Generators may use this space to indicate special transporta!ion, treatment. storage or dis;::o
information or Bill of lading_ lnlormation. For international _shipments, generators must enter in this space the point ol departure {city and s:ate) !er :nose
shipments destined for treatment, storage, or disposal outside the jurisdiction ol the United States ...... ·. I
16. Generator Certilicalion: The generator must REAO,'SIGN (BY HANO IN INK), and DATE the cer1ilicatiC)n stalement. ir a mode other' than highway is usec. •
word .. highway" should be lined out and the appropria~e mode (rail. water .or air) inserted In lhe space below. ti another mode in additiori to the hign· .... ay moc ,
used. enter the appropriate additional mode (e.g.;_and_ rail) in the space below. · .
TRANSPORTER SECTION . · •
11: Transporter 1 Acknowledgement: Ente; the name of the person acceptinQ the waste on behatl of the first transporter. That person mus! acknowlec■
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf of the second transporter. That perscn r:-.us:
acknowledge acceptance ol the waste described on the manilest by SIGNING (BY HANO IN INK) and entering the DATE ol receipt I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator mu St note in this space any discreoanc'/ :Jet· ... e _,,
the waste described on the manifest and tho waste aclually received al the facility. Owners and operators of facilities who cannot resolve s1,;.".d,car.t
dlscreoancies within 15 days receiving the wa:sle must submit lo the Oeparlment a letter with a copy ol the manifest describing the discrepanc·1 and ar:er.i~t,
reconcile it The treelment. s1ora9e, or dlsposnl toclllty mus! enter the ac1uol weight ~f waste In pounds in the spaces provided ii the amounl varies any trom :r
specified by the generator in Hom 13 or II lhe generator uses a unit of meas11re other than pounds, ,
20. Facility Owner or Operalor Cerlilicalion: Print or type the name ol the person accepling the waste on be hall ol !he owner or op!?rator ol the l.1c1t11'/, Tt1Jt :ierson
mus! acknowledge acceptanc·e of lhe waste described on the manilest by SIGNING (BY-HAND IN INK)and entering the DATE ot receipt 1 IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST,.CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIG"'•cO
f':C = THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEE.KDAYS FROM 8:00 am TO 5:00 pm. · .
I South Carolina Department of Health
and Environmental Control
LEASE PAINT or TYPE (Form desf ned for use on ellle 12-ilch writer
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N C D
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name 6. U.S. EPA ID Number
Willms Truckin Co Inc.
7. Transporter 2 Company Name
. Manlfe•t Oocumenl No.
0 0 1 5 2
9. Designated Facility Name and Site Address
GSX ·services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10, U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
of
Bureau Of Solid & Hazardous Waste Mgt
2600 Bull Str~~ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 EJ:t,ires 9.30.ga
Information in the shaded areas is n01
required by Federal law, but is by Stale llw.
11. U.S. DOT Description (including Proper Shippfng Naf!76, Hazard Class, and ID Number} 12. Containers 13. Total Quantity 14. Unit ._.tWafll.....,,.,~·
No. Type 'MNrJ >J>~ :/-:>,~f:;/'.(j"<'t~~
L Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and ~ddilional Information
GSX Work Order No.: 71895
1 D T 2 0 Y
11. GIE:Hl!RATOR"S CERTIFICATION: I hereby declare th■tthe cont■ nt■ olthl1 con■lgnmentair■ lullyand ■ccur■i.>ly d■1crlbed ■bov• by pro~r ■hipping n■m• anCI ■re ClaNiNN.
p•cked. marked, •nd 1a'beled, and are In all re:11pecta In proper condlUon ror transport by highway according to applfceble International and n■lfOnal gov•mmanl regu1 ■oon1 &NI
tt,e law1 ol lhe State ol South Carolina. ·
11 I ■m • large qu■nlity generalor. I certify Iha! I have a program In place to reduce the volume and toxlcltyolwe■teganaratod lo the degree I have determined to be economic.ally
practicable and thal I have selectad.tha_practlcabte method of treatment. storage, or dlapoaal currently avaUable to me which mlnlmltH the proent and lutura ttuNI 10 human
haallh and the environment: OR. Ill am a a moll Quonlityganaralor,I have mado a good lailh·e"ort to minimize my wasle generation and 1 ■lec1 the beat wute man•o•m■nt n,,eltlod.
thal is available to me and that I con allord. ·
· Printed/Typed Name ROGER L. COATS Signature
17. Transponer 1 At.:11:"nowledgement of Receipt of Materials
Printed/Typed Name •
. . -lh UJL,, ,;;: I/
Printed/Typed Name Signature Month Day Year
i9. Discrepancy Indication Space
a I l1bs. C I pm
b I pt,s. d I libs.
20. Facility Owner or Operator; CertificatiOn of receipt ol hazardous malerials coverecfby !his manifesl excepl as noted In Item 19.
Prinled/Typ~ Namt Signature Mot>lll o,, YIM
EPA Ferm 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86)1
' I
IMPORTANT:
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEASLTL COPIES MUST BE LEGIBLI.
TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ,
GENERAL INFORMATION: Federal Regulations require generators and lransporters of hazardous waste and owners or operators ol hazardous waste trea:mel
storage, or disposal licililies to use the U.S. EPA Form 8700:22 Rev."9/86 (OHEC 1988 (A.EV 10/.86)] and. if necessary, th~ cOntinu~tion sheet U·.S. E~A Fe
8700-22A Rev:9186 (DHEC 1988A) loi both inter-state and intr.:i-stale tranSport.3tion: Transpor1ers.who transport hazardous waste into the United Sta:es Ir .
another country are responsi6te for completing the manifest Federal .ind State regul8tions also require generato_rs and trclnspor1ers ol hazardous .... asie a:-:ci
::::::~::•~a~:;
1
:!Nhazardous waste treatment. storage. or disposal lacilities to complele the !allowing inlormnlion. · I
Generalor's U.S. EPA JO Number. Manlfesl Oocumenl Number: Enter the generalor's U.S. EPA twelve digit identification number and the ur.icue tive digit
number a'ssigned to this manifest by the generator beginning with 00001.11 your company does not have·a U.S. EPA Identification Number. please con:ac: S.C.
OHEC at (803) 734•5200 about obtaining an Identification number. . · I
Page 1 ol: Enterthetolal number al pages used to complete this mani_lest, i.e., the fiiSt page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P.EV 10185)1 clws: ·
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) i! any.
1.
2;.
A
a:
3.
••
5.
6.
C.
D.
T..
8 ..
E ..
F ..
9.
10.
G:
.·H;.
11'.
12..
Stale Manifest Document.Number: .Leave blank. . ·
State Generator Identification Number: Leave blank. · · · · · I
Generator's Naffle and Mailing Address: Enter the name and mailing ~ddr'ess of the generator who will manage the returne~ manifest forms.
Generator's Phorie Number: ,Enter a leleph_one number wit~ area code where ari autho~ized agent of the generator can be reached in :he ever,: cl ,
emergency inc!udirig nights, weekends, and holidays.
Transport 1 Company Name: Enter the company.name ol the first transporter who will transport the waste.
U.S. EPA ID Number: Enter the U.S. EPA 1we1ve ~igil identification number of the first transporter identili~d in item 5. I Slate Transporter's ID Number: Leave blank.
Transpor1er's Phone Number: 0Enter a telephOne number including area·code where an authorized agent ol the first transporter can be reacheC in :r.e e·-1er.t cl
an emergency inc:luding nights. weekends, and holidays. . . · . . . ' '" ·, · ' · .
Tn1n~por1er 2 co;;,pany Name: II appllcab1e, enter the c'Omp8r\Y name Oi the seC~"ri'dt,ans·port-er Who wm'tra'n'spOrl th~ waste. II more thari 2 trans;,orters
be used. use a U.S. EPA Form 8700-22A Rev. 9/ 86 (DHEC 1988A) continuation sheet and list the transporters in the order they wilt be transcor:ir.g the wa
U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit 10 number al the second transporter identified in item 7.
Slale Transpor1er's ID Number: Leave blank. I
Transporter's Phone N~mber_: E~ter a telephone number i_ncluding area code where an authorized agent of the second transporter can be reache": int
event al an emergency mclud1ng nights, weekends, and holidays. . ·
Designated Facility Name and Sile Address: Enter the company name and site address ol the treatment, storage, or disposal facility designatec :o r~ce1ve rt-,e
waste listed on this manifest The address must be the' site address, which may dilfer lrom the mailirig address. • ••
U.S. EPA ID Number: Enter the U.S. EPA tw~lv·e digit id~n'tification number ol lhe desig~ated treatment, storage. C?r disposal lacitity iden:ifie: in item 9.
Slate Facility's ID Number: Leave blank. . · • .
Fac:llity's Phone Number:. Enter a telephone number including·area code where an authorized agent of the facility can be reached in :he e·,er.t of an
emergency including nights. weekends. and holidays. . · · · .
U.S; DOT Descriptions: Ent.er proper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 171-, 77. !I aC:::i:iCr.al s:,al ··--~
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ·
Containers (no. and type): Enter number ol containers !or each waste and !he appropriate abbreviation from Table I (below) for the type or containers
TABLE I .
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank truck~) CM= Metal boxes. cartons. cases. roll cffs·
OW II Wooden.drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF m Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF = Fiber or plastic boxes. canons. cases
·TP II Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity al waste described on eaC:h line, relative to the unils used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviation_s l_rom Table II (below) for lhe unit ol measu~e: I
Table II
P = Pounds L = Liters K = K0ilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid ell I
I. Waste Number: Enter hazardouswasle numbers as specified in South Carolina Hazardous Waste Managemenl Regulation R.61-79.261 _Sut:;a~s C ar.c
identity lhe hazardous waste on each line.
J. Additional Oescriplions lor Malerials LI sled Above: In the spaces pro~ided, enter the authorization number (from lhe S.C. DHEC Au1hor1za11on Reques1 F ormJ
for each waste stream listed in section 11 above. t1ole: Before any hazardous waste can be accepted for treatment storage or disposal in South Carel in a. me
generator must obtain prior authorization from the treatment, storage or disposal facility. · I
K. Handling Codes tor Wastes Listed Above: Leave blank. · ·
15. Special Handling lnslructlons and Addilional lnformalion: Generalors may use this space to indicate special transportation, treatment. s1orage or Cis;;o .sl
information or Bill of Lading lnlormation. For international shipments, generators must enler in this space the point ol departure (city and s:are) rcr :nos~
shipments destined for treatment, storage, or disposal outside the jurisdiction ol the United States. · , . · , , I
16. Generalor Certiliealion: The generator must READ, SIGN (BY HANO IN INK), and DATE lhe certificaliOn statement.Ha mode other than highway is usec.
word '"highway" should be lined out and the.appropriate mode (rail, water, or air) inserted in the space bel(?W, U another mode in addition 10 1r,e highway moc ,
used, enter the appropriate additional mode (e.g.,_and rail) in the space below.
TRANSPORTER SECTION .. . . . . . I
11: Tr~nsporter 1 Acknowledgement: Ent~r tli~ name al \he person acc~pting the wilste on b~hall ol the lirst transporter. That person musi acknowle
acceptance al the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE ol receipt. ·
18. Transporter 2 Acknowledgement: Enter, if applicable. the name al the person accepting the waste on behalf ol the second transporter. That perscr: r..us:
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipl I
FACILITY SECTION
19. Discrepancy 1ndicalion Space: The authorized representative al the designated facility's owner or operator must note in !his space any discrepanc1 oet·.., ¥ ¥
the waste described on the manilest and the waste actually received al the facility. Owners and operalors of facilities who cannot resolve s1;:-:d1car.:
discrepancies within 1 5 days receiving !he waste mus I submit to the Department a le lier with a copy ol the monilest describing the discrepancy ar.c ar;er.i:itl
t1c:onc:il1 il. Tht 1reetm1nl. 1toraoe, or dl1posol loc1H1y mu1t onlor tho actual waloht (!I wo1to ln pound1 In Iha 1poc11 provided if Iha amount varies .any from: :
specified by lhe generator in item 1J or Uthe generator uses a·unit ol mcnst.1re other than pounds. . .
20. Facility Owner or Operator Cerlilicalion: Print or type the name of the person accepling lh_e -...:aste on be hall ol the owner or operator or'the r.1c1l1ty. Tt1Jt person
must acknowledge acceptance ol lhe waste described on the manifest by SIGNING (BY-HANO IN INK)and entering the DATE of receipt · 1 IF A~.S•STANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OES1G,1>,1!0
P"C -~ THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT_ [phone] WEE.KDAYS FROM 8:00 am TO 5:00 pm. • . .
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt.
2600 Bull Stree~ Columbia., SC 29201
Phone: (603) 73,4.520()
Emergency & Holiday.: (BOJi734-5-42•
I LEASE PRIHT or TYPE {Form desianed for.use on ellte r12-l'liichl "·-ewriler) ·
UNIFORM HAZARDOUS 11. Generalor'sU,S.EPAIDNo.
WASTE MANIFEST N, c, D, 0, g, 7, ~. n. 1,,. 7,
Form A nroved. 0MB No. 2050-0039 EJ:pires 9-30-&e
· · Manlreet .I 2. Page 1 lnlormallon in the shaded IM'HS is not
I, , •• ~~~u:","~~ ~0.; I ol. i · required by Federal law, but iJ by Stale law.
I
I
I
I
I
I
I
I
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield;
,. Generalor'sPhoner 919 l 934-9711
5. Transporter 1 Company Name
Willms Truckin<> Co. Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 25S
Pinewood. SC 29125
NC 27577
6. U.S. EPA ID Number
1 ~. Cr Dr Or 7r 1r 71 n. a. .,, <>
8. U.S. EPA 10 Number
oX · i'PhoM',A.i 11n -:i 1-1 ~ ,..;.~., ~ ., .. ·
,#){~❖_f'"•"> , .. ,-.. . .., "jj'"iJ~~~;:,:..-.,. 1·:",'.':::;J·:.-.~-!i.~·:,.-.·: .;.;,;.
I I I I I I I I I I I t Fft··•
10. U.S. EPA ID Number
, Sr C, D, Or 7r Or 3, 7r ·:
tf~1~~1~a?t~~~10i!Xif;;);Mt;¼~-ih~~~;:1fa1:{:
~ B , 11t~it'.~l~~~t~t~!i:zi~~z~4~--~~,1taj\!iJ
11. U.S. OOT Description (including PropOr Shippfng Name, Hazard Class, and ID Number} 12. Containers 13. Total Ouanti~ 14. Unit l'W&sllltMnbef..__,,..
No. Type VNVr:J ;~1-:~~~r\,~Y;~::f:;-'.ii
' I . • o O O I
d.
I I I I I ' '
15. Special Handling Instructions· and Additional Information
GSX Work Order No.: 71896
, e. GEMERA TOR'S CERTI_FICA TION: I hereby declare that the content• ol thl• con■ignment ar■ lully and accurately do•crlbed above by prop.er ■hipping name and are cia ... ned,
packed. ,nuked. and labeled, and are in all respect■ In proper.condlllon for transport by highway according to appllcablo lntornaUonal and natlonal govarnmenc re,gulauona al'ld
V'la la ... a ot the Stale ol Soulh Carolina.
. If I am a large Quantity generator, I certify that I have a program In place lo reduce the volume andtoxlcltyol watilagenerated totha dogrN I have determined to be economk:.ally
practic:able and th al I have selected lhe pracllcabla method ol traalmant. storage. or dlapoaat currently avaltabla to ma which ·minimize a tho praMnt and luture lt\r-110 h1,1man
r,ealth and lhe environment; OR. II I am a smoll Quanlit)CQonorator, I hove mado a good lalth effort to minimize my waste ooneratlon and selacl tho beat waat• manaoemenl ,r,,eO'IOd
tl"lal ii available 10 ma and thal I con 0110,d.' · I Prinled/Typed Name ROCER L. COATS . ISignalure f''.--/~ t7Z {1,., +; :,6:~i ;:~,;:;
~T+1~7:-. ~T=ra::n-,po--:n:-e-r :-1-:A-«-:n::o-w-:led-:-g-em __ e __ n::,-o:-I R;:e--·c_;e'=ip71 .. or~M-:a-.,--.r~ia":'1,--...:..L ____ __:_-:v.-,!::::::.::::.._..;!:::_,.::.,.....:;;;;;;:~;l.:~:::::,----.l.!~:Z::l.2.U:~~~ At-----'--------''---------'-------~----------------------------------1 A Printed/Typed.Name . ISign"atu_re .~. . . · ·,_~ .·· -Z. h: Month Day Year
INO~k-=-~j;)~p~~~~~r~~~/f;~~~?c:,t'.e~y~·:___-,-__ L~~~::::~~~~'//~~(c,~o~~~=~======_;_ll_LJ,l~J..J•IL.lt~
A ~1_8_.,,r..,ra_n_s;..po-:n,..e_r_2_A_c_kn_o_w_le_d.;;gc.e_m_,n_1_o_r_R_ec_e..;ipc..l_o_r M_a1_e_ria_l_•...,.--.,.-,,---------·---------.;..-------,,,---,--,---i
T Prinled/Typed Name !Signature. Monin Day Yw
t , I , I· , I !!E+----------------'-----------"---------~-'-.._'-'.....L.~
F
A
19. Discrepancy Indication Space
I ~1-....,,-----------·---~ 20. Facility Owrier or Operator, Certilicalion of receipt ol hazardous materials covered by this manifest except as noled In Item 19.
Prinled/Typed Nama I Slgnaluro
PA Form 8700-22 (Rev. 9/88) Previous Edhlons ore Obsolele (DHEC 1988 (Rev. 10/86)1
• L-1 ,._,_...1....r....L..JJlbs. 'L.l .,__....1....r....L..JJlbs.
b I Jibs. d I Jibs.
Monl!l Day YNI
I , I , I ,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ,· . I
IMPORTANT: TYPE [on a 12-pitch (elite) typewdte,J OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIB~'
GENERAL INFORMATION: Federal Regulations require generators and transporters of h·azardous waste and owners or operators al hazardous was:e treai.ml
slorage. or disposal licilities to use the U.S. EPA Form 8700-22 Aev:9/86 (OHEC 1988 {A.EV 10/.86)] and, if necessary, the continuation sheet U·.S. EPA F
8700•22A Rev:9/86 (OHEC 1988A) loi both inler-stat8 and intra-state transport.iition. Trnnsportcrs who lransport hazardous waste into the United Sta:es tr
another country are responsible for completing the manifest Federal and State regu18tions also require gencratorS and transporters or hazardous was:e a:--,d
owners or operators of hazardous waste treatment, storage. or disposal la~!lities to complete the following information. I
1. · Generator's U.S. EPA ID Number-Manllesl OoCument Number: Enter the generator's U.S. EPA twelve digit identification number and :he ur.icue'tive di;it
number assigned to this manifest by the generator beginning with 00001. lfyour company does not have·a U.S. EPA ldentilication Number. please con:a_c: S.C.
OHEC al [phone] about obtaining an Identification number. • . . · : I
2.:. Page 1 ol: Enter the total number of pages used to complete this mani_fest, i.e .• the riist page EPA Form 8700-22 Rev. 9/86 IDHEC 1988 (P.EV 10186)] ~l:.is ·
GENERATOR SECTION
number of continuation sheets EPA Form 8700-22 Rev. 9/86A {OHEC 1988A) if any.
. _A.
B:
State Manifest Oocumenl_Number: .Leave blank. . · • · .
State Generalor ldentiflcallon Number: Leave blank.· · · · · I
Generator's Name and Mailing Address: Enter the name and mailing ~d~ress of the generator who will manage the returned mani!es: forms. .
Generator's Phol'le Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in :ne ever.: c , .
emergen.cy including nights, weekends, and h·olidays. ·
3.
5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. I 6. U.S. EPA ID Number: El')ter the U.S. EPA twelve ~igil identiricalion number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transport'er's Phone Number: Enter a teleph0ne number-including area·code where an authorized agent ol the first transporter can be reache(: in t!"'.e e·,ent of
an el'T)ergency_ir:i~/uding nights, weekends, and holidays... , ...... . .. · .. -.... ·-· --........ _.. ... '. '. · :·: : .·. . · · I
T.. Tran1porter 2 Company Name: II appllcable, enter the company name ol the second transporter who will transport th, waste. II more thari 2 trans;:,or:ers 1
be used, use a U.S. EPA Form 8700-22.A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:ir,i; :he wa ..
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve ·digll 10 number of the second transporter iden!Hied in item 7.
State Transporter's 10 Number: Leave bl.ink. . I
F .. Transporter's Phone Number: Enter a lelephone number including ~rca code where an authorized agent ol the second transpor1er can be r'eacr.e: in
event ol an emergency including nights, weekends, and holidays.
Oesignaled Facility Name and Sile Address: Enter the compan·y name and site address or the treatment, storage, or disposal racility designateo :o r~ce1ve the
waste listed on this ma~ifesl The address must be the site.address. which may diller from the mailirig address. · I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment, storage, 9r disposal fac.ility iden11!iec:i in 1:ern 9:
8 ..
E ..
9.
10.
G:.
'H;.
11'.
Stale Facility's ID Number: Leave blank. . · .
Facllily's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in :t-.e e•Jer,: ol an
emergency including nights, weekends, and holidays. I
U.S: DOT Descriptions: Ent_er proper shipping name, hazard class and ID Nuniber (UN/NA) for each waste as identified in 49 CFR 171-177. !I ac:i:ici':al s:>
is needed. use a U.S. EPA Form 8700·2~A Rev. 9/86 (DHEC 1988A) Continuation Sheet. .
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) ror the !''/Pe or c:::n1a1ners.
' TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons, ca~es. roll'ctts·
OW II Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases I
OF• Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic bo;,ces. car1ons. ca5es
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plas11c t:a;s
i3 .. Total Ouanlily: Enter total quantity of waste describe'd on each line. relative to lhe units used in Hem 1.4.
14. Unit (weight/volume): Enter the appropriate abbreviations l_rom Table II (below) lor the unit or measure: I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons · N = Cubic Meters Y = Cubic Yards G = Gallons {liquid of)
I. Wast_e Number: Enter hazardous~astc numbers as specified in South Carolina Hazardou~ Waste Management RegulatiOn R.61 • 79.261 Sutpar:s C a_r.c
iden11ty the hazardous wnstc on each line, . ·
J. · Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. OHEC Author1zat1on Request Form).
for each waste stream Hs!P.d in section 11 a.bove. Note: Before any hazardous waste can be accepted for treatment. storage or disposal in South Car:-lina; the
generator must obtain prior authorization lrom the tre3tment. storage or disposal facility. . ·. . I
K. Handling Codes !or Wastes Listed Above: Leave blank. · · : · · . .
TS. Special Handling lnslrucllons and Addillonal lnforiTialion: Generators may use this sPace tO indicate special transportati9n, lreatment. storage or disp 1
information or Bill ol Lading Information. For international shipments, generators must enter in this space the point .ol departure (city and s:a1e) rcr :no5e
shipments destined lor treatment, storage, or disposal outside the jurisdiction of the United Slates. , · , . I
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE thecertilication statement. II a mode other than highway is used e
word Mhighway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. H another mode in addilion to the hignvway mo ,s
used. enter the appropriate additional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION • ' . I
17: Tr•nsporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalt ol the hrs! transporter. That person must ac>no•le e
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgemenl: Enter. ii applicable, the name or !he person accepting the waste on behalf of the second transporter. That pers'cr. r.-a:s;
acknowtedge acceptance ol the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE al receipt I
FACILITY SECTION · . ·
19. Discrepancy Indication Space: The authorized representative ol the designated lacility's owner or operator musrnote in this space any discreoancy :,et· ... ~ _n
the waste described on the manircst and the wasto actUally received al the facility. Owners and operator's.of facilities who cannot reso1 .... e s1~.-,d,can.t
dlserepancies within 15 days receiving lhe waste musl submit to the Oeparlmenl a letter with a copy ol the manilest describing the discreoancy ar.c ar:em:;lo
reconcile il The uealmen~ s1orege, or dlsposol loclllly must onler the actuol weight C!I waste In pounds ii'\ the spaces provided ii lhe amount varies any :r~m :
specified by lhe generator in item 13 or ii the generator uses a unit ol mens1Jre other thon pounds. . .
20. Facility Owner or Operalor Certilicalion: Print or type the name ol lhe person accepting the waste on behnll of the owner or operator ot the toc1i,1•;. Tt1Jt ::ierson
· mus! acknowledge acceptanc·e or the waste described on lhe maniresl by SIGNING (BY·HANO IN INKfand entering lhe DATE or receipt t
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CO:J,:.cr THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OES1Gri>,eO
REC ·1: THE 'NASTE OR THE S.C. OHEC MANIFEST SECTION AT (80~! .,o WE~·KDAYS FROM 8:00 ,1m TO 5:00 pm.
I South Carolina Department of Health
: and Environmental Control
9. Designated Facility Name and Site Address ,
GSX Services of SC, ·Inc.
Route, 1 Box. 255
Pinewood SC 29125
Manlfeet Document No. 0 0 1 5 4
10. U.S. EPA 10 Number
S C D O 7 0
Form A
2. Page 1 ol
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull S~ee\ Columbia. SC 29201
. Phone; (BOO) 73-4-5200
Emergency & Holidays; (803)73-4-5-124 •
roved. 0MB No. 2050-0039 E.i ·,es 9-30-sa
Information in the shaded atHS is nor
required by Federal law, but is by State law.
11. U.S. DOT Description (incfuding Proper Shippfng Name, Hazard Class, and ID Number} 12. Conlalners 13. Tola! Ouanti1y U.Unrt l'Wa!a--:'·
No. Type VNV~ \/·'·/:·(:->~L·):\-,I:'.t
Hazardous Waste, Solid,.nos ORM-E
NA 9189
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 71897
1 D T 2 0 Y
18. GENE.RA TOR'S CERTIFICATION: I hereby declare thetthe contentaol thlscon1lgnmenlara lullyend accurately deacrlb~ above by pro~r ahlpplng name and ere c••-fted,
packed, marked, and 18beled, and are In an respect• In propercondl\lon lor tranaport byhlghwey according 10 appllcable International and national government re,,;ulationa al'\d
U'le laws ol the State ol South Carolina, ·
111 am a large Quantity generator, I certily that I have a program In place to roducathevolume andto•lcltyol waslegeneratod totf'le d9'-'rH 1 have determined to be oeonomQlly
practicable and thet I have selected the practicable method ol trealment. storage, or dlapoaal currently avallable to ma which minlmizH the" prawn! and future lhrut io hu~n
health and the environment: OR, Ht am II small qUnnUty_goncrator, I have mado a good lalth enort to minimize my waslo ganeratlon and ntecl O'la bHI wula managemenl ~thod
ltlal ia available 10 me and 1h01 I con altord, · ·
Printed/Typed Name · RO.GER L. COATS Signature
17. Transporter 1 At.:l(nowledgemenl of Aeceipl of Materials
Printed/Typed Name Signature
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name Signature
19._ O\screpa_ncy Indication Space
20. Facility Owner or Operator; Certilication of "receipl ol hazardous materials covered by this manifest except as noled In llem 19.
Printed/Typed Name Signature
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsole1e (DHEC 1988 (Rev, 10/86)]
• ... I.._._._...,_
b I'-'-.................
Month Day Year
0
Month Day Year
Month Day Year
Jibs. C I ,~
lib,. d I Jlbo.
Month Day Year
I:
STATE OF.SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT:· TYPE [on a 12-pitch (elile) lypewriterJ OR USE FIRM POINT_PEN' PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and lrnnsporters of h·azardous waste and owners or operat~>rs ol hazardous was:e trea1ml
storage. or disposal licitilies to use the U.S. EPA Form 8700-22 Aev.'9186 [DHEC 1988 {R·ev ·101.86)] and. if necessary, thEt continuation sheet U·.S. EPA Fo
8700-22A Aev:9186 {OHEC 1988A) loi both intcr.-slale and intr.i-stnlc.tr.inSport.ilion. Transporters-who transport hazardous waste into the United Sta:es Ir , .
another country are responsible lor ccimpleting lhe manifesl Federal and State re9u1£11ions also require generators and transporters or hazardous was:e a:.o
owners or operators of haz. a·rdous waste treatmen·t. storage, or disposal facilities to complete the following information. I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manllesl OoCumenl Number: Enter the generator's U.S. EPA twelve digit identificalion number and the unicue tiVe digit
number assigned to this mani!est by the generator beginning with 00001.11 yourcompc;1ny does not have·a U.S. EPA Identification Number. please con:ac: S.C.
OHEC at"[phone] abo~t ·obtaining an Identification numb"er. . · · · · I
2.;. Page 1 ol: Ente"r the tolal number of pages used to complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REV 10186)] ~l:.is ·
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any.
A.· State Manifest Document.Number: .Leave blank.· · . ·
a: suite Generator ldenliflcallon Number:' Leave blank:· · · · · I
3. Generator's Naffle and MaHirig Address: Enter th8 name·and mailing 1:1d~ress of the generator who will manage the relurne~ manifes: forms. ·
4. Generator's Phoiie Number: -Enter a tele'ph_one number with area code where an authorized agent of the generator can bC: reached in the even: cl
emergency including nights; weekends, and holidays.
5. Transport 1 Company Name: Enter the company.name ol the first transporter who will transport the waste. I 6. U.S. EPA ID 'Number: Er,ter0the U.S. EPA twelve digit identHicalion number of the first transporter idenlilied in item 5. ·
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: Enter a teleph0ne number including area·code where an authorized agent ol the first transporter can be reached in the event of
an emergency including nights, weekends. and holidays. · . '.:.. ·, · : · ' · 1 ·
T.. Tran~_porter 2 c~~pany Name: II applicable, enter the cOmPBny Mame Oi lhe seco·;dtr.irls'POrterWho w111·1ra·n·spOrt lh~ waste. If more thari 2 lrans;,oners I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transpor:ir.g the wa .
8 .. U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number ol the second lranspor1er identified in item 7.
E .. Slate Transporter's ID Number: Leave blank. I
F .. Transporter's Phone Nu~ber: Enter a telephone number including area code where an authorized agent or the seCond transporter can be reacne~ in·
event al an emergency including nights, weekends, and holidays. . ·
9. Designated Facility Name and Site Address: Enter th~ compan·y name and site address ol the treatment, storage, or disposal facility designatec :o r~ce1ve 1r",e
waste listed on this manifest The address must be the site address. which may differ from the mailing address. I
10. U.S. EPA ID Number: Enter the U.S. EPA"twclve digit identification number ol the desig~ated treatment, storage, c:,r disposal lacility iden1die::: ;n 1:em 9.
G:. Slate Facility's ID Number: Leave blank. . .
.. H;. Facilily's Phone Number: Enter a telephone number Including area code where an authorized agent of the racilily can be reached in tr.e e·,ent o! an
emergency including nights, weekends, and holidays. · I
11·. U.S: OCT Descriptions: Enter Rroper shipping name. hazard class and ID Number (UN/NA) !or each waste as identified in 49 CFR 171 • 1 ii. If aC-:::i:ic~al so
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. .
12.. Containers (no. and type): Enter number of containers !or each waste and the appropriate abbreviation from Table I (below) lor the type at c:::nw1ners.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank truck~) CM= Metal boxes. cartons. cases. roll c:-ts·
OW a Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cas,es
OF •.Fiberboard or plastic drums. barrels. kegs· OT= Dump truck CF = Fiber or plastic boxes. canons. ca!tes
TP = Tanks portable CY= _Cylinders SA= Burlap, doth, paper or plastic bags
13 .. Total Quantity: Enter total quantity al waste describfid on each line, relative to the units used In item 14.
14. Unit {weight/volume): Enter !he appropriate abbreviations l_rom Table II (below) !or the unit ol measure:
. . Table II .
I
I
P = Pounds L = Liters K = Kilograms T =Tons. M = Metric Tons - N =:'-Cubic Meter~ Y = Cubic Yards G = Gallons (liquid oil I
I. Wast_e Number: Enler hazardous waste numbers as specilied in South Carolina Hazardous Waste Management RegulatiOn R.61 • 79.261 Sut;:;ar:s Car..:::
identity lhe hazardous waste on each line. . ·
J. Addilional Descriptions for Materials LI sled Above: In !he spaces provided. enter the aulhorizallon number (lrom lhe S.C. DHEC Authorization Request Form)
for each waste stream listed in section 11 above. Nole: Belore any hazardous waste can be accepted tor treatment. storage or disposal in Sou1h Car::lina. ine
generator must obtain prior authorization from the lreatment, storage or disposal lacility. J
K. Handling Codes !or Wastes Listed Above: leave blank. · • · · · .
TS. Special Handling lnslrucllon, and Addillonal lnlormalion: Generalors may use lhis space lo indicale special lransportalion, lreatment. storage or cisp I
. information or Sill al Lading lnrormation, For international shipments, generators must enter in this space the point al departure (city and s:atel !er :nose
, shipments destined !or treatment, storage, or disposal outside the jurisdiction of the United States. , : · · I
16. Generalor Certification: The generator must READ,.SIGN (BY HAND IN INK), and DATE the certilicatiOn statement. II a mode other than highway is useo.
word '"highway"' should be lined out and theapproprie.te mode(rail, wnter,or air) inserted in the space bel~w. ti another mode in addition 10 u·.e hignway r.ioc ,s
used, enter the appropriate additional mode (e.g.,_and_ rail) in the space below.
TRANSPORTER SECTION . . I 11: Transporter 1 Acknowledgement: Enter lhe name or the person accepli~g lhe waste on behall 01 the first transporter. That person n-:usi acknowle
acceptance al the waste described on the manilest by signing (BY HANO IN INK) and entering the DATE ol receipt ·
18. Transporter 2 Acknowledgement: Enter, if applicable, the name al the person accepting the waste on behalf ol the second transporter. That perscr: r,a:us:
.acknowledge acceptance al the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE ol receipt I
FACILITY SECTION ·
19. Discrepancy Indication Space: The authorized represenlative of the designated facility's owner or operator must nole in this space any discrepancr O~!·.-. __
the waste described on tho manifcsl and 1h8 waslo actually received at the fac.ility. Owners and operators of facilities who cannot resolve s1~nd1can:
discrepancies within 15 dnys receiving the wasle must submit fo the Oepar1ment a lefler with a copy ol lhe manifest describing !he discrepancy at'1d a:-:em:,tr
reconcile it. The treetmen~ storage, or dlsposol loclllty muat onter the aciuo1 weigh! ~lwosle In pounds in the spaces provided if lhe amOunl varies any :rem :
specified by the generator in ilem lJ or II the generator uses a·unit or mens11rc olher !hon pounds. . '
20. Facility Owner or Operalor Certilicalion: Print or type the name al the per'son accepting.th_e \-'.'.aste on be hat/ al the owner or operator ol the lac1!11y. Th.JI ;,erson
must acknowledge acceptance ol lhe waste described on !he manilest by SIGNING (BY·HAND IN INKfand entering the DATE ol receipt · ,
IF '·""STANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TRF.ATMENT, STORAGE, OR DISPOSAL FACILITY oes:Geo>;:o
Ff.~ -~ iHE '.'I.ASTE OR THE S.C. DHEC MANIFEST SECTION AT (803) 734•5200 WEEk':)AYS FROM 8:00 nm TO 5:00 r,m.
South Carolina Department of Health
·, and Environmental Control
· UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
c. Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc·.·
7. Transp0rter 2 ~riipany Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
10. U.S. EPA 10 Number
S C D O 7 0 3 7
Form A
2. Page f
ol
Bureau ol Solid & Haurdous Waste Mgt
.2600 Bull Street. Columbia. SC 29201
Phone: [phone]
Emergency & Holidays; (803!734-~2•
roved. 0MB No. 2050-00:39 E.x ·,es 9-30-!a ·
Information in lhe -shaded are&s is nol
required by.Federal law, bul is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity u. Unit l'.WUlltibnbef;• .. ~:
No. Type 'M/V~ \ff+i;{.·:•2!}:4:j-~<J
Hazardous Waste, Solid, nos ORM-E NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71898
I D T 2 0 Y
.-.:: ... :.~'.·,~,.; .... ~ .... ,:'.~ •~~_.___.__, . 'l, :~,
1e. Ql!.NERATOR0S CERTIFICATION: I herebydeclerethat lhe contents olthla conalgnm•ntare lullyend eccura .. ly da1crlbed 1bov• by proper ■hipping"•'"• •nd are claa .. ned,
packed, marked, and la-beled, and are in all respects In proper condition for transport by highway according \o app11cablo lntarnalional and natlonal governffl•nt re,ou11uon1 af'ld
v,a law-1 ot Iha SUiia ol Soulh Carollna. · · .·. . ·
111 am a large quantity generator, I cer11ty that I have a program ln place lo reducethevolume"andtoxlcltyol we1logeneraled to tho degrff I have datarmlne<l to be ecOf\OmtCally
practicable and that I have Hlected tho practicable method ol trealment, storage, or disposal currently avallable to me which mlnlml1e1 the present and lutura tJ'\rNI io human
health and the environment: OR, HI am a smotl Quantity generator, I havo·mada a good lailh aNor1 to mlnlmlzo my waste generation and 1aloct tha belt wa11a man•g•mant ,,...U'lod
ltlat is available to me and that I con allord,
Printed/Typed Name RO.GER L COATS
Signature
17. Transponer 1 Ac.;1mowledgemenl of Receipt of Materials
Sign'al~re
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name · Signature Monll1 Day Year
19. Discrepancy Indication Space •J._.__._. ...... ..,. Jibs, C I Jb.
bJ....,_ ........ _._. Jibs. d J Jibs.
20. Facility Owner or Operalor, Certification ol receipl of hazardous malerials covered by !his manifesl excepl as n_oled In Item 19.
Printed/Typed Name Sig·nature Monll1 Day· y..,
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (~HEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pilch (elite) typewrilerJ OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators ol hazardous waste treatment. I
storage, or disposal ficilities lo use the U.S. EPA Form 8700-22 Aev."9186 [DHEC 1988 (REV 10/86)) and, ir necessary, thEt continu<!tion sheet U-.S. EPA Form
8700-22A Aev:9/86 (OHEC 1988A) for b·olh inter-stale and intra-state lrnnsportation: Trnnsportcrs who uansport hazardous waste into the United Sta:es !ram
another country are responsi61e lor completing the mani1esl Federal and State reg~1ations also require generators and transporters or hazardous waste a:-:d
. '
owners or operators ol hazardous waste treatment. s. tC?rage, or disposal lil<=:ilities to complete the lortowing information. . . . . 1.
GENERATOR SECTION
1. Generator's U.S. EPA ID Number. Manilest Document Number: Enter the generator's U.S. EJ:'A twelve digit identillcation number and :he ur..icue hve d1g1t
number assigned to this manifest by the generator beginning with 00001.11 your company does not have·1a U.S. EPA Identification Number. please con:act S.C.
DHEC at [phone] about obtaining an ldenlilication number. . I
2:. Page 1 of: Enter the total number of pages used to co.mplete this mani_lest, i.e., the first page EPA Form 8_700-22 Rev. 9/86 (DHEC 1988 (REI/ 10186)] clus ::-,e
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. · ·
A.. Stale Manifest Document.Number. .Leave blank.
B:
3.
State Generator _Identification Number: Leave blank. · · · · · · • · I
Generator's Name and Maillng Address: Enter the name and mailing address ol the generator who will manage the returned manilest forms.
Generator's Phorie Number: -Enter a telephone number with area code where an authorized agent of the generator can be reached in the even: cf an
emergency including nights, weekends, and ti·olidays. · ·
5. Transport 1 Company Name: Enter the company.name or the first transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the lirst lransporter identilied in item 5.
C. State Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: Enter a telephOne number inc!uding'area·code_where an authorized agent of the first transporter can be reached in the event of
an en:,ergency.ir)~_luding nights, weekends'. an~ holidays... . .... _. . .. -

.

· .. ______ ·-····· .. -'. ;_ · :· : ·' · · I
T.. Transporter 2 Company Name: II appllcable; enter the company name of the second lransporte.r'Who wlll tran.sp0r1 th~ wasle. u·more_thari 2 trans;,orters will
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHec· 1988A) continuation sheet and list the transporters in the order they wi!1 be transoor:ing the was:e. .
U.S. EPA ID Number:lf. applicable, enter the· U.S. EPA twelve digit ID number of the second transporter identified in item 7. a ..
E.. Sl.ale Transporter's ID Number: Leave blank. I
F .. Transporter's Phone Nu~ber: Enter a telephone number including area code where an authorized agent al the second transporter can be reacr.e~ in the
event of an emergency including nights, weekends. and holidays.
9 ..
10.
G:.
Designated Facility Name and Sile Address: Enter the compan·y name and site address ol the treatment, storage, or disposal facjlity designateo :a r~ceIve the
waste listed on this manilest The address must be the site address. which may differ lrom the maitirlg address.
U.S'. EPA 10 Number: Enter the U.S. EPA tWelve digit identirication number al the designated treatment. storage, 9r disposal raci!ity identdiec in I:ern 9.
Slate Facility's ID Number: Leave blank. · I
Facility's Phone Number: Enter a telephone number including ·area code where an authorized agent of the facility can be reached in :r.e event of an-
emergency including nightS, weekends, and holidays. .· ' · . ·
U.s: DOT Descriptions: ~nt_er proper shipping name, hazard c!ass and ID Number (UN/NA) lo~ eac~ waste as identified in 49.CFR 171-177. l! aCCi:icr.al s::iacel
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. _ . '
12.. Conlalners (no. and type): Enter number ol conlaincrs tor each w_aste and the appropriate abbreviation rrom Table I (below) lor the type o! c::r:i:aIners
TABLE I .
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank truck:3) CM= Metal boxes. cartons. cases. re/I ct1s·
OW• Wooden drums, barrels, kegs .TC= Tank cars CW= Wooden boxes. cartons. cases
OF s Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF = Fiber or pl.is tic boxes. cartons. cases I
TP = Tanks portable CY= _Cylinders BA= Burlap, cloth, paper or plastic t:ags
13 .. Total Quantity: Enter total quantity ol waste describe'd on each line: relative to the units used in item ~4.
14. Unil (weight/volume): Enter the appropriate abbreviations ~rom Table II (below) ror the unit of measure: I
Table II
P = F'ounds L = Liters· K = Kilograms T = Tons M = Metric Tons N ~ Cubic Meters Y = Cubic Yards G = Gallons (lic;uid cnly)
I, Waste Number: Enter hazardous waste numbers as specilied in South Carolina Hazardous Waste Management Regulation R.61-79 261 Sut:.,ar.s C ar.c D ti
identify the hazardous waste on each line. .
J. Addilional Descriplions tor Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. OHEC Author1zat1on Request F ormJ
for each wasle stream listP.d in section 11 above. Nole: Belore any hazardous waste can be accepted !or treatment. storage or disposal in South Carclina. tne
generator must obtain prior authorization from the lreatmenl, storage or disposal lacility. · • . . · 1
K. Handling Codes for Wastes Listed Above: Leave blank. · · · · . ·
l S. Special Handling Instructions and Additional lnlorma1ion: Generators may use !his space lo indicate special transportation. treatment. storage or Cispcsa
information or Bill ol Lading Information. For international _shipments, generators must enter in this space the pain I al departure (city-and s:a:e) !er :nose
•. shipments destined !or treatment, storage, or disposal outside the jurisdiction ol the United States. • · · , . I
16. Generator Certilicalion: The generator must AEAD,.SIGN (BY HANO IN INK), and DATE thecertilicatiOn s1atemen1. it a mode 01her than highwaY Is useo. :r:
· word '"highway" should be lined out and the appropriate mode (rail. water.or air) inser1ed in the space below. If another mode in addiIior.10 tr.e hign .... av rnoce 1
used. enter the appropriate additional mode (e.g.,_and_rail) in the space below. · · ·
TRANSPORTER SECTION . I
11: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalf al the lirsl transporter. That person mus! ackno-,.ledg
acceptance ol the waste described on the manirest by signing (BY HAND IN INK) and entering the DATE cl receipt. · .
18. Transporter 2 Acknowledgement: Enter, H applicable, the name ol the person accepting the waste on behall ol the second transporter. That perscr: r.,usi
acknowledge acceptance of the Waste described on the manifest.by SIGNING (BY HANO IN INK) and entering the DATE ol rec·eipL · I
FACILITY SECTION . · .
19. Discrepancy Indication Space: The authorized representative of the designated lacility's owner or operator must nole in this space any discrepancy ~,;-1-.-. ee
the waste described on lhe manilest and the waste actually received al the facility. Owners and opcra!ors of facilities who c.i.nnot res01..-e s1i;nd,canI
discrepancies w1lhin 15 days receiving the waste must submit to the Department a letter with a copy ol the manilest describing the discrepancy ar,Cl ar:er:i:m 11
reconcile it The 1reatment.11torage, or dlsposnt laclllly musl onler Iha ocluot weight (!I wosle In pounds in the spaces provided if the amount varies ~ny trom :r.a
specified by \he generator in item 13 or ll tho generator uses a unit ol mcn111.1rc other than pounds. . ·
20. Facility Owner or Operator Cerlilicalion: Print or lype the name al the person accepting the Yo'.aste on beholl ol the owner or operator al.the l.:icil11Y. Tt,.lt person
must acknowledge acceptance or the waste described on the manifest by SIGNING (BY-HANO IN INKfand entering the DATE ol receipt
1F ~ssIs,~NCE Is NEEDED IN COMPLETION DF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, DR DISPOSAL FACILITY 01:sIGri•,Eo Tl·
.-.;Cr ,HE '.'//,STE OR THE S.C. DHEC MANIFEST SECTION AT. (B03) 734-5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
'and Environmental Control
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Mas.ter
1. Generator's U.S. EPA ID No.
N C D O 7 0 1
Manlfe■t
Document No. 0 0 1 5 6
P.· 0. Box 1416, Smithfield, NC 27577
4. Geneialor's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co
7. Transpo.rter 2 Company Name
Inc.
6. U.S. EPA ID Number
·SCD0737
8. U.S. EPA ID Number
Form A
2. Page 1
of
Bureau of Solid & Hazardous Wuto Mgt.
2600 Bull Street, Columbia, SC 29201
Phone: [phone]
Emergency & Holiday,: (803)734-5-124
rov&d. 0MB No. 2050-0039 E.r ·res 9-30-M
Information in Iha shaded a,,eas is nol
required by Federal law. but is by Stale law.
9. Designated Facility Name and Sile Address·
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood ·sc 29125
10. U.S. EPA ID Number
S C D O 7 0
i11dtftl11~~~{i~!~1ij~!ii:i:i)!(;l~H-~i#{,;'}fi{i
:~J~il~r~:~i~:~tt:t~ih)b':~/i4:~,-~~~tiBjJ)
11. U.S. DOT Description (including Proper Shipping Name; J:lazard Cfa!!, and fO Nurrlber)
L
b.
C.
d.
Hazardous Waste, Solid,' nos ORM-E
NA 9189
15. Special Hand_ling Instructions and Addil_ioniil lnlormalion
GSX Work Order No.: 71899
12. Containers
No. ·Typo
1 D T
13. Total Quantity u. Un~ , l',W.ulll-h•
. WtN~ '.\~L'fj)>:t-.:::.~.:•j~·:~~
2 0 Y
115. QENERA TOR'S CERTIFICATION: I hereby declare that !he conlenls ollhls conalgnmenta,e lullyand accuratolyda1crlbed above.by proper ahJpplng name and· are cta• .. fl9d.
packed. marked. and labeled.and are In all respects In proper condition lortransi;:,ort by highway according 10 applicable lntarnallonal and national governmenl ra,g1,11at1on1 ar>d
U'le law• ol the Sta1• of Sou1h Carolina.
II I Im a large Quantity ganerelor, I certify that I have a program In place lo reduce the volume and toxlcltyolwHlegenerated lo thedOQrN I haYtl datarmlned 10 M .conomieally
pr11c11cable and that t have selected lhe practicable method of trealment, storage, or dlspotal curren\1y avallablo to mo which mlnlmllH th• preNnl and luture thr"NI to hu~n
hHIU'I and 11,, 1nvlro~manl: OR, 111 am a amo11 quantity gonornlor, I hove mado a good lallh effort to mlnlmlH my wutegenaratlon and Hltcl ~• bHI w1111 man1g1mant l'MV'IOO
thal is available to me and th111 I can afford ..
Printed/Typed Name
Prinled/Typed Name Signature Montn Day Year
19. Discrepancy lr:,dication Space
'I pt,s. C I pbs.
bl pbs. d I pbs.
20. Facility Owner or OPerator: Certiricallon of receipl ol hazardous materials Covered by lhis manilesl excepl as noled In llem 19.
Printed/Typed Nama Signature Monltl Dey y..,
EPA Ferm 8700-22 (Rev. 9/86) Previous Edlllons oro Obsolete [OHEC_ 1988 (Rev. _10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (eWe) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulalions require generators and transporters of hazardous waste and owners or operators of hazardous waste treatl.
storage, or disposal licililies to use the U.S. EPA Form 8700·22 Aev.'9186 {DHEC 1988 (R.EV 10/.86)1 and. ii necessary, th~ cOntinuation sheet U:S. EPA
8700•22A Rev:9186 (OHEC 1988A) foi bo1h inter•sta18 and intril·Slilte transport3tion. Transporters.who transport hazardous wa~!e into the United Sta:es .., ,
another country are responsiDle !or completing the manifest Federal 8nd Slate regulations also require gene'ratorS and transporters of hazardous waste a,~,c
owners or operators ol hazafdous waste treatment. storage. or disposal facilities to complete the rollowing information. I
.GENERATOR SECTION ,. Generalor's U.S. EPA ID Number -Manifest OoCumenl Number: Enter the generator's U.S. EPA twetve digit identification number and the ur..icue live digit
number assigned to this manifest by thegeneralorbeginning with 00001.11 your company does not have·a U.S. EPA Identification Number. please con:ac: SC.
0':'4EC at (803) 734•5200 about Obtaining an Identification number. . . I
2.:. Page 1 ol: Enterthetolal number of pages used to complete this manliest, i.e., the lirst page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (P.EV 10185)1 ~I~ .e ·
· number ol continuation sheets EPA Form 8700·22 Rev. 9/86A (OHEC 1988A) ii any.
k State Manifest Document.Number: .Leave blank. . e: State Generalor ldenlrficallon Number: Leave blank.: · · · · · · I
3. Generator's Nallle and Mailing Address: Enter the name and mailing· address ol lhe generator who will manage the returned maniles: lorms.
,. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent al the generator can be reached in :he ever.t n
emergency including nights, weekends, and h·olidays. ·
5. Transport 1 Company Name: Enter the company.name of the first transporter who wilt transport the wasle. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: "enter a te!ephOne number including area·code where an authorized agent of the first transporter can be reachee in the event ot
an en:iergency_ ir:i~)uding nights. weekends, and holidays... . . ..... . ... ..-.. --. --··-····-.. ... ':: :·: : .. '. · · I
T.. Transporter 2 Company Nar'ne: If applicable, enter the company n·ame of the second transporter who w.~11 ~ransport th~ waste. If more thari 21,a_ns;:,orter ill
be used, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in lhe order they will be tra_nspor:1r.g :hew .e.
U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit ID number of the second transporter identiried in item f
Stale Transporter's ID Number: Leave blank. · · · · I
F.. Transporter's Phone N~~ber_: E~ter a telephone number i_ncluding area code where a~ authorized agenl of the second Iran sporter C~~ be rE:acr,e: i _e
event of an emergency ,nctud1ng nights, weekends. and holidays. · ' · ,.
8 ..
E ..
9.
10.
G:
12..
Designated Facility Name and Sile Address: Enter the compan'y name and site address of the treatment, storage, or disposal facility desigr\atea :o receive the
waste listed on this manifest The address must be the site address, which may diller lrom the mailing address. · ; I . ' U.S. EPA ID Number: En1er the U.S. EPA tW~lve digit identification number of lhe desig'.'ated treatment. storage. (?r disposat facility iden11!ieci in 1:ern
Stale Facility's ID Number: Leave blank.
Facilily's Phone Number: Enter a telephone number' Including area code where an authorized agent al the facility can be reached in tr,e ever,! at an
emergency including nights, weekends, and holidays. · I
U.S: COT Descriptions: Ent.er proper shipping name, hazard class and ID Number(UN/NA) for each waste as identified in 49 CFR 1 71-1 ii. II acc1:icr.al s >:?
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. ·
Containers (no. and type): Enter number ol conlainers lor each wast8 and the appropriate abbreviation lrom Table I (below) lor the·r-,oe ol c:::n1a1ners.
nBlil .
·OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cart'ons. ca.ses. roll ctts
ow·• Wooden drums, barrels, kegs TC= Tank cars CW z:a Wooden boxes. cartons._ cases
OF• Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. ca~es
I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic ~a£is
13 .. Total Ouantily: Enter total quantity or waste describe·d on each line·. relative to the units used in Hem 1_4. · I T4. Unit (weighllvolume): Enter the appropriate abbreviations (rom Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters· K = Kilograms T = Tons M = Metric Tons · N ~ Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management RegulatiOn R.61-79.261 Su. tpar:s C ar.110
identify lhe hazardous waste on each line. . ·
J. Addilional Oescriplions lor Malerials Llsled Above: In the spaces provided, enter the authorization number(from the S.C. OHEC Authorization Aequeil Form)
!or each waste stream listed in section 11 above. Nole: Before any hazardous waste can be acCepted lor lreatment, storage or disp_osal in South Carctina. 1ne
generator must obtain prior aulhorizatio_n lrOm the treatment, storage or disposal facility. . I
K. Handling Codes tor Wastes Listed Above: Leave blank. · · · · ,s. Special Handling Instructions and Addillonal lnformalion: Generators may use this space to indicate special transportation, treatment. st~ra_ge or dis ..... al
information or Bill ol Lading Information. For international shipments, generators musl enler in this space the point of departure (Ciry a0d s:ate) !er :nosl?
. shipments destined lor treatment. storage, or disposal outside the jurisdiction ol the United States. · · , -· I
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE lhecertificatiOn slalemeril. II a mode other than highway is use e
word "'highway" should be lined out and the appropriate mode (rail, water.or air) inserted In the space below. U anothe'r mode.in addition to the hignway mo... 1s
used, enter the appropriate additional mode {e.g.,.and rail) in the space below:1 · ·
TRANS~ORTER SECTION , , . , • · ■
17'. Transporter 1 Acknowledgement: Ente.r the name of the person acc~pling the waste on behal! ol the first transPortei'. Th~t person must ·ackno,..l~e
acceptance al the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE·ol receipt. ·
18. Transporter 2 Acknowledgement: Enter, ii applicable, !he name of the person accepting the waste on behalf of the second transporter. That perscr: mus;
acknowledge acceptance ol lhe waste described on the manilcsl by SIGNING (BY HAND IN INK) and entering the DATE ol receipt I
FACILITY SECTION . • •.
19. Discrepancy lndicalion Space: The authorized representalive or the designated ladity·s owr:,er or operator must note fn this space any discrepancy ~-:1· en
the waste described on the manifcsl and lho waslo actuat1y received at lh!l facility. Owners and-operators or facilities who cannot resolve s11;nd1can1
discrepancies w11hin 15 days receiving the wasle mus! submit lo the Department a le!ler with a copy of lhe manliest describing !he discrepancy anc: a::er.il10
reconcite it The trealmenl stor8ge, or dlsposol loclllty must enter the actual weloht (!I waste In pounds in the spaces pfovided if the amount varies any fro , .at
specified by the generator in item 13 or ii the generalor uses a unit ol mcns11re other than pounds. . .
20. Facility Owner or Operator CerliliCation: Prinl or type the name or the person accepling the waste on behatr of the owner or opl?rator 01·1he lac1/11y. Tt,.::i: =ierson
must acknowledge acceptanc'e ol lho waste described on the manifest by SIGNING (BY-HAND IN INKf and entering the DATE ol receipt I
1' ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OES1G,,<,E O
R:C ·, THE '.'/ASTE on THE s.c. DHEC MANIFEST SECTION AT_ (SOJi 734-5200 ·u"" •([JAYS FROM 8:00 am TO 5:00 om. .
I
'
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Huardous Waste M~
2600 Bull Str~l, Columbia, SC 29201
Phone; (SOJ) 73-4.5200
Emergency & Honday,: (803)7~-5'24.
I •LEASE PRINT or TYPE (Form deslaned for use on ellle 112-cilchl "'•ewdlerl
UNIFORM HAZARDOUS 11. Gono,alor'sU.S.EPAIDNo ..
. WASTE MANIFEST N,C,D,O,Q,7,~.0,1--,,
Form A1 rovtld. 0MB No. 2050-0039 EJpire, 9-30-M
-'Manlreet 12. Page 1 Information in the shaded a<eu is no1 . Document No. ol I ed b Fed 11 b . l• '··O,O, 1,5, 7 . ,-requr y era_ aw, ul1JbyStalelaw.
I
I
I
I
·1 Generator's Name a~d Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
4. Generator's Phone I 919 .I 934-9711
5. Transpor1er 1 Company Name
Willms Truckin~ Co. Inc.
7. Transponer 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood. SC 29125
NC 2_7577 flit~;~; /:~W~~;:~t}i~H1:fo:'.~It~ti~tt}ii\f:
6. U.S. EPA ID Number 'Cf .-.. y~. ·: -... ,.,❖,__,.,.,_. __ ·91))'i-:\;·:--,,~··,/,·t=.'. .. ·_,;.-:: . ._::.,.;,:-_ ... , :,· ~,.
8. U.S. EPA ID Number
I I I I I I I • ' I
10. U.S. EPA ID Number
, S, C, ri. 0, 7, ci. "-7, ~-
t: ~i~t=i:~~'~0,[~f:~ij:i!:ii~\iji{j0it~t:!41\if ~i-ilt;Ii:'.··
·~ 8 5.t~1t1;tr(~~t~~~J~tz,~~~~1ra~~:~;s
11. U.S. DOT Description (incfuding Proper ~hipping NafT!e, Hazard Class, and ID Number) 12. Containers 13. Total Quantity It Uni! l''WalliNll'aber'···~:·
No. Type 'MJJ~ />l:i/·~::i.:~:£~}~)
I~ L Hazardous Waste, Solid, nos ORM-E ;\jF ;·o·r1fg·,'j,!,
N . NA 9189 1 11 o ,r , , , 2 ,o Y ?], E , o , o 1 6, ':1
E
I i 1-b--_____ _; _______ ___: ________ -'---------l--J'_j'LI-L'.j...J'_j'LL'J'-IL-i:'.:::l.!:=· =i=· =
1
=·=·=·:.:.::i:,i,i
A c. ·::'l··•·"···
I c,'.; I
I I I . 01 I I I ti.i.
I
I
I
I
I
d.
I I I I I I I
15. Special Handling Instructions and Addilional tnrormation
GSX Work.Order No.: 71900
115. GENERATOR'S CERTI_FICATION: I herebydecrerethat lhe contenls olthls con•lgnmentere fully end eccuuitelyde•crlbed •bove by prop., •hipping name and are c1e•a,ft«i,
packed, marked. and labeled.and are in ell respects In proper condition forlransport by highway according to appllcable lntern•tlonat and naUonar government r99ulallon1 al'\d
tne l•w• ol 11,e State ol Soulh Carolina. · ·
111 am a large quantity generator, I certify that I have a program ln piece lo reducethevotume end loxlcltyofweat_egenera1ed lo the d&gr-I have d•termlned to be eco,,omlc.ally
practicable end that I have s"lecled the practicable method ol troalment. :,torage, or dl:,posal currently avaUable to me which mlnlmlz:ea the prea.ent and future tnrMI 10 l'luman
l'lealth end the environment: OR, HI am a small qu11ntltyoonor11tor, I hove mado a oood laith erlort lo mlnimlz:e my we~le genoretlon end select the best wast• management ,,,.t:nod
that ia available lo me end that I can allord. · ·
I Printeo/Typed Name. Signalure .,r7_
RQCt,t L. COAi:~ 1/ --~ -
Month Oay Year
1 Cl 4, O,<f,P,7
T 17. Transporter 1 A~'l.nowledgemenl of Receipt of Materials -11 V /1 ...
l ~:1:~~in~•ed:ji:Typ=eo=N•=mUr-;.:1(:~k=/=,=1;~=======~/~s~;·:·•1/.t~·:,)=·=0;;•~·:,;=J=·~i-f===;•1~~-·:;j:j:11==·=;:Mn~=n•Q:,n:D4a;yl~~~=J
~ 1-1..:B._T,..:a_n;;:spo:....rt..:er_2:..A..:c..:k..:n..:o..:w..:l•..:d,_g•:..m..:•:..n..:l..:ol:..A..:•:..:c..:•.:;ip..:lo:..l:..M..:a:..l•:..•..:ia..:l•:....---f-/-· __________ ....,.:;//,1.-__________________ .....c/-l
1-TRE+-P-ri-nt_ed_/_T_yp_ed_N_a_m_• _____________ ..1..S-ig_n_•_lu_r•---------(/---'------------._M_o.1,nltl--''-DL.ay...L-Y.l.oat-f I , I , I ,
19. Discrepancy Indication Space
: • ~I ........................ I'"'-'I~ ........................ llb!.
IC bl libs. di I'"'-
~-..,.,...,,.....,.,....,...---,,-----,,-..,,,,....-,,-~ 20. ,ao1111y Ow"u o, Opu1I0,: CoRHir:ralle" of receipt ol ha11,dou1 m11torlal1 ooyerod by 1h11 ma"IIOII Hoopt 11 "otlkf In ltom 10,
Printed/Typed Name . Signature
I EPA Form 8700-22 (Rev. 9/86) Previous E_dlllons are Obsolet'e (DHEC 1988 (Rev.10/86))
Month Day Year
I , I , I . ,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter} OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters al ha~ardous waste and owners or operat?rs al hazardous waste trea:ml
storage. or disposal ficilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1968 (REV 10/,86)1 and, ii necessary, lhEl conlinuation sheet U·.S. EPA F
8700-22A Aev:9186 (OHEC 1988A) tor b·o1h inter-stat8 and intra-state tranSportiition. Transporters.who transport hazardous waste into the United Sta:es tr "
another country are responsiOle !or completing the manilesl Federal and State regu181ions also require generatorS and transpoi1ers or hazardous .... aste a:-:a
owners or operators ol hazafdous waste treatment, slorage, or disposal facilities to complete the following infprmation. I
_GENERATOR SECTION ,. Generator's U.S. EPA ID Number -Manifest Document Number: Enter !he generator's U.S. EPA twelve digil ldenlilication number and the ur:1icue five digit
numbe.r assigned to this m. anifest by the generator beginning with 00001. lfyour company does not have a U.S. EPA Identification Number, please con:a_c: SIC
OHEC at [phone] about obtaining an Identification number. · · .
2.:. Page 1 of: Enter the total number ol pages used to complete this manifest, I.e .• the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (P,EV, 0186)] ~tus ·
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) it any. ·
A. State Manifest Document.Number. .Leave blank. .
B: State Generalor ldenliflcallon Number: Le8ve btaryk. · , · · · . · · · · · I
3. Generalor's Name and Mailing Address: Enter the iiame and mailing address ol the generator who will manage-the returned maniles: forms.
,.-Generalor's Photie Number: Enter a teleph_one number wit~ area code where an autho~ized agent of the generator can bei reached in :~e even: cl 1
5.
emergency including nights, weekends, and holidays.
Transport 1 Company Nanie: Enter the company_name-ol the first transporter who will transport the waste. I 6." U.S. EPA ID Number: Enter the U.S. EPA twelve digit identHicalion n~mber of the first transporter identified in ilem 5.
C. Stale Transporter's ID Number: Leave blank.
O. Transporter's Phone Number: Enter a telephOne number including area·code where an authorized agent ol the first transporter can be reached in t!"',e e·-,,er.t ol .
an erryergency_i,:t~Juding nights, weekends, and holidays... ....... . .• · -------_________ . .. ... ':'. · :·: : .·. · I r.. Tran3portei 2 ComPany Name: II appllcable, enter the company riame ol the second transporter who will transport th, waste. I! more" tha1"1 2 lrans;,crters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the lransporters in the order they will be lransoor:ing !he wa -·
U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit ID number of the second ~ransporter identilied in it-em 7. 8 .•
E ..
9.
Slate Transporter's ID Number: Leave blank. · · I
F .. Transporter's Phone Number: Enter a telephone number including area co_de where an authorized agent ol the second transporter can be reacr.e-: in
event ol an emergency including nights, weekends, and holidays. . · · . . ,
Designated Facility Name and Sile Address: Enter the compan"y name and site address ol the treatment. storage, or disposal lacility designatea to r~ce1ve the
waste listed ori this manifest The address must be lhe· siie .. address, which may differ from the maililig address. · I
U.S. EPA ID Number: Enter the U.S. EPA"tWelve digit identilicati"on number ol the designated treatment. storage. 9r disposal lac.ility iden11fieO 1n 1:em 9, ,
Stale Facility's ID Number: Leave blank. · · .
.·H;.
,,:
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in t/-,e ever:t o! an
emergency including nigh1S, weekends, and holidays. · · · I
U.S: DOT Oescriplions: . Ent_er proper shipping name, hazard class a~d ID Number (UN/NA) loreach waste as identified in 49 CFR 171-1 ii.1! aC:ci:icr.al s;:i
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number of containers !or each waste and the appropriate abbreviation lrom Table I (below) for the type of c::n1a1ners.
. TABLE I . .
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank lrucks) CM= Metal boxes. cartons. cases. roll c:-ts·
OW 11 Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes, cartons. cases
OF• Fiberboard or plastic drums, barrels, k_egs OT= Dump truck CF = Fiber or plastic boxes. cartons. cases
TP • Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic b~i;s
13 .. Total Ouanlily: Enter Iota! quantity ol waste describeid on each line, relative to !he units used in item 1_ 4.
14. Unit (weighl/volume): Enter the app'ropriate abbrevi"ations !_ram Table II (below) !or lhe unit ol mea~ure:
I
I
Table II
P_ = Pounds L = Liters · K = Kilograms T = Tons M = Metric Tons · N =:: Cubic Meters Y = Cubic Yards G = Gallons (licuid cfl I
I. '."'ast_e Number: Enler. hazardous"."'as.tc numbers as specified in South Carolina Hazardous Waste Management RegulatiOn A.61-79.261 Su. t;:iar:s C ar.d
1den11ty the hazardous waste on each hne.
J. Additional Oesc,ipllons for Materials Listed Above: In the spaces pro~lded, enler the aulhoriz.nllon number (from lhe S.C. DHEC Authorization ReQues.t Form)
for each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted ror lreatment storage or disposal in South Car::-lina. ine
generator rriust obtain prior authorization from the lrealment, slorage or disposal facility. I
K. Handling Codes for Wastes Usled Above: Leave blank. , · ·
15. Special t:1andling Instruction, and Addillonal lnlormalion: Generators may use !his space to indicale special tranSportation. treatment storage or disp .st
information or Bill or Lading Information. For international _shipments, generators mus! enter in this space the point al departure (city anc s:ate) !er :r,osl?
shipments destined tor treatment. storage. or disposal outside the jurisdiction of lhe United Slates. · . J
1Ei. Generator Certificalion: The generator must AEAD,"SIGN (BY HANO IN INK), and DATE the c~rtiiic';:)tfon statement. II a mode other than highway is used e
Word "highway" should be line_d out and !he appropriate mode (rail, water .or air) inserted in the space below. II another mode in addition to tr,e highway r:io ,s
used, enter the appropriate additional mode (e.g ... and rail) in the space below. ·
TIIANSPORTER SECTION ' \ . . . ' . . . I .
· 11: Transporter 1 AcknoWledgemen·t: Enter the name ol the person accepting the waste on behalf of the first tranSporter. That person must ackno,..Je e·
acceptance al the waste described on the manilesl by signing (BY HANO IN INK) and entering the DATE or receipt
18. Transporter 2 Acknowledgement: Enter, if applicable, the name al !he person accepting the wasle on behatr of the second transporter. That per:::cr. r:-:ws:
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt I
FACILITY SECTION
19. Oiscrepancy Indication Space: The authorized representative ol the designated facility's owner or operator mus! note i_n this space any discrepancy betw • n
the wasle described on lhe manifest and the wasto actUatly received at the facility. Owners and operators ol facilities who cannol reso!,,,e sii;nd1car,: 1
discrepancies within 15 days receiving lhe waste musl submit to the Departmenla teller wilh a copy ol the manifest describing the discrepancy ar:c a:-:em:i,,
reconcile it Tl"le treatment. storage, o_r dlspoe.ol locU!ly must enter lhe actual weioht ~I waste In pounds in the spaces provided ii the amount var res any trom r
specil1ed by lhe generator in item 13 or ii the generator uses a unit ol meaurc other thon pounds. , .
20. Facility Owner or Operalor Cerlillcalion: Print or type lhe name ol lhe person accepting the waste on be hall ol the owner or ope"rator ol.the lactlt!J. ·Tt1J! :ierson
must acknowledge acceptanc"e ol the waste described.on the manifest by SIGNING (.BY-HAND IN INKfand enteri.ng the DATE ol receipt . t
1< A~,ISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, DR DISPOSAL FACILITY CESIGCJ<T:O
· ' ·, THE 'NASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TD s·oo pm. ·
I South Carolina Department of Health
and Environmental Control . '
Bureau ol Solid & Hazardous Wu!e M;t.
. 2600 Bull Street, Columbia., SC 29201
PhOne: {803) 734-5200
UNIFORM HAZARDOUS
. WASTE MANIFEST
3. Gtnerator's Name and Mailing Address
Channel Master
P. 0. Box 141~, Smithfield, NC 27577
,. Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin .Co Inc.
7. Transporter 2 Company Name
9. Designated Facility.Name and Sile Address
GSX Services of SC, ·Inc.
Route, 1 Box 255'
Pinewood SC 29125
6. U.S. EPA 10 Number
S C D O 7
8. U.S. EPA 10 Number
10. U.S. EPA 10 Number
11. U.S. COT Description (incfudlng Proper Shipping Name, Hazard Class, and ID Numb6r)
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
i0,;i0~i'tr,~ii~;~'"''"'
L lE.Jlij-!o 12 1117141-11ii10121.
b. Lu-I I :--1 . I . I 1t11;!;l;'i:;,j,l,~: W::J
15. Special Handling l~structions an~ Additional, Information
GSX Work Order No.: 71901
Form A
2. _Page .1
of.
Emergency & Holidays: (803)73'-~2•
rov&d. 0MB No .. ioS0-0039 El: ·res 9-30-$8
Information in the shaded atHS is n01
required by Federal law, but is by Stale l1w .
:~i}~='.:~;:~,~:;.:ti~}~~f:~:ff{\t
;111~tf¥i10:(~:~}1r;.:2Ji'.:t.f}kt1.t~tr/>~·-
12. Containers 13. Total Quantity 14.Unit l'.W&itaNl.dbw"~·
No.· Type 'M.NrJ \{\:fi;:.,,~J;;:};'.j,t l(~
1 D T 2 0 Y
._.._.,__,.___,1 b
~' L....1-.J-..L...JI/,
1fS. GIE:HIE:RATOR'S CERTI_FICATION: I hereby declare u,atlhe Contents olthl:11 conalgnmentare lullyand ecc~ratelydeacrlbed abova by proper shipping name and are c1 .... t1ec1,
packed, marked, and labeled, and are In all respects In proper condition for transport by highway accoidlng to app11cable lntern1llonal and national govemmenl re,gulationa af'd
the laws ol the State ol South Carolina. ·
111 am a large Quantity generator, I certiry that I have a program ln place to reduce the volume and toxlcltyol waste generated lo the d&gree I have determined to be economically
pracricable and Iha! I have selected Iha practicable method of lreatm.ent. storage, or dh1posal currently available to me which minimizes the preuint and luture tl'UNI to hurna:i
heellh and the environment.: QA, ii I am a smoll ciuonllty goneralor, I have made a good feilh etfortto.mlnimlze my wute generation and select the beat wu1e managemenl method
thal i:11 available to me and.that I can allord. · · ' ·
Printed/Typed Name ~§.§~R L. COATS Signature .
17. Transporter l Atacnowtedgement ol Receipt ol Materials
SI
Signature Month ·Day Year
19. Discrepancy Indication Space
I I ptio. CI Its.
b I pbs. d I ptio.
20. Facility Owner or Operator; Cer1ificatlon of receipt of hazardous malerlals covered by !his manifesl except ea rloled in llem 19.
Prinled/Typed Name Signature Monl!l Day y..,
PA Forni 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86)]
•< •• !.~":.z ,· STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFE:T I
IMPORTANT: TYPE (on a 12,pitch (elile) typewriter] OR USE FIRM POINT PEN~ PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
.: GENERAL INFORMATION: Federal Regulations require generatOrs and transporters o·f h·azardous was le and owners or operal~_rs of hazardous was~e 1reat~e~t.1
· .• storage. or disposal licilitfes to use the U.S. EPA Form 8700-22·Aev:9/B6 (DHEC 1988 (A.EV lot.86)] and, ii neCes·sary, the continuation sheet U:S. ·EPA Form
.. 8700-22A Rev: 9/86 (DHEC-1988A) loi both inter-stale and inlrri-slate tranSport3tion: TranSportcrs .who transport hazardous waSte into.the United States lrom
.,. another country are responsible lor completing the maliilest. Fcdera1·and State reg~18tions also require gene"ratorS and transporters of hazardous waste and
· .owners or operaIors of hazardous waste trealment, storage, or disposal f8ci1Hies lo complete the following inlormatlon. I
... GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest OoCumenl Number: Enter the generator's U.S. EPA twelve digit identification number and the ur:iic.ue five digit
., ....... number assigned to this manilestbythe generator beginning with 00001, II your company does nothave·a U.S. EPA Identification Number. please con:a_cI S.C .
. -:.;,· .• OHEC at [phone] about obtaining an Identification number. . · ■
2;, Page 1 of: Enter the total numberolpages used to complete this manifest, I.e .. the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] "lus tr ...
·-· • number of continuation sheets EPA Form 8700-22 Rev. 9186A (OHEC.1988A) if any. ·
· .'-·A. Stale Manifest Document, Number: .Leave blank. ·
... ~ a: . Stale Generalor ldenlH1callon Number: Leave blank, I
·, _3. Generator's Naffl~ and Malling Address: Enter the name and mailing adciress of !he generator who will manage the relurned mandest forms
."to\.C. · Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached In the event or an
"";•: ~--... emergency inc1udinQ nights, weekends, 8nd holidays.
S:1! Transport 1 Company Name: Enter the company_name of the first lransporter who will lransport the waste. I
'~6._:: U.S. EPA.ID Number: · Er:iter the u.5:, EPA twelve ~!git identilicalion number of l_he first lransportei' identiried in ile~ 5. •
. ·. C. · Slate Transporter·, 10 Number:, Leave blank: , =. · . , . . · ·
' .. : •. 0 •. Transporter's Phone Number: Enter a telephone number including area ·code where an authorized agent of the lirsl transporter can be reached in the event of
.. ~ an 8"'.'erge~cy_i_rn:;Juding nights, week~nds, and holidays .... '. ...... . . .• -... -.--·-··--.•-.,... ... ','1, ', :·. :._._1 • . I
r.: Transporter 2 Ciin'ip'a~ny Nafflfi: 'if a'Ppticabre; en!er'the company riame of the second transporter Who wlll Iran.sport th, waste. u·more" thari 2 Iranspor1ers wit
,. . be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continualion sheet and list the transporters in the order they will be transpor.ing the waste.
-·· 8.: U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
· , E .. Slate Transporter's ID Number: Leave blank. · I
"· F .. Transporter's Phone N~~ber: E~ter a telephone number '.ncluding area code where an authorized agent of the second transporter can be reached in th
. event ol an emergency including nights. we_ekends, and hohdays. · ·
· "': 9. • Designate~ Facility Name and Sile Address: Enter lhe com pan)' name and site address ol the treatm_ent. storage, or dis~osal facility designatea :o receive rhe
•,.:.... ~ waste listed on this manifest The address must be thE! site_'address. which may_dilfer from lhe mailirig address. I
1 t 10. U.S., EPA 10 Number: Enter the U_.S. EPA' tWelve digit ldentilication numb8r ol the designated treatment, storage, 9r disposal facility identified in 11em 9.
k'..,;G: Slale Facility's ID Nufflber: Leave blank. · ·
tr~l H; Faellily's Phone Number: Enter a-telephone number Including area code Where an authorized agent ol the facility can be feached in tl"',e event ol an
• •'-: ··emergency including nightS. weekends, and holidays; · · · I
; ~ 1~ ~.s:_OOT Descriptions: Ent.er proper shipping name, hazard class and ID_Num_ber(UN/NA) for each waste as identilied in 49 CFR 171-177.11 acc:i:iC:r.al s;,ac
:· ,s needed, use a U.S. EPA Farm 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. .
· 12..' Containers (no. and type): Enter number ol containers lor each waste and the appropriate abbreviation from _Table I (below).lor the type ol containers.
, r. TABLE I .
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank truck_s) CM = Metal boxes, cartons. cases. roll ctts ·
OW a Wooden drums, barrels, kegS TC = Tank cars CW = Wooden boxes. cartons. cases I
OF• Fiberboard or plasllc drums, barrels, kegs DT =. Dump truck CF= Fiber or plastic boxes. cartons. cases
.. ··-M·•-•~·"·Tp·a Tanks portable CY =_Cylinders BA= Burlap, cloth, paper or plastic bags
'13 .. Total Ouantily: Enler Iota! quantity olwaste describe'd on each line, relative to the units used in Item 14.
TA. Unit (weight/volume): . Enter lhe appropriate abb_revi'ations l_rom Table II (below) lor the unit ol measure:
. Table II
I
P = Pounds · L =Liters· K =Kilograms·. T .= Tons · M::: Metric Tons · N =:=-Cubi~ Meters Y = CubiC Yards G = Gallons (liQuid onI,·
I. Waste Num. ber: Enter hazardous waste numbers as specified in.South Carolina Hazardous Waste ManagE!ment AegutatiOn R.61-79.261 Subpar:s C ar.d Dt •
-· identify the hazardous waste on eaCh tine.. · , ·
·: J. Additional Descriptions for Maler/a ls Llsled Above: In the spaces pro~ided, enter the authorization number(lrom the S.C. DHEC Au\honzation Reciuest Form)
·~' , .. for each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. Ine
ger1erator must obtain.prior authorization lrom the lreatment, storage or disposal facility. . · -
K. Handling Codes for WasteS Listed Above: leave blank. · · · . · · . ·
15. Special Handling Instructions and Addillonal Information: Generators may use this space lo indicate special transportation. treatment storage or disposa
information or Bill of lading lnlormalion. For international.shipments, generators must enter in this space the point or departure (City and state) !er those
. shipments destined for trealment, storage, or disposa_l outside the jurisdiction ol the United States., r i_-.. 1 . , 1. • , , . -
16. Generator Cer1illcation: The generalor must READ, SIGN (BY HANO IN INK), and DATE lhecertificalion statement II a mode other than highway is usec. :n
· word Mhighway'" should be lined out and the appropriate mode (rail, wnler,or air) inserted in the space below. II another mode in addilion to the highway rnoc:e 1
· used, enter the appropriate additional mode (e.g .•. and rail) in the space below. · · ·
mANSPORTER SECTION . . . ~ 1 ' · _ . · . 1 ·
..... _17: Tr1nsporter 1 Acknowledgement: EntE?r the name ol the person accepting the waste on bah.ill ol lhe lirst transporter. That person rr:ust ac_knowledg
acceptance ol \he waste described on the manifest by signing (BY HANO IN INK) and eritering the DATE of receipt ·
·~ 18. Transporter 2 Acknowledgement: Enter, ir applicable, the name ol the person accepting the wasle on behalf of the second transporter. That person mus:
acknowledge ;:icceplance of the waste described on the manifest by SIGNING (BY, HANO IN INK) and entering the DATE or receipt -
FACILITY SECTION . · ·
19. Oiscrepancy Indication Space: Th~ authorized representative Ol lhe designated facility's owner or operator must note in this ~pace any discrepancy betwe!?-
the wasle described on lhe manilesl and the waste actUaHy received aI the facility. Owners and operators of facilities who c;:inno! resolve s1;ndicanI
discrepancies wtlhin 15 days receiving the waste must :submit lo lhe Department a lefler with a copy ol the manirest describing the discrepancy and ar.em::,ts •1
rtccncile it The ireatmen~ alorage, or dlapoaot loctllty must onter the acluol weight C!I woste In pounds In the apacea provided ii the amounl varies any rrom ir:
1Pecified by the generator In ilem 13 or II the generator usos a unit ol mens"re olher than pounds. , .
•. 20. Facility Owner or Operator Cerllllcalion: Print or typ_e the name ol the person accepting lh_e w:aste on behalf ol the owner or operator oi°the I3c1i.ry. ThJf person · ·
. must acknowledge acceptanc·e of the waste de~cribed on the manilest by SIGNING (BY·HAND IN IN".()and entering tiie DATE or receipt. · . _ 1
IF •.SStST~NCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE.TREATMENT, STORAGE, OR DISPOSAL FACl~ITY CESIGll>,EO T
· .. fHE ','If.STE OR THE S.C. IJHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm. •
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste M;t
2600 Bull Street. Columbia., SC 29201
Phone: (BOJJ 734-5200
I
I
Emergency & Holidays.: (803)734-5'24 rE PRINT or TYPE (Form desiQned lor use on elite 112-oitchl ~"ewriterl . Form A oroved. 0MB No. 2050-0039 Expires 9·30·!.I
UNIFORM HAZARDOUS ,,. Generato,'sU.S.EPAIDNo.
WASTE MANIFEST N, C, D, O, q, 7, <. O· '·· 7,
Manlleat
1
, 2. Page 1 . ':)oc flument No. of l l• 1··"· I, 11 <, Q
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
•· Generator's Phone I 919 l 9 34-9 711
5. Transporter 1 Company Name_
Willms TruckinP Co. Inc,
7'. Tnlnsporter 2 Company Name
9. Designated Facllity Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood. SC 29125
6. U.S. EPA ID Number <:/~;;.·;
10. U.S. EPA ID Number
, S, C, D, 0, 7, 0, 1. 7, '
lnlormetion in the shaded a,eu is no1
required by Federa_l law, but is t?Y State la«.
11. U.S. DOT Oescripliol'.' (including Proper Shipping Name; Hazard-C,lsn." and ID Number)" 12. Containers 13. Total Quantity U.Unit L:Wut!INl.wuber'1~;.
No. TyPQ 'M/V~ /1/\i;l/-';f--\V_f~<fi I L Hazardous Waste,. Solid, nos ORM-E . :~~t;b,rt~r,~
~ i-..!N:!;A:!,_,:9_:l_:8:,:9:__...:._ ________ ~--------------'-·-~·-4_JI_· .J'L'.l+D'...l 'T~_J•LL'l'2:...l'C::0+.Jy'.._+:;\;~•:::E=•~Q::::I 0::=•:::6=1-'£~· · 1 F,IT b. . <Z t I.,.:;._,,-,:;
~ .. ,. ~!
O i------------------....:..-----------.l--.l•......J'-l_j'LJi-'LL'L'.li-4 _ _J.;;n~,.::::::::::!:::!:::!.';:;'"~
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15. Special Handling lnslructions and Addlllona1 Information
GSX Work Order No.: 71902
, •. GIEHIEAATOA"S CEA0TIFICATION: I herebyd~el'ue lhiltthe content, olthll con,lgnmiin't•r• i~lly•nd accurately d11crlbed above by pro~r ■hipping ne~e ■nd er1 CIIH•h■<ll,
· P9Cked. marked, and 11,"t:ioled,and are In all respect, In proper condition for tr8nsport byhighwayaccordlng to appllcable lnlernetlonal end national governmen1 re,gulat1on1 a/\d
U'le lew1 ol l~e Sta.le ol South Carollnlll!. · · · ·
111 am a large Quantity generator, I certity that I have a program In place to roducethevolume and toxicity of westeganeratod lo thedet;1rH I hive datarmlnod to~ economically
prac11ciible and \hat I have ,elocted the prnctlcable method ol lre&lmont. s1orage, or dlapoaal currently avallable lo me which mlnJmlze1 the prea.ent and future ll"lrNI IO humal'I
health and the envi,onmont on, HI pm n 11m11II QUDnlitygono,olor, I hOvo mado o good laith etlort to minimize my waslo generation and 1.alec1 the be11 wuta menagemenl rT>eO"lo<II
tf'lat is· available 10 me and that I con allord, ·
Printed/Typed Name • R0,1.,ti< L. COATS I Slgnalure
~ 17. Transporter 1 Al.Knowledgement_ol Receipt of Materials
Month Day Year
, o, y-,o, U,,f-,'7
I ~ Printed/Typed Name
~ ~';::..u~t'\ ~ --n...-...l
o 18. Transporter 2 Acknowledgement of Rec"eipt of Materials'
~lure \2. Montn Day Ye.tr
IO,'\ 10, L/1~,t
A . .
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i Printed/Typed Name
19. Discrepancy lndica!ion Space
F
l Signalure
•!,._,_.._._ ........
b!,._,_.._,__.__._
pbo.
!'bo.
Month Day Year
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I I I ' I ' PA Form 8"7(?0-22 (Rev. 9/86) Previ?us ~~ilions are Obsolete (OHEC 198~ (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN. PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
· · ·GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
. storage. or disposal ficililies lo use the U.S. EPA Form 8700-22 Rev.'9/86 {DHEC 1988 (REV 10/.86)1 and, if ne"cessary, the c0ntinuation sheet U:5.·EPA For
• • 8700-22A Aev.-9/86 (DHEC 1988A) foi bolh inter-state and intrri-state 1ranSpor1a1ion: Transporters.who transport hazardous-waste into.the United Sta:es Ira,
:·"" ~ another country are reapon,IOle tor complellng ttie mOnitesl Fodera! &nd Stole rogu181ion'S also require generators and lransporterS or hazardous wasie ar.d i owners or operalors of hazardous waste lreatment, s. torage, or disposal lac1lilies to complete the following inrormotlon. I
i' -· GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manliest Document Number: Enter !he generator's U.S. EPA twelve digit Identification number and the unic:;ue live digit
number assigned to this ma·nifest by the generator beginning with 00001. If your company.does nothave·a U.S. EPA Identification NulTlber, p!ease con:a.ct S.C .
• • . _ OHEC at [phone] about obtaining an Identification number. · . . · •. ·. · · · I
2;: Page 1 of: Enter the total number of pages used to complete this mani_fest.i.e .• the fiist page EPA For_m 8700-22 Rev. 9/66(DHEC 1988 (P.EV 10186)] i:;lus t, ·
r ··-• number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any. · . · · · .
r ·:: ~ St.ale Manifest Oocument.Numbei: .Leave blank. . . .
!.,~ .... 9: .. St.ate Generalor ldenUficallon Number: Le"ave blank.· ·· · ·. · · I f.1·• 3. . Generator's Name and Mailing Address: Enter thC name and mailing 13ddress of the generator ·who will manage the returrled manifest lorms. . ·
. ' ·' •· Generalor's Phorle Number: -Enler a telephone number with area code where an authorized agent of the generator can be reached in the event or
~-., · • emergency including nights, weekends, and ti'o1idays. · _· · · · · · . · . .. · .
I 5. ,, Transport 1 Company Name: Enter the company_name of the first transporter who will transport the waste. . · I
f''"' ~•:. 6 • ..,~ U.S. EPA ID Number: ~rrter the U.S. EPA tw~lve ~igil identification num.ber ol the first transporter identified in item 5.
t '.,. C. 'state Transporter's ID Number: Leave blank. f.' ~ 0 •. Transporter's Phone Number: 'enter a telephOne number including area·code where an authorized agent olthe first transporter can bE! reached in the event ol
!T
1
\! ··~: ~r;.::;:~e;c;~::;~i~~ ~~9!:~· ~~=~~~:=b~;.~~~~~~~:o·m·P~~Y r1ame o;~he s~~O-n_d ir.irls"sle)rte·rwho w11
1
1:;.r1:~s~~~ ~hf? waste. ff more· thari 2 trans;,orte;s :.I .
1 -1,' , • be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they wilt.be transpor-dng the wa~
'·--·~ &:• U.S. EPA 10 Number:11 applicable, enter !he U.S. EPA twelve digit 10 number ol the second transporter identified in item 7.
1
: E:. Stale Transpor1er's ID Number: Leave blank. • · · · · I
F .. Transporter's Phone Nu~ber: Enter a telephone number including area code where an authorized agent of the second transponer can be reache~ int
event ot an emergency including nights, weekends, and holidays. ·
9. Designated Facilily Name and Site Address: Enter ihe compan'y name and site ~ddress al the treatment, storage, or disposal facility desii;;natea 10 receive the
~~ -waste listed on this manifest The address must be the site address, which may differ lrom the mailing address. I
10. U.S. EPA ID Numbe:r: Enter the·u.s:EPA tW~lve digit idenlification number or the desig~aled treatment. stOrag~. _r:,r disposal rac.ility identdieo in Hem 9 .
•.. G:. Slate Facility's ID Number: Leave blank. _ · · · · ~ .. ~ H;. Facility's Phone Number: Enter a telephone number including area code ~here an aulhorized age"nt ol ·lhe facility can be reached in 11",e event ol an
• 1 emergency including nightS, weekends, and holidays. • · · .
'. 11~ ~.s:_OOT Descriptions: Ent,erprope·r shipping name, hazard class and to_Num.ber(UN/_NA) lor each waste as identified in 49 CFR 171-1 Ti. II aCCi:i6r1a1 soal
·. · ,. needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheel
1~. Conlalners (no. and type): Enter number ol containers for each waste and the aPpropriafe abbreviation lrom Table I (below) for the t;pe al c::;n1a1ners. ne~1 · ·
, OM= Metal drums. barrels;. kegs TT:::: Cargo lanks (tank trucks) CM= Metal boxes, cartons. cases, roll cHs· -
~ ... ~ OW II Wooden drums, barrels, kegs TC= Tank cars CW :ca Wooden boxes. cartons. cases
. . · OF• Fiberboard or plastic drums, barrels, kegs OT 11_ Dump truck_ CF .. Fiber or plastic boxes, canons. cases
l .... :, .... _-.,. TP • Tanks portable CY =_Cylinders BA= Burlap, _cloth, paper or plas11.c bags
·13 .. Tolal Quantity: Enter total quantity al waste describe'd on each line; relative to the·units used in item 14. ·
1,. Unit (weight/volume): Enter the.appropriate abbrevi'ations from.Table II (below) !or the unit of measu~e: . , . . , Table II . . .
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P = Pounds L = Liters· K = Kilograms T .= Tons · M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardouswasle numbers as Specified in South C3rolina Hazardo~s Waste.Management RegulatiOn R.61-79.261 Sut:par:s C ar.d DI
··-~ ... , ~-identity the hazardous waslc on ea Ch line.. · •
'--1•· J. Additional Descriptions lor Materials Llsled Above: In lhe spaces provided, enter the authorization number(from the S.C. DHEC Authouzation Request For
'-.-.... • 'o(:, for each waste stream listP.d in sectlori 11 a hove. Note: Before any hazardoUs waste can be accepted lor lreatmerit'storage or disposal in South Carclina. the
,..;.z:....-,. generator must obtain prior authorization lrom. the" treatment, storage or disp_osal facility. . . 1 ·
K. Handling Codes lor Wastes Listed Above: Leave _blank. · · · · .. · · . · · · . :
',., 15. Special Handling lnstrucllons and Addillonal lnlormalion: Generelors may use lhis space lo.indicale special transpo~alion, 1rea1men1, storage or dispc
inlormalion or Bill ol Lading_ Information. For international _shipments, generators must enter in this space the point ol departure (City and state) for tt'lose
shipments destined !or 1reatment, storage, or disposal outside the jurisdiction ol the United State's.' •~· .) .! .,...,. .-•. I
16. Generator Certillcalion: The generator must READ,.SIGN (BY HANO IN INK), and DATE thecertilicatiOn· stateme.nt. II a mode other than highway is used, t
word Nhighway'"should be lined out and the appropriate mode (rail, water.or air) inserted In the space be.low. If anolh.er mode in addition to the highway r.ioce
used, enter the appropriate addilional mode (e.g.,_and, rail) in the space below.
TRANSPORTER SECTION . . • . . . . I
11: Tran:sp~rier 1 Acknowledgement: Ente_r !he name of the person acCepliMg the waste on behalf ol the first transp~rter. That person must ·ack.nowted
acceptance ol the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE ol receipt. · .
18. Transpor1er 2·Acknowledgement: Enter, ii applicable, the nrime of lhe person accepting the waste on behalf of the second transporter. That perscn mus:
acknowledge acceptance ol the waS1c described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE of receipt I
FACILITY SECTION · · . .
19. Discrepancy Indication Space: The authorized repreSentative of the designated facility's Owner or operator mUst note in this space any discrepancy be1we~ .
·1he waste described on the manilesl and the waste actlially received al lhe facility. Owners and operators ol lacililies who cannot resotve s1i;nd1cant
discrepancies within 15 days receiving the waste mu:,! submit to lhe Departmenl a letter wilh a copy of _the manifest describing the discrepancy ar.d ar:em:itl
reconcile il The 1rea1men~ storage, or dlsposot loclllly mus I enter the acluol welghl_~I waste In pounds in lhe spaces provided ii the amount vafleS any rrom t
specified by the gen~rator in ilem 13 or II the genernlor uses a unit al meas11rc olher than pounds. . .
20. Facility Owner or Operalor_Cerllllcation: Print or type the name of the person nccepling-lh_e ..-.:aste on behatr ol lhe owner or opl?rator of,the lac1l11y. That person
mus! acknowledge acceptance of the wasl_e described on the manifest by SIGNING (BY·HAND IN INK)°and entering the DATE ol receipt ·
1• P.SSISTANCE IS NF.F.DED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIGt/H:O I
r • "THE WAST[ ,-a'' 1~ S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
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South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAtDNo.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,·Smithfield,
4. Generator's Phone [phone]
5. T ransp6rter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA.ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71903
Form A
2. Page 1
of
. Emergency & Holidays: [phone]
roved. OMS No. 2050·0039 E.x ·,es 9-30-88 _
lnlormalion in the shaded ·a,eas is rio1
required by Federal law, but is by State taw.
12. Containers 13. Total Quantity 1'. Unit = L1Walll'Humbei-f.+
No. Type 'MNo ;};'Y);.'i;;'};)/t;t
16. OEN ERA TOR'S CERTIFICATION: I hereby declare th al the contents of I his coneignmant ara fully and accurately dae~rlbed ·•~va by proP,:.r shipping nama' and ua 'c•••••ll9d,
pack ad, mark&d, and la.baled, and are In an respects In proper condition tor transport by highway according to appUcabte International and naUonal govarnmant r-aulatlon• and
tr,e law1 ol Iha Stale cl South Carolina.
111 am a large quenlity generator, I certify that I have a program In place to roducathavolume and toxicity ofwa1tagenaratod totha degrN I h•-detarmlnod to be oconomlcally
practicable and thal I have selected Iha practicable method ol treatment, storage. or dlsposal currently available 10 ma which minimize• Iha preaenl and lutura lt'lrNI to tluman
heallh and !he environment: OR, ii I am a smoll quantity gonorolor, I tlave made a good lailh effort to minimize my waste generation and salact the best wuta managemant method
that is available to ma and ttlal t can allord,
lr.:-'r:-:--:P:--rin-ted-/T"."yp-ed"""."N-•m_•"""."-:-:-R"."O,.;,'--=-c-,{:'"L:'"."."C"."O".""':A-l:J4S--..J.--r,""".".!..;;;:;.;,:.:::::.: .... ...,.p.;;;.._.,;;;:;;:;.~;:;:.:-----L.:::.U.1.:a:DL:ay:w'-Yearl.l-l
~ hA::.:::nc:•:,P:;:O:'rt::•:..r .:,1 :.;A::<:::•nc:o:,:w::;l~FmC:e::n::.l;:o:..f :,:Re::c;;e;,ciP:,:lc:o::.f.::M7a:::le::r:;.I ::;l'Z----,-:::--f-:-+---.!:::----++...:.-!.J----,+...:.--:1!....,------:-:---::---::----:-:---I
. ,· ~ ~-\ . Pµ,...~q:_.l'.YJ..lL.c!:.;l,_/L-__::~a:µ:_LJL.,6'----14~::1.L~ll.J..I..I=.::b~-2:::::l.Ll.~L.+L.....:,--'---'---l.!:::.Ji::µ,.i!.l..:...JJ.l..l.fl
~ i-c:...:.c::;.c;:c::.:::..:.:..:::=:=::.:::;m::;e:;n.::l.:;.o:..f R.:;_•::;<:,:e.:;_iP::.t :;of.:;_M.:;_a:;l:;er.::iac:ls:.......:....:....,.----,1------------------------.;_--------l
11-i'-. +--P-n-·n-teo-/T-y-ped_N_a_m_• ________ ..,. ____ ..,1.S_i_gn_•_tu_r•....,.._ ___________________ .1,,..,1...,,1-'.._'-,_-I
19. Discrepancy Indication Space
Month Day Year
F Ir I 1-:,-,-:,-:-:--:,-----,,----,---,,,...---,--~ 20. Facility Owner or Operator; Certification ol recelpl ot hazardous materials covered by this manifest except as noted In Item 19. I · Prlnled/Typed Nama Slgnalure
·: EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete {DHEC 1988 (Rev. 10/86))
a I l1bo. C I jibs.
b I jibs. d I jibs.
Mo,,th Day Year
'!
!
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
IMPORTANT: TYPE [on~ 12-p;tch (~\;!~) typewrHer] OR USE FI_RM POINT PEN -PRESS DOWN ~ARD
I
ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators. and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage, or disposal licilities to use the·U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, if necessary, th~ continuation sheet U.S. EPA For
8700-22A Rev:9/86 (OHEC 1988A) for both inter-state and intra0slale lransportat/on. Transporters who transport hazardous waste into the United States !ram
another country are responsible !or completing the manilesL Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operator~ of haza.rdous waste treatment, storage, or disposal ·facilities to complete the following information. I
GENERATOR SECTION
1.
2;.
A.
a:
3.
4.
5.
6 . . c.
D.
7:.
8,.
E
F ..
9.
,a;
G:.
H;.
11:
12..
Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue live digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number, please con:act S.I
OHEC at (803) 734•5200 about obtaining an identification number.
Page .1 of: Enter the total number of pages used to C?mplete this manifest, i.e., the fiist page EPA Form 8700·22 Rev. 9/86 [DHE~ 1988 (REV 10186)1 plus t
number ol continuation sheets.EPA Form 8700·22 Rev. 9/86A {OHEC 1988A) ii any. ·
S.t.ate Manifest D0cum·ent Number: .. Leave blank. .
State Gen~rat~r ldeiiliflcatlon·Number: · Le"ave blank. •··
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who wilt manage the returned manifest forms.
Generator's Pholie Number: En'ter'a telephone number with area code where an authorized agent ol the generator can be reached in the event cl an
emergency including nights, weekends. and holidays. I Transport 1 Company Name: · Enter the company name of the lirst transporter who will trans.port the waste.
U.S. E~A ID Number: Enter the U.S. EPA twelve digit identification number ol the first transporter identified in iterTI 5.
Slate Transporter's ID Number: Leave blank.
Transporter's Phone Number: 0Enter a teleph0ne nuniber including area code where an authorized agent of the first transporter can be reached in the event of
~:~:=~~e;,c:~~~~~~; ~~g!~~-~~=~~~~=i,~;-~~~;~~~·~ompany name oi the seco.ndtrans·p-orterwho wil; ;,~~:.;h~ the waste. II more ttiari 2 trans~orters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transpo~ir:,g !he was,e.
U.S. EPA 10 Number:lf applicable; eiiter the U.S. EPA twelve digit ID number of the second transporter identified in iterTI 7.
Slate Transporter's 10 Number: Leave blank. · . . · . I
Transporter's Phone Nuf!lber: Enler a telephone number including area code.where an authorized agent.of the second transporter can be reached int
e-.,ent ol an·emergency including nights, weekends, and holidays.
Designated Facility Name and Sile Address: Enter the_ comp8ny name and site address of the treatment, storage, or disposal facility designated :o receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing address. . I
U.S. EPA.'~ ~umber: Enter the U.S. EPA twelve digit identification number ol th~ designated treatment. storage, or disposal facility identified in item 9.
Slate Facility's ID Number: Leave blank. ·
Facility's Phone Number: Enter a telephone number including area code where an authorized agen.t ol the facility can be reached in the event al an
emergency including nights, weekends. and holidays. I
U.S: DOT DescriPtions: Enter proper shipping name, hazard class and JD Numb~r (UN/NA) for each waste as identified in 49 qFR 171-177.11 additional soa
is needed. use a U.S. EPA Form 8700·22A Rev. 9/86 {OHEC 1988A) Continuation Sheet.
Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) for the type ol c::intainers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. roll otts
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases I
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plasuc ':Jags
i3 .. Tola! Ouantily: Enter total quantity al waste described on each line, relative to the units used in item 14. · . , I
i4. Unit (weight/volume): Enter the appropriate abbreviations rrom Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid onl,
I. Waste Number: Enter hazardous waste numbers as speciliedin South Carolina Hazardous Waste Management Regulation A.61-79.261 Subpar1s C ar.d D
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number (rrom the S.C. DHEC Authorization Request Form)
for each waste stream listf!d in section , 1 above. t-k>te: Before any hazardous waste can be accepted !or treatment storage or disposal in South Carc,lina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. ,,
K. Handling Codes lor Wasles Listed Above: Leave blank. . . ""
l 5. Special Handling Instructions and Addillonal Information: Generators may use this_ space lo indicate special transportation, treatment. stor'age_ or disposa ·
information or Bill of Lading Information. For international shipments, generators must enter in this space the point of, departure (ciry and state) for tnose
shipments destined for treatment. storage, or disposal outside the jurisdiction or the United States. .' . · · . '
16 .. Generator Certification: The generator must READ,.SIGN (BY HAND IN INK), and DATE thecertificatfOil'Staterrient. II a mode other than highway is Used, I ·
word .. highway" should be lined out and the appropriat~ mode (rail, water.or air) inserted in .the space below. II another mode in addition to the highway mode 1
used, enter the appropriate additional mode (e.g.,,and rail) in the space below.
TRANSPORTER SECTION . ' ' ' I
17: Transporter 1 Acknowledgement: Enter the name al the perso~ accepting the·waste on behalf ol the first transporter. That person must acknowled
·· acceptance of !he waste described on the manifest by signing (BY HA~O IN INK) and entering the DATE al receipt.
18. Transporter 2 Acknowledgement: Enter. if applicable, lhe name of the person accepting the waste on behalf ol the second transporter. That person mus:
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt. · I
FACILITY SECTION
19. Discrepancy Indication Space: The authorized representative al the designated la.cility's owner or operator must note.in this space any disCrepancy between
the waste descri~ed on the manifesl and the waste actUatly received at the facility. Owners and opcra!orS of facilities who cannot resot-.,e significant
discrepancies within 15 days receiving the waste mus I submit to the Department a letter with a copy al the.manifest desCribing,the discrepancy i:ir.d a~emptl
reconcile it The treatment storage, or disposal laclllty mu St enler the actual weight ~I waste In pounds in the spaces proyided H the amount varies any from 1
specHied by the generator in item 13 or ii the generator uses a unit ol meas11re other than pounds. · , •,
20. Facility Owner or Operalor Cerlilicalion: Print or type the name al the person accepting the waste on behalf al ihe owner or operate~ ol 1he.lac1h1y. Tt1.:i1 person
m_ust acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK}° and entering the DATE of receipt. I
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DEStG'l•TED
Af:C' ".tE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (803) 734•5200 WE!;:KDAYS FROM 8:00 .im TO 5:00 pm.
I
F
. A
South Carolina Department of Health
and Environmental Control
Buieau of Solid & H.uardous Waste Mgt.
2600 Bull Stree\ C-Olumbia. SC 29201
Phone: [phone]
Emerge~cy & Holidays: (803)734-~24
E PRINT or TYPE (Form desl wriler Form A roved. 0MB No. 2050·0039 E.i 'res 9.30.ga
UNIFORM HAZARDOUS
WASTE MANIFEST .
1. Genera10·,·sus. EPAID No.
N c D O 7 0 1
3. Generator's Name and Mailing" Address.
Channel Master··
,,,P. O. Box 1416,
•· Generator's Phone 919
5. Transpor1er 1 Company Name
Smithfield,
934-9711
Willms Truckin Co .Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services·of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
10, U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Oescriptio~ (including Prope~ Shipping Name, Hazard Class, ~nd ID Number}
L · Hazardous Waste, Solid, nos ORM-E
NA 9189
15: Special Handling Instructions and Additionar"l,:ilormalion .
GSX Work Order No.: 71904
2. Page 1
of
12. Containers
No, Type
1 D T
lnlorfflation in the shaded attn is not
required by Federal law, but is by State 11 .....
13, Total Quantity It Unij __l',Wulll -:!
'M/Vri ~':::r=+c-,~n-,i;n,ti~{
2 0 y
18. GE.NEAATOA"S CEATI_FICATION: I herebydecl■ rO thalthe COntenta olthlscon•lgnment■re lully and accurately de1crlbod ■bove by prop.er ehlpplng name aMd ere c1a-,t1ed.
· packed. marked, and labaled,and are In an respecta In proper condlUon for transport by highway ■c_cordlnl) to appllcablo lnlarnatlonal and national government re-QulatJon• a1'd
ttoe law1 ol u,e State ot Soulh Carolina, . . · · · ·
111 ■·ma large quantity generator, I Ce_r1ify !hall haVa a progra_m In place lo reduce the volume and toxlcltyol wa1tegeneratod lo the degree I have delarmlnia-d to b.-eeonofflieally
practicable and th al I have selected the practicable method ol treatment. atorage, or dlapoaal currenlly avail able lo me which minimize, the pruent and lutur1 trltMI IO humAn
hH1!h and the envitonmcnt;OR, Ill am a amoll quontltygonerotor, I hove mado a good lellh eNor110 minimize mvwasle generation and 1,tect tf'le bHI wut, management mre«J'lod
ttlel i1 available 10 me and thol I con alford. ·
Printed/Typed Name · RO.GER L. COATS Signature Month
~
Signalur -#-C)J
Prinled/Typed Name Signature · Month Oay Yw
19. Discrepancy lndicalion Space
• I pt>s. CI libs.
bl l'bs. d I pt>s. I ~1-...,,...-------------~ 20. facility Owner or Operator; Cer1ificalion of receipt of hazardous materials covered by !his manifesl except as noted In Item 19.
Monlh D1y Yl&I , Prlnltd/Typtd Name. · · . · . . Signature , ·
IEPA F~rm_ 8700-22 (Rev, 9/86) Previous Editions ore Obsolele IOH~C 1988 (Rev. 10/86))
SJ ATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) lypewriter) OR USE FIRM POINT PEN; PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require 9enerat6rs and transporters o·f h·azardous waste and owners or operators ol hazardous waste treat~enl
storage. or disposal licililies to use the U.S. EPA Form 8700-22 Rev:9/86 (OHEC 1988 (A.EV 10/.86)) and, ir necessary, thEt cOntinuation sheet U:S. EPA For
-8~00-22A Aev:9186 {DHEC 1988A) foi both inter-s1a18 and in1rll-s1a1e tranSportiitlon. Transporlcrs.who transport hazardous waste into the United States fro,
• ar\other country are respoM~ible !or completing the manilesl Federal and Stale regut8tions also require gene·ratorS and transpor1ers ol hazardous_ waste ar,d
.. -::~:::~::•:a~:;
I
:INhazardous waste treatmenl, storage, or disposal facililies lo complete the loll owing information. I:
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the ur:iic;ue live digit
.. , . ~ number assigned to this ma"nilestbythe generator beginning with 00001.11 your company does not haye·a U.S. EPA ldentilication Number. please con:act S.C .
.. Ow.~ _ OHEC at [phone] about obtaining an ldentilicalion·number. · . . · · : I·
2:: Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the fiis~ page EPA For_m 8700-22 Rev. 9/86 [D_HEC 1988 (REV, 0186)] i:lus tr,
·-•~-number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHec·,seeA) if any. · · ·
,. .. ~·A. · State Manifest Document.Number. .. Leave blank .
.. ,.. B:. Stale Generator Identification Number:. Leave blank. · · · · · 1
. · 3. Generator's Naffle and Mailing Address: Enter th~ nam~ and mailing ~ddress of the generator who will manage the returfle~ manifes: lorms. , ·
.. :~~"·. Generator's Phorle Number: -Enter a telephone number with_ area code wh.ere an authorized agent of the generator can be' reached in :he event cl a,
emergency including nights, weeke.nds, and h·olidays. · . . I
5. ·;1 T~ansport 1 Company Name: E~ter the company.name of the llrst transPorter who will tranSport the waste._ . .. I
-,_: .. 6.~-, U.S. EPA 10 Number: Er,ler the U.S. EPA twelve d_igit i~entilication number of the first lransportei' identified in item 5. :
.. C. Slate Transporter's ID Number: Leave blank. · 1
..•. · O. TranspOrter's Phone Number: 0Enter a telephOne number in~luding area'code where an authorized agent of the lirst transporter can b~ reached in the e·,ent or
} -~ ·~-. ~:::;:~ee~ci ~~~;~i~: ~~g;~~· ~~=~;~~:b~;.~~:~~~::·omi,'Einy n·ame Of ~he sE!CO~dtr~ns·po·rt-er Who wil
1l:;,1:~s~6~
0
th, waste. If 'more' thari 2 transporte;s wl·
····s ..
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and 11st the transporters in the order they will be transpor:ing the wast
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit 10 number al the second transporter identified in item 7.
Stale Transporter's ID Number: Leave blank. · . •.
F .. Transporter's Phone N~~ber~ E~ter a telephone number i_ncluding area code where an authorized agent of the second traiisporter can be reached in th
. _.,., event al an emergency 1nclud!ng nights, weekends, and holtdays. ·
E.
9." · Deslgnaled Facilily Name and Sile Address: Enter ihe compan·y name and site ~ddress of the treatment, storage, or disposal facility desii;nateCI to receive the
·~-• waste listed on this manifest The address must be the' sile .. address, Which may differ lrom· lhEl mailirig address. · · I
.". :· 10. U.S. EPA ID Numb4!!r: Enter the U.S._ EPA tWelve digit identilication number of the desig~ated treatment, storage, I?' disposal facility identified in item 9. • {{ G:. State Facility"s ID Number: Leave blank. · ·
•.-H, .. Faclllly's Phone Number: Enter a telephone ·number Including area code where an authorized agent al the lacilily can be r~ached in tt-.e event o! an
emergency including nightS, _weekends, and holidays. · · . · ·
11: U.S~ DOT OescriptionS: · Ent_er proper shipping name, hazard class and ID Number(UN/NA) ror each waste as identified in 49 CFR 171-1 ii. If aCCi:iCr.al s::>acf
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. ·
12.. Containers {no. and type): Enter number al containers !or each waste and the appropriate abbrevialion from Table I (below) for the type of containers.
TABLE I . .
OM = Metal drums, barrels, kegs TT = Cargo tanks (tank truck~) CM = Metal boxes. cartons. cases. roll ctts ·
OW• Wooden drums, barrels, kegs TC = Tank cars CW= Wooden boxes. cartons, cases
OF• Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
....... ~ TP :a: Tanks portable ' CY =::.Cylinders BA= Burlap, cloth. paper or plastic bags
·13 .. Total Ouanlily: Enter total quantity al waste described on each line, relative to lhe·units used in item 14.
T4. Unit (weighl/volume): Enter the appr.opriate abbreviations ~rom Table II (below) ror the_ unit of measu~e: . Table II . , .
I
I
P = Pounds L =Liters· K = Kilograms T .= Tons M = Metric Tons • N ~-Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I; Waste Number: Enter hazardous waste numbers as specified in South C3rolina Hazardous Waste Management Regulation R.61 • 79.261 Subpar.s C ar::d DJ
-·-· .. ..: identify the hazardous waste on eaCh line.. . · , · · · · · '. , i, .. Additional Oascriptlons lor Materials Listed Above: In the spaces pro~ided, enter the authorization number (rrom the S.C. DHEC Aulhonz:ation Request For .
• ...... ,,, tor each waste stream llsted in section 1, above, Nole: Berore any hazardous waste can be accepted lor treatment. storage or disposal in South Carelina, 1t1e
,._.,..,, generator must obtain prior authorization from the treatmenl, storage or disposal facility. . I
K. . Handling Codes tor WasleS Listed Above: Leave blank. · · · _ · . ·
1 15. Special Handling lnslrucllons and Addilional lnformalion: Generators may use this space to indicate special·lransportation, treatment. storage or di spas
inlormation or Bill al Lading Information. For international _shipments, generators mu.st enter in this space the point ol departure (ciry and s:a1e) tor tnose
shipments destined lor treatment, storage, or disposal outside the jur1sdicl1on al the United States. · • I
, 16. GeneralorCertillcation: The generator must READ, SIGN (BY HANO IN INK), and DATE thecertll1catlon statement. II a mode other than highway 1s used, t
,. · word "'h,ghway" should be tined out and the appropnate mode(ra1I, woter,or air) inserted in the space below.II another mode in add111on to the highway moc:e
. ~ used, enter the appropriate additional mode (e.g.,,and_ rail) in the space below .
. TRANSPORTER SECTION · ·
_:._ 11: Transpor1er 1 Acknowledgement: Enter the name oi the person accepting the was_te on behalf ol the lirst fransporter, That person mus_! ·acknowledl ·
acceptance of the waste described on lhe manHest by signing (BY HANO IN INK) and entering the DATE ol receipt. · ·
· · 1a. T,.anspor1er 2 Acknowledgement: Enter. if applicable, the name of the person accepting the wasle on behalf of the second transporter, That perscn mus:
acknowledge acceptance al the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE Of receipt. I
FACILITY SECTION · ·
19. Oiscrepancy lndic<'.ltion Space: Th~ authorized representative of the designated facility's owner Or operator must note in this ·space any discrepancy be!we_
the waste described on the manilest and lhe waste ac!Ually received at the facility. Owners and operators ol facilities who cannot resolve s1i;ndicant
discrepancies within 15 days receiving the waste musl submll lo the Oepar1menta renerwith a copy of the manifest describing the discrepancy and ar.emoul
r1concile it The treatmen~ storage, or dlsposol foclllly must onler lhe actual weight ~f waste In pounds ln !he apacea provided ii the amount varies any lrom 1r.
specified by lhe generalor in itom 13 or II the generator uses a unit of meas11re other than pound.9, , .
20. Facility Owner or Opi!ralor Certlllcalion: Print or type the name of the person occepllng.the "".3S te on beholl of the owner or operator o,-the f.Jc1t1Iy. Tti.1I person
must acknowledge acceptance ol the waste de~cribed on the manifest by SIGNING (BY-HAND IN INKf and entering the DATE al receipt Tl
IF ASS1STANCE IS NEEDED·IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESrGri< T:O
REC. . THE WASTE OR THE S.C. DHEC MANIFEST SECTIQN AT (B03) 734-5200 WEE.KDAYS FROM B:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau or Solld & Ha.z..ardous Waste ~gt.
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
3. Generator's Name and Mailing Address
· Channel Master
rP. 0. Box 1416, Smithfield, NC 27577
•: Generalo(s Phone 9 1 9 9 3 4-9 7 11
5. Transporter 1 Company Name
;Willms Truckin · Co Inc.
7. Tran_spor1er 2 Company Name
9. Designated Facility Name and Site Address "
' GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
1~. U.S. DOT Description (including P(oper Shipping Name, Hazard Class, and ID Number) .· .·
L t .~ • • ·. Hazardous Waste,· Solid,-nos ORM-E
Form A
2. Page 1
of
Emergency & Holiday,: (803)734-5-124
roved. 0MB No. 2050.Q0.39 E.z: 'res 9-30-U
Information in the shaded areas is nol
r_equired by Federal law, but is by State law.
~~==\~,:~~:{[i!~~*~
'.llf~~?~I~!~ff~;:~;z~~~-~~~Wktr~~f~t
cMsiir. · · · "
•··8'/>t>Oii.:V+
N -NA 9189 1 D T
b.
·:!'/~_:.,!::
C.
d. .• - .
. '·-
~~c{~j~:~i~iii~'
L~-I01217J7!4l-l!Jl!QJ21
b. LLJ-1 1-1
15. Special Handling lnslructions and Additional Information
·,ic·.GSX-;Work Order No.: 71926
S.. 1 GENERATOR'S CEATIF1CATION: I horoby doclaro that tho contents ol this consignment are fully and accurately described above by proper •hipping name and ara c:la.aaolft-.d.
·;,('._packed. marked. and labeled. and are In all respecta In proper c:ondlllon tor lronaport by highway according to appllcablo International and natjonal govammant ragutaaona and
tne lawa or Iha Stale ol Soulh Carolina.
HI am a largo quantity generator. I certlty that I have a program In place lo reduce tho volume and toxicity of waalo gonoraled to tho degree I have determined to be 1teonom6calty
praclicable and that I have selected the practicable method ol treatment. storage. or dlspoaal c:urranlly available to mo which minimize a the praNnl and lutura th, .. , to human
ilt; health and Iha environment OR, Ill am a small quanUtygenorator, I hove made a good lallh artort to minimize mywaategenaratlon and HI act th• beal waala manageman1 ma1hod
i:'•'.U\al la available to ma and that I can aN'ord.
Prinled/Typed Name roocER L c·o· ·.·.,~ ,,a., I), . AIS ·--· 1-•
Signature Year
eipl ol Materials
Signature
Prinled/Typed Name Signa!ure Monlll Day Year
19. Discrepancy Indication Space
I I !Jbs. ' I Jibs.
bl I 1ro.. d I libs.
20. Facility Owner or Operator; Cet1ificallon or receipt of hazardous malerlals covered by this manifest except as noted In Item 19.
Prinled/Typed Name Slgna!uro MOfllll O.y Year
H~-
EPA Form 8700-22 (Rev. 9/86) Previous Edllions are Obsolele (DHEC 1988 (Rev. 10/86))
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haz.ardous Waste Mgt.
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
:EASE PRINT or TYPE ewriler
. UNIFORM HAZARDOUS :;;;" ~ WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D 0
l Generator's Name and Mailing Address
Channel Master
•. P.,O. Box 1416,. Smithfield,.NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
6. U.S. EPA ID Number
S C D O 7
Emergency & Holiday,: (BOJ)7J.4-5"24
Form A roved. 0MB No. 2050-0039 EJ: ·res 9.30.ga
Manlleat 2. Page 1 Information in the shaded a,eas is nol 'Q0 c()mint 6°3 of required by Federal law, but is by State law.
. : •' \~i:ii'}'./;,;~•fr:~: ·:a:.,;;.+f.~~:li~'~
9. Designated Facility Name and Site Address 10. U.S. EPA ID Number :if \lJt~t1;~1l~!Jiil~::;it,!j!f l}J~:t~t:Wii~~i1~J-· GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125 S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Crass, and ID Number)
L . 4• ~Hazardous Waste,. Solid, nos ORM-E
N NA 9189
b.
d. " "
'. {l,."''-'.Jll'..· ; •
15. Special Handling Instructions and Additional lnlormalion
;11;csx, Work Order No. : 71927
~2. Containers 13. Total Quantity U. Uni! :VW&itii'~
No. Type 'M/WJ i·~i·N~:i}i;1:~;:F:,~1
1 D T
)Tt'i'tr;i~
2 0 Y ~1F1010161I
d,'·1"tT1
N' J I I l~i
1 e.' Gl!Nl!RA TOR'S CERTIFICATION: I hereby docl■re that the contents ol this conslgnm•nt are fully and accuraWly da1crlbed abov• by proper ahlpplng nam• and are cla..,nect.
. p.cked, marked, and la°beled, and are in all respects In proper condlllon for transpor1 byhlghwayaccordlng to appllcable lnlernalional and national govemm•nl f9'Qulatlona al"ld
lt'le laws ol lh• Stale ol South Carolina.
tf I am a large quantity generator, I certify !hat I have a program In piece lo reduce the volume and to,ilclty ol waste generated to the degree I have datarmln.cl! to M .conomlcatly
. pracucab1e and that I have selected !ho pracllcable method ol treatment, storage, or dlapoaal currently avallabla to ma which minimizes the preaenl and lu1"re lhrNt 10 human • .t h.•allt, and Iha onvironmont;OR, II Jam a small quontltygeneralor, I have made a good faith oNor1 lo minimize mywasle generation and select the bait wa11a managamenl ~
•;'.! that la available to me and tha1 I can alford.
Printed/Typed Name ~;-~ ~ .
/Typed Name
19. Discrepancy Indication Space
Signature
20. Facility Owner or Operator, Certification of receipt ol hazardous materials covered by this manifesl except as noled In Item 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolele IDHEC 1988 (Rev. 10/86))
Monlll
cJ.
Year
Monlll Day Year
a ._! .1....1...w....1-1Pbs. c lu...1....1...w....1llbs.
b I pto. d I pto.
Moolll Day YNI
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Boll Stree~ Columb;a, SC 29201
Phone: [phone] ·
Emergency & Holidays: (803)734-S(24.c
writer Form A roved. 0MB No. 2050-0039 Ex 'res 9-30-84
UNIFORM HAZARDOUS
WASTE MANIFEST
1 Generator's Name and Mailing Address
Channel Master
1. Generalor's U.S. EPA ID No.
N C D
~.P •. O, Box 1416, Smithfield, NC 27577
(. Genera1o(sPhone 919 934-9711
5. Transporter 1 Company Name
•1 Willms Truckin Co Inc.
7. Transp0rter 2 Company Name
Manifest Document No. 0 0 1 6 4
9. Designated Facilit'j Name and Site Address 10. U.S. EPA 10 Number·
,. GSX Services of SC, Inc,
'."Route, 1 Box 255
· Pinewood SC 29125 S C D O 7 0
11, U.S. DOT Oescrlplion (including Proper Shipping Name, Hazard Cfass, and ID Number)
,.:,
L.-. · . . Hazardous Waste, Solid, nos ORM-E
.,.,NA 9189
15. Special Handling Instructions and Additional tnrormation
:,·,, GSX Work Order No, : 71928
2. ·Page 1
of
1 D T
Information in the shaded areas is nol required by Federal law, but is by State law.
2 0 Y
· 11. GENERATOR'S CERTIFICATION: I hereby declare that the contenls ofthlsconalgnmentare fully and accurately described abova by prcp,ar ahlpplng nama and are cla..,ti.cs.
1 packed, marked, and ta"beted, and are In all respects In proper condition lor lrensport by highway according to applicable International and naUonal govemmenl regulaUon• al'ld
Iha la .... • ot the State of South Carollna.
HI am a large quantity generator, I certify th al I have a program In place to reduce the volume and toxicity of waste generated to the d~ree I have determined to M econom'catty
practicable and Iha! I have selecled the practicable method ol lrealmenl, storage, or disposal currently available lo ma which minimizes the presenl and lul\Jre threat 10 hurnan
!"..:t health and u,e environment; OR, If I am a smo11 quantity genera1or, I have made a good faith effort lo minimize my wa11te generation and salecl the best wa1ta managam...,t rneihod
,-.:;:itr\al is available to me and that I can afford. ·
"rnnled/Typed Name ROGER L. COATS
1-·-,;.,I. . , .
Year Signature
'I
Prinled/Typ Signature Month Day Year
19. Discrepancy Indication Space
F •'' ·. • ... I, .._._.._._._.!Iba: 'I !k ~~ ~'.~~:,hty Owner or OperalOr, Ce"mca!lon o1 receipt of hazardous materials covered by this man;fes1 except as noled In Item 19. b I !Ibo. d I jibs. ',,.i PMled/Typed Name Signature
'tPA ·F:rm 8700-22 (Rev. 9/86) Previous Edlllons are Obsolete (0HEC 1988 (Rev. 10/86)]
Moolh Day Year
South Carolina Department of Health
and Environmental Control
Bureau or Solid & Ha.z..ardous Wa.ste Mgt
2600 Bull Streel. Columbia. SC 29201
Phone: [phone]
.. UNIFORM HAZARDOUS
-.-~-. WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
~P-oO. Box 1416, Smithfield, NC 27577
4. Generetofs Phone 9 I 9 9 3 4-9 711
5. Transporter 1 Company Name
'Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Desfgna!ed Facility Name and Sile Address
GSX Services of SC, Inc.
· Route, I Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
C D O 7
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class. and ID Number)
L -... , .. Hazardous· Waste, Solid, nos ORM-E
.. NA 9189
15. Special Handling Instructions and Additional Information
.;.-.csx Work_ Order No. : 71929
Emergency & Holidays: (803)734-5"24
Form A roved. 0MB No. 2050-0039 Ex 'res 9-30-88
2. Page 1 lnlormation in the shaded a,eas is nol
of required by Federal law, but is by State law.
12. Containers 13. Total Quantity 14. Unit =_ ~l ~&.1111 ~M
No. Type · VNVrJ '.-\f\i;J;:~•!Ji{~;Jl~~
1 D T 2 0 Y
1 S. GENERA TOR'S CEATtFICA TION: I hereby declare that tho content• of this con•lgnmont are fully and accurately de•crlbed llibove by proper •hipping name and are ~n..:1.
·packed.marked. and libeled. and ara In all respects In proper condlUon for transport by highway according to appllceble International and national government r~ulatlona &I'd
. , u,a lawa ol lh■ Stale ol Soulh Caroline. .
· tf I am a largo quanlity gen•rator, I certify that I have a pr<>Qram In placa to reduce the volume and toxicity of waste generated to thedogree I have determined to b9 .conomiealty
practicable and that I have selected the practlcabla method of treatment. storage, or dlspoaal currently available to ma which minimizes the preMnt and tutu re thrMI \0 human z:~ health and the environment;OA. Ill am a small quontltygenerotor.l have made a good faith errortto minimize my waste generation and select the be1I wula management metrlOd
H:iaiat ii available to ma and tha1 I can attord. ··
Printed/Typed Name i.,. ROCER L. COATS j • • •
Signature
Signature
ipl of Materials
ame Signature
19. Discrepancy Indication Space
20. Facility Owne, or Operator; Certification of receipl ol hazardous malerlals covered by this manifest except as noled In Item 19.
Prinled/Typed Name SlgnalUre
PA Form 8700-22 {Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 {Rev.10/8611
• I ................... Pbs. ' 1 ................... llbl.
b I jibs. d I fibs.
Mo<ilh Day Ya,r
...
I
.
;(
"""°'"""'..,,._ ~
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST· N c D o
3. Generator's Name and Mailing Address
Channel Master
i. 0. Box 1416, Smithfield, NC 27577
4, Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
Form A
2. Page 1
of
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88.
lnlormalion in the shaded Meas is not
required by Federal law, but is by Stale law.
11. U.S. DOT Description (including Proper Shipping Name, ·Hazard Class, and ID Number} 12. Containers 13. Total Quantity 14. Unit
No. Type 'MN~
a
b.
C.
d .
Hazardous Waste, Solid, nos ORM-E
NA 9189
• -i'
1 D T
1l~t1 ~~:~:;~1~11:~;1j!!!i;l:!~J:1::~1~:li(l!:1l:;!;l:!!!l;~/!~]11;:i!i:l1'~~:!~:rl!~;!.:
a.lr..tl:L]-!0,2,7,714!-!l!l,0,2hlWl\W)t§!0·LLJ-I I I I I 1-1 I I I hi!
b. Lu-I 1-1 _ 1g~f~lt~l~W.:L.. Jil
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 7193!)
2 0 Y
16. GENERA TOR'S CERTIFICATION: I hereby dec1aro that tho contents of this eOnalgnmonl are lully and accurately described abov• by proper shipping name and are ctasail19d,
packed, marked. and 1aheled, and are in au respects in proper condition !or transport by highway according to appUcablo lntamatlonal and natlonal govommont r..gulatlona and
lha laws ol tho Stale ol South Carolina.
111 am a large Quantity generator, I certify Iha! I have a program ln place to reduce Iha volume and toxlcltyol wastaganerated to tho deg,_ I have determined lo be economically
practicable and tha1 I have selected the practicable method of treatment, sloraga, or dlapoa.al currently ovallablo to mo which minimizes the preNnt and future thrMl to human
health and Iha environment: OR, II I am a smo.11 Qoanlltygonoralor, I hove m_ado a good faith effort to minimize my waste generation and select the best wast• management method
that is available to me and thal c n ti rd.
_Signature Month Day Year
t!)
Month Day Year
;;?
18. Transporter 2 Acknowledgement of Receipt of Materials
Prinle<J/Typed Name Signature Month Day Year
19. Discrepancy Indication Space
I I ....... ......_......,, pbl. C I llbl.
bl .............. ......... pbs. d I l!bl.
20. Facility Owner or Operator. Certification ol receipt ol hazardous materials covered by this manifest except as noled In Item 19.
Printed/Typed Name Signature Mooth. Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)[
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12'?pHch (elite) typewdter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous was:e trea:mel
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and. ii necessary, the continuation sheet U.S. EPA For
8700-22A Rev.-9/86 (DHEC 1988A) loi both inter•stc1te and intra-st<lle transportation. Transporters who lranspOrt hazardous waste into the United States fro
another country are responsible !or completing the manilesl. Federal and State regulations also require generators and transporters of hazardous waste aria
owners or operators al hazardous waste treatment. storage, or disposal facilities to complete the ronowing inrormation. I
GENERATOR SECTION
1.
OHEC al [phone] about obtaining an identification number. _ ·
Generator's U.S. EPA ID Number-Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please con:act S.1 2;. Page 1 of: Enter the total number of pages used to complete this manliest, i.e .. the fifst page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (R.EV 10/86)] t:!us :,
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A {OHEG 1988A) if any.
A. SI.ale Manifest Document Number. . Leave bliink.
B: St.ate Generalor Identification Number: Leave blank. · I
3. Generator's Name and Mailing Address: Enter lhe name and mailing address of the generator who will manage the returned maniles: lorms.
4. Generalor's Phoiie Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the even: ol an
emergency including nights, weekends. and holid.:iys.
I 5.
6. . c.
Transpor11 Company Name: Enter the company name ol the first transporter who will transport the waste.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identHication number al the lirst transporter identified in item 5.
Slate Transporter's ID Number: Leave blank .
D. Transpor1er's Phone Number: 0Enter a teleph0ne number including area code where an authorized agent of the first transporter can be reached in the event or
1:. ~:~:;:~eeryrci~~~;~i~~ ~~g;:~· ~~=~~~~:b~;~~~~~~~:•o'mp;~y n~me Of the seco~·dtra~-p~·rte'r'Wh~ wil;-t~~·~:s~O~ the waste. l(rTiorethan 2 transporters WI
8 ..
E ..
be used. use a U.S. EPA Form 87_00-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transoor:ing the was:fl
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
Stale Transporter's ID Number: Leave blank. · I
F .. Transporter's Phone Number: Enter a telephone number including area code where an authorized age~! of the second transporter can be reached in th
even! of an emergency including nights, weekends. and holidays.
9.
10:
G:,
Oesignaled Facility Name and Site Address: Enter the company name and site address al the treatment. storage, or disposal facility designated to receive the
waste listed on this manifest The address must be·the site address, which may ditfer lrom the mailing address. I
U.S: EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage, or d_isposal lacility iden:ilied in item 9.
State Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event ol an
emergency including nights. weekends. and holidays. I
U.s:·ooT Descriptions: Enter Rt.aper shipping name, hazard class and ID Number {UN/ NA) for each was'.e·as iden_tilied in 49 CFR 171 -1 i_7. If addi:icnal soa_
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
11:
12. Containers {no. and type): Enter number ol containers !or each waste and the appropriate abbreviation rr_om Table I (below) for the type or containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll c\fs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases I
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. car.ans. cases
TP = Tanks portable CY= Cylinders ·BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to lhe units used in item 14.
t4. Unit (weight/volume): Enter the appropriate abbreviations !ram Table II (below) for the unit ol measure: I
Table II
p = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid onll
1. Waste Number: Enter hazardous waste numbers as specified in S_outh Carolina Hazardous Waste Management Regulation R.61-79.261 Subpar.s C ar.d D
identily the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided. enter the authorization number (rrom the S.C. DHEC Authorization Request F ormJ
!or each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted !or treatment. storage or disposal in South Carc-lina. the
generator must obtain prior authorization lrom the treatment. storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Addilional lnlormation: Generators may use !his space to indicate special transportation, treatment. storage or dispos
inlOrmation or Bill al Lading Information. For international shipments. generators must enter in this space the point or departure (city and s:ate) !or those
shipments destined for treatment. storage. or disposal oulside lhe iuriSdiclion or the United States. · · '": ' I
16. Generator Cer1ilication: The generator must REA0,·s1GN (BY HAND IN INK), and DATE the certification statement. Ir a mod1f other than hignway is usec.:
word .. highway·· should be lined out ;rnd the appropriate mode (rail, water. or air) inserted in the space below. II another mode in addition to tr.e hignway mode
used, enter the appropriate additional mode (e.g ... and_ rail) in the space below.
TRANSPORTER SECTION I
17: Tran$porter 1 Acknowledgement: Enter the name al the person.accepting the waste on behalf ol the first transporter. That person must acknowled
acceptance of the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name of the person accepting the waste on behalf of the s8cond transponer. That person must
acknowledge acceptance ol the waste described on the manirest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt. J
FACILITY SECTION ,
19. Discrepancy Indication Space: 'The authorized representative of the designated facility·s owner or operator must nole in this space any discrepancy betwe_
the waste described on the manirest and !he waste actUalty received al the facility. Owners and operators of facilities .who cannot resolve significant
discrepancies within 15 days receiving the waste must submit to the Department a lener with a copy of the manliest describing the discrepancy and ar:em;:its I
reconcile iL The treatmenl storage, or disposal lacility must enter the actual weight ~I wasle in pounds in the spaces proyided ii the amount varies any from th
specilied by the generator in item 13 or ii the generator uses a unit or mects11re other than pounds. . .
20. Facility Owner or Operator Certification: Print or type the name ol lhe person accepting.the waste on behalf of the owner or oper.itor or the loctlity. Tt1Jt person
m. us\ acknowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HANO IN INK)° a·nd entering the DATE or receipt. 1 IF ASSISTANCE IS NEEDEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT. STORAGE, OR DISPOSAL FACILITY DESIGrlATED T
REC· , ... , · ~ ··,' ~ r:: -')n THE S.C. DHEC MANIFEST SECTIOM AT [phone] WE~KDAYS FROM 8:00 am TO 5:00 pm.
, South Carolina Department of Health
and Environmental Control
E PRII/T or TYPE
., ,UNIFORM HAZARDOUS
· WASTE MANIFEST
3. Generator's Name and Mailing Address ·
Channel Master
1. Generator's U.S. EPA ID No.
N C D 0
Manlto11t Document No. 0 0 1 6 7
.· P. O. Box 1416, Smithfield, .NC 27577
,. Generalo(s Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
S C D O 7 0
Form A
2. Pago 1
of
Buraau ol Solid & Ha.z.ardous Waste Mgt.
2600 Bull Streei Columbia; SC 29201
Phone: [phone]
Emergency & Holidays: {803)734•5'24
roved. 0MB No. 2050-0009 Ex ·res 9.30.ga
lnlormatlon in the shaded MHS is nol
required by Federal law, but is by State law.
11, U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers 13. Total Quantity
L·
Hazardous Waste, Solid, nos ORM-E
"'NA 9189
d. .•.
' ·."i, '.~··'!·1:-.:·
15. Special Handling Instructions and Addilional Information
;·, GSX Work Order No.: 71931
No. Type
1 D T 2 0 Y
, e. QE.Nl!RA TOR"S Cl!RTI_FICATION: I hereby doclero that lho contont• of thle conelgn1T1ont aro lully and eccurataly doecrlbod above by proper ehlpplng n•"'• end are ci.-n.d.
· packed, marked, and labeled, end are In ell respect• In proper condlllon fortronsportbyhlghweyeccordlng toeppUcable lnterne1lonal end national government reg~letione al'ld
t,,a lows of 11,e Stale ol South Caroline.
HI am a large quantity generator, I certify that I have a pr~ram In pleco to reduce tho volume and lo,ilclty olwaeto generated to tho dogrM I h•v• dolormln.cl to bo aconom'calty
praclicablo and lhet I havo selecled Iha pracltcablo method ol troe1mont. s1orage, or dlspoaal currently available to mo which mlnlmli:o• tho pre.ont and luturo lt'lrNt to human
', hoallh and !ho environment.: OR, lfl am a smott qunnlilyganorator, I have mado ii good faith orlort lo minim lie my waslegenarallon and sa1acl tho boil wa11a management method
.-thal Is avaitat>la to ma and !hot I can arlord.
Prinled/Typed Name B,Q,g_ER L C Signalure
Printed/Typed Name Signaluro Monlh Day Yw
19. Discrepancy Indication Space
i I l'bs. C I 1it..
bl libs. d I l'bs.
20. Facility Owner or Operator; Certilicallon of receipt or hazardous fflaterlals covered by lhls manilesl except as noted In Item 19.
Printed/Typed Name Signature Moolh Day YNI
PA Form 8700-22 (Rev. 9/86) Previous Edlllons ore Obsolete (DHEC 1988 (Rev. 10/86))
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Stree~ Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
LEASE PRINT or TYPE (Form desi ned for use on elite 12· itch ewriter Form A roved, 0MB No. 2050-0039 Ex ·res 9-30-&8
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D 0
Manlfeot 2. Page 1 Information in lhe shaded a<eas is nol oocomrl 6°8 of required by Fede_ral law, but is by State law.
3. Generator's Name and Mailing Address
Channel Master .
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
·Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shippfng Name, Hazard Class, and ID Number}
a. Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 71932
12. Containers 13. Total Quantity 14. Unil
No. Type 'M/VtJ
l D T 2 0 Y
:!!1fY"671,91~
.\!1fl01016Ffy'
1 &. GENERATOR'S CERTIFICATION: I hereby declare lh11t the con1en1s of this conalgnmentare fuUYand accurately described above by proper shipping name and are cla.-itl~.
packed. marked. and la°beled, and are in all respects in proper condition for transport by highway accordlng to appllcable International and national government regulallon• a/'\Q
the laws ol lha Stale of Soulh Carolina.
111 am a large quanlily generalor, I certify !hat I have a program In place to reduce the volume and toxlcltyolwastegeneraled to the deg,_ I have determined to be oconomlcally
prac1icable and that I have selected the practicable method of treatment. storage, or disposal currently available to me which minimizes the present and future thrNI lO human
health and the environment: OR, Jfl am a smoll quantltygonorolor, I have made a good lailh effort to minimize my waste generation and select the best was1e management m,othod
that is availat>le 10 me and Iha! I con afford.
Printed/Typed Name Signature Month
CJ
Signature %Yr Month
0
Printed/Typed Name Signature Montt, Oay Year
19. Discrepancy Indication Space
• I Jibs. C I Jibs. C
b I jibs. d I pbs.
20. Facility Owner or Operator; Certification ol receipt ol hazardous malerials covered by this manifest excepl as noted in llem 19.
Printed/Typed Name Signature Month Dey y..,
EPA F.orm 8700-22 (Rev. 9/66) Previous Editions are Obsolete [OHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elile) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters ol_hazardous waste and owners or operators al hazardous w?ste trea:meJ
storage. or disposal licilities to use the U.S. EPA Form 6700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)j and, if necessary, th~ continuation sheet U.S. EPA For
8700-22A Rev:9/86 (DHEC 1988A) tor both inter-state and intra-st;itc transportation. Transporters who transport hazardous waste into the United States Ira ,
another country are responsible !or completing the manifest Federal and State regulations also require generators and transporters or hazardous ·...-aste·aiio
owners or operators al hazardous waste treatment. storage. or disposal racilities to complete the following inrormalion. . •
GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manirest Documenl Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number as::;igne:::I to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number. p!ease con:ac: S.1 DHEC at [phone] about obtaining an identification number.
2;. Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] ~lus:
number or continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A. State Manifesl Document Number. . Leave blank.
B: Slate Generator Identification Number: Leave blank. I
3. Generator's Nam~ and Mailing Address: Enter the name and mailing address al the generator who will manage the returned manifest forms
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of an
emergency including nights, weekends. and holidays.
I Transport 1 Company Name: Enter the company name of the lirst transporter who will transport the waste. 5.
6.
. c.
o.
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in i!em 5.
Slate Transporter's 10 Number: Leave blank .
Transporter's Phone Number: 0Enter a telephOne number inc!Uding area code where an authorized agent of the first transpor1er can be reached in the event of
an emergency including nights, weekends, and holidays._ . . ' '· ' · ' I
1:. Tran~porter 2 c~~pany Name: II applicable, enter the cOmp~~y name ;i the seC-;;',;'dira,;-s:porter who will'i'ra'n'spOrl the waste. II more than 2 trans;::iorters w
be used. use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they wilt be transpor:.ing the was_: .
U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identilied in item 7. a ..
E Slate Transporter's ID Number: Leave blank. I
F .. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol the second transpor1er can be reached int
event al an emergency including nights, weekends, and holidays.
9. Designated Facilily Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designateo to receive the
waste list_ed on this manifest The address must be the site address. which may ditfer lrom the mailing address. I
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number al the designated treatment, storage, or disposal facility iden:ifiea in item 9.
Slate Facility's 10 Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facil_ity can be reached in the event ol an
emergency including nights. weekends. and holidays. · I
11: U.S: DOT Oescriplions: Enter proper shipping name, hazard class and JD Number (UN/NA) for each waste as identified in 49 CFR 171 -1 77.1! aCCi:icnal s;::ia
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no, and type): Enter number ol containers for each waste and the appropriate abbreviation from Table I (below) for the type of containers.
TABLE I
OM= Metal drums. barrels. kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll ells
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. canons. cases I
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks por1able CY= Cylinders BA= Burlap, cloth, paper or plas:ic bags
13 .. Total Quantity: Enter total quantity of waste describe'd on each line, relative to the units used in item 14.
T-1. Uni! (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit ol measure: I
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metrtc Tons N = Cubic Meters Y = CubiC Yards G = Gallons (liquid anti
I. Waste Number: Enter hazardous waste numbers aS specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.26.1 Su. bpans C ar,d D
identity the hazardous waste on each line.
J. Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. OHEC Authorization Request Form)
for each waste stream listed in section 11 above. Note: Berore any hazardous waste can be accepted lor treatment. storage or disposal in Sou!h Carc:-lina. lhe
generator must obtain prior authorization from the treatment. storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
15. Special Handling Instruction:, and Additional lntormalion: Generators may use this space lo indicate special !ransportation, lrealment. storage or dispos
inlormation or Bill ol Lading Information. For international shipments, generators must enter in this space lhe point of departure (city and s:ate) for :nose
shipments destined tor treatment, Storage, or disposal outside the jurisdiction or lhe United States. · I
16. Generator Certilication: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. If a mode other 1han highway is used. t
word "highway" should be lined out and the approprit?te mode (rail. water.or air) inserted in the space below. If another mode in addition to the highway mode .
used. enter the appropriate additional mode (e.g.,.and rail) in the space below.
TRANSPORTER SECTION . .
17: Tran:,porter 1 Acknowledgement: Enter the name of the person aCcepting the waste on behalf ol lhe first transporter. That perSon musi ~cknowledl
ac~ep!ance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter. if applicable, the name al the person accepting the waste on behafl al the second transporter. That perscr: mus:
acknowledge acceptance of the waste described on the manifest by SIGNING (B.Y HANO IN INK) and entering the DATE al receipt. J
FACILITY SECTION ·
19. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy bet we
the waste described on lhe manifest and the waste actUally received at the facility. Owners and operators or_ facilities who cannot resolve significant
discrepancies within 15 days receiving the waste mus! submit to the Department a lener with a copy ol the manifest describing the discrepancy and a~em::ts I
reconcile it The treatment. storage, or df:,posal la'cillty must enter the actual weight ~I waste in pounds in the spaces provided ii the amount varies any from :r:
specilied by the generator in item 13 or ii the generator uses a unit of meas1.1re other than pounds. . .
20. Facility Owner or Operator Cerlilicalion: Print or type the name of the person accepting.the wnste on behatl of the owner or operator o! the lac11!1y. Tt,a1 per~on
must acknowledge acceptanc'e of the waste described on the manifest by SIGNiNG (B)'. HANO IN INK)and entering lhe DATE ol receipt. I
lF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE. OR DISPOSAL FACILITY DESIGtJ.:..TEO T .
REI.I" •--; THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WE~KOAYS FROM 8:00 am TO 5:00 pm. .
South Carolina Department of Health
and Environmental Control
Bureau ol So/Jd & Haz.ardous Waste Mgt.
2600 Bull Street. Columbia, SC 29201
Phone: [phone]
E PRltfT or TYPE ewrlter
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
N C D O 7 0
9. Designated Facility Name and Sile Address ··csx Services of· SC, Inc •
. Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA 10 Numbor
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) . ' .
L ~• .. , . -~Hazardous. Waste, Solid, nos ORM-E
N NA 9189
b.·.
15. Special Handling tnstructi_ons and Addiliona1 Information
•:_.GSX.,Work Order No.: 71933
Emergency & Holida)": (803)734-5-124
Form A roved. 0MB No. 2050-0009 Ex ·res 9-30-M
Information in the shaded a,eas is not
required by Federal law, bul is by State law.
12. Containers 13. Total Quantily 14.Untt ,L'.W&Stlllt.rllb«t:f:
No. Type 'MJVd ~{J+i>!-lZ:~:JA~1
I D T 2 0 Y
,e.· 01!NERATOR'S CERTIFICATION: I hereby declare thettho contents olthlsc:::on•lgnmontoro lu11yond eccurattilydesc:rlbed above by proper shlpplno name er•d ere c:.La..,nad,
peeked, marked,aMd t8beled,and are IM all raspoc:ta In proper condition lor transport byhlohway ac:c:ordlMO to appllcable lnternatlonal and natlonal oovernmen1 reo;ulatlons at'ld
tne laws ot !he Stale ol Soult'I Caronna.
tfl am a larga Quantity oanarator, I certify thal I have a prooram In place lo roducathevolumo and 101,;lcltyol waatagonerated to the deg roe I have detarmlne-d to M economlea.lty
practicable and that I have selected the practicable method ol lrealment, storage, or dlsposo1 curranlly available to me which mlnlmb.e1 the present and lutura thrNI IO human
health and the environment;OA, Ill am a small quantllygonerator, I have mad a a good laith oHor1 lo mini mite my waste gonerallon and select tho bell wuta managomenl meU'lod
11'\al 11 availati1e to me and that I ean aHord.
Prinled/Typed Name
'. ~ ' RO.GERL. COATS Signature
er 1 Ac:Knowledgemenl of Receipt of Materials
wledgement ol Receipt of Malerials
Slgnalure
19. Discrepancy Indication Space
20. Facility Owner or OPerator. Certilicalion of receipt of hazardous materials covered by lhis manifest except as noted in Item 19.
Prlnlod/Typod Name Slgnalure
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
y..,
Monlh Day Yw
I 1..I .J...L--'-'-'--'jlbs. C 1..I .J...L--'-'-'--'Jlbs.
b I jibs. d I Jibs.
Monlll Dey YNI
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Stre-et, Columbia. SC 29201
Phone: [phone]
E PRINT or TYPE {Form desl ned for use on elite 12-itch
1 UNIFORM HAZARDOUS
. ' WASTE MANIFEST N C D 0
3. Generator's Narne and Mailing Address
Channel Master
,,,,,P,. 0. Box 1416,
•· Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc:
7. Transparter 2 Company Name
9. Designated Facility Name and Site Address
· GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
NC 27577
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and.ID Number}
L Haz'ardous Waste, Solid, nos ORM-E
Emergency & Holidays: (803)7l-4-5-'24
Form A roved. 0MB No. 2050-0039 E.x ·res 9-30-88 ·
2. Page 1 Information in the shaded ateas is n01
of required by Federal law, bul is by State law .
12. Containers 13, Total Quantity 1'. Unit
No. Type 'M/Vd
N NA 9189 1 D T 2 0 Y
b.
C.
d.
15. Special Handling lnslructions and Additional Information
.;_ GSt Work Order No. : 71934
8. GENERATOR'S CERTIFICATION: I hereby declare that Iha conlenls of this conalgnment are fully and accurately described above by proP4r shipping name and are cia ... tled.
packed. marked. and labeled, and are In a11 respect• In proper condition tor tran1port by highway according to appllcabla lnlarnatlonal and national government r90u1at1ona al'ld
trta laws ol Iha State of South Carolina.
HI am a largo quantity generator, I cer1lfy lhal I have a program In place to roducathavolume and toxlcltyofwastagonerated totha dog,_ I have detarmln.ct to b9 .conom6cany
practicable and that I have selected the practicable method ol treatment. storage, or dlspoa.al currently available to ma which minimize• the preMnt en.d lvture 1:1i, .. 1 lo r,un,an
· ! health and lhe environment: OR, 111 am a small Quanlltygeneralor,1 have made a good lailh effort to minimize myw■steoeneratlon and 1elecl Iha be•I wail■ management~
, l:hal is available 10 me and Iha! I can afford.
Printed/Typed Name RO.GERL. COATS Signature
17. Transporter 1 Ac,mowledgemenl of Receipt of Materials
Printed/Typed Name
J)~n1'\\/ ,.J. '])A r'l6 'f'rc:':c/.d
Signature
Ch-w,,IA/ l,)' Uw).A~t[J
18. Transporter 2 Acknowl°edgemenl'ol Receipt of Materials I I I
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator. Certilicallon of receipt ol hazardous materials covered by !his manifesl excepl as noted In llem 19.
Prinled/Typed Name Signature , ..
EPA Form 8700-22 (Rev. 9/86) Previous Editions ore Obsolete (OHEC 1988 (Rev. 10/86))
I IL..J..IL..J..IW
b IL...L..L..L..L..1 I
Month
(l
Monlh
p=. CI
ptn. d I
Momh
Yw
Day Yoar
jib&
I libs.
Day y..,
South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Ha.urdous Waste Mgt
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
E PRINT or TYPE
. UNIFORM HAZARDOUS . WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
ewriter
1. Generator's U.S. EPA ID No.
N C D O 7
, P •. O. Box 1416, Smithfield, NC 27577
,. Generator", Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
1
Emergency & Holiday,: (803)734-542(
Form A roved. 0MB No. 2050-0039 Ex ·res 9.30.ga
ManUeet 2. Page l Document No. ol Information in the shaded Meas is not
required by Federal law, bu! is by State law. 0 0 1 7
~~~~~~{tzm.tj.;6~;i~~tf~-:f
;u;;~0~~ir1I~,~;~t0~\it;::;1~f:~~t2;~1;;~;
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Oescriplion (including Proper Shipping Name, Hazard Cfass, and 10 Number) 12. Containers 13. Total Quantity 1( Uni! : l 1 w&St11Ntwbcir¥,<
No. Type 'MNrJ S{?f:=>:!Jf:f;Ji/{~
L. -· _,Hazardous.Waste, Solid, nos ORM-E
NA 9189 1 D T 2 0 Y
~1t=,o,n~
;;j1f IQ 1Q I 61i
15. Special Handling Instructions and Addilional Information
,;, GSX Work Order No. : 71935
. -··· .... ,...
18. G£NERATOR'S CERTIFICATION: I hereby declare 1hat !he conlents olthls con•lgnmentare rutty and accuratelyde•crlbed above by proper •hipping name and are cleaad\ed,
packed. marked, and 18beled, and are In all ·respecls In proper condition for Ir ans port by highway according to appUcable lntarnatlonat and national govarnmant ra-;ulationa at'>d
Via 1 ...... or oia Stal• ol South Carolina. ·
111 am a large qu,ntiry generalor, I car1lfy lhet I hava a program ln place 10 reduce thevolumoand toxicity of waato generated 10 tho degree I have dolormlnitd to be oconomk:aJty
prac11cab_le and thal I hava selecled the pracllcabte method of treatment, storage, or dlsposal currently a.vallabla to ma which mlnlmtz:es Iha present and lutura lhrMI &o humen
' health and the environment: OR, HI am a small quantitygonoralor,I hove mado a good faith effort to mlnlmh:e mywasiogeneretlon and set act Iha be•I wuta management rne!J'IOd
. , lhat is available 10 ma and that I con afford, -
Printed/Typed Name ROGER L. COATS Signalure
17. Transporter 1 Ac.:1mowledgemenl of Receipt of Materials
Signature
18. Transparter 2 Acknowledgemenl of Receipt ol Materials
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owne, or Operator; Certiricalion of receipt ol hazardous malerials covered by !his manilesl except as noted In llem 19.
Prinled/Typed Name Signature
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 {Rev.10/86)1
Year
Montll Day Year
• .. 1 .L.J._._L..L.Jjlbs. ' .. I .................. libs.
b I jibs. d I jibs.
Montll Day YNI
I South Carolina Department of Health
and Environmental Control
Bureau or Solid & Haurdous Waste Mgt
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
I
l
i
Emergency & Holidays: (603)73-4-542.C
E PRINT or TYPE (Form deslaned for use on elile r12-oilch1 tvr1.ewrilerl Form A .. ,oved. 0MB No. 2050-0039 E.Ioires 9.30.sa
, UNIFORM HAZARDOUS 11, Generalor'sU.S.EPAI0No. ManllHI . j 2. Page 1 Information in the shaded ..-,as is nol
1, /,a 0(\cr_;"l7' 7'0 ·'JI ol 1 required by Federal law, but is by State law. WASTE MANIFEST N• C• D• 0-q, 7, n, 0, , .. 7,
3. Generator's Name and Mailing Address
Channel Master
,P. 0. Box 1416, Smithfield, NC 27577
,.Generator'sPhone( 919 l 934-9711
5. Transporter 1 Company Name
Willms Truckina Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
' GSX Services of SC, Inc.
Route, l Box 255
Pinewood. SC 29125
6. U.S. EPA ID Number
Is, c, D1 o, 7, 3, 71 n. q, ?, a,
8. U.S. EPA 10 Number
I I I I I I I I I I I I
10. U.S. EPA 10 Number
, S, C, D, 0, 7, 0, 1. 7, 5
11. U.S. DOT Oescriplion (including Proper Shipping N~me, Hazard Class, and ID Number} 12. Containers 13. Total quantity 14. Unit =Llwast.=~~
No. Type W'.Nr:J ~(3/:.t•.\;'}-/t:(f~i}~
L
• , ,2 ,0
' ' ' ' ., ' '
15. Special Handling Instructions and Additional lnlormallon
, .. GSX Work Order ·No. : 71936
18. GENERATOR'S CERTIFICATION: I hereby declare thal tho conlonts oflhis con•lgnmenl are fully and accuratelydo•crlbed above by pro~r ahlpplng name end are claaadted.
pack&d. marked.and la'beled,and are In all raspacts In proper condition tor transport byhlghway·accordlng to appllcablo lnlornatlonal and national govommenl r~ulatlona af'd
tr'lo laws of tho Slate ol South Caronna.
111 am a 1■rgo Qu■r'l!!ty generator, I certify Iha! I have a program In place lo reduce Iha volume and loxlclly ofwaaleganaraledlo the do,;,_ I have determined to be oconomlcally
practicable and 1hat I have selected Iha practicable method ol truatmenl, storage, or dlspou.l currently evallablo lo mo which mlnimlz;es th• pre Mn! and luture tr'\r-1 to human
health and tho environment: OR, II I am a amaU Quantity goneralor.l have mado a good talth etlort 10 mlnimtz;e my waste genorelion and sa1ect tho best waste management moihod
tt\At Is available lo me and thal I can atlord.
~~inted/Typed Name RO.Cl.:R L. COATS Signature A'/ (/<._,8.;:,,,.
Month Day Year
1 ~ <?, 1?.Rl I>,7
T 17. Transporter 1 Au,riowledgement or Receipt of Materials {../ A
:. r-P::-r7;n"'ted-',c/:=T-yp-ed-:-:N-;a-m_e _ _,,_ /)-:-----'--------,-::;Si:-.~-,,::------~---J //'1-----------------,-M;-o-n""1n--::O:-a-y-c;Year--l
,·,· . _,,...--/,//4 #.~/_.,,, \ l~-. ,// /f") --;f/, l '-' .,..,,.o 10,~R','1
o 18. Transparter 2 Acknowledgement of Roc'eipl ol Materials · // ' U R!-"--'--==::..::.===========--'---~-"'----------'--=-------------------l T Printed/Typed Name Signalure Monti\ Day Year
-I , I , I ,
19. Discrepancy Indication Space
I~ L
I lw..Jw..JU-i!lbl. C .... I .................... llbl.
bl pt,,. di pt>s.
11---------------
t
~ 20. Facility Owner or Operator: Certification ol recelpt of hazardous malerlals covered by this manilesl excopl as noted in l!em 19.
Prinled/Typed Name Signature Month Oay Year
I , I , I •
EPA Form 8700-22 (Rev. 9/86) Previous Ed1t1ons are Obsolete [DHEC 1988 (Rev. 10/86)]
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Street, Columbia. SC 29201
Phone: [phone]
E PRINT or lYPE
UNIFORM HAZARDOUS
WASTE MANIFEST
l Generator's Name and Mailing Address
Channel Master
ewriler
1. Generator's U.S. EPA 10 No.
N C D O 7
.P._O. Box 1416, Smithfield, NC 27577
4. Generalor's Phone [phone]
5. Transporter 1 Company Name 6. U.S. EPA ID Number
Willms Truckin Co Inc.
7. Transporter 2 Company Name
M111nlfuel
Oocumont No. 0 1 7 3
Emergency & Holidays: (803)734-5-124
Form A roved. 0MB No. 2050-0039 Expires 9-30-88
2. Page l Information in the shaded a<eas is not
ol required by Federal law, but is by State law.
:~l:t;~;::~;:~~:'...:btit%i'~i'.~Ii'
~-~;;~;;y?;;~t:J:):~i;::~·::;:·:i;,'·;:~')/~\ft~~i~i!!~~:-
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
L ·'Hazardous Waste, Solid,-nos ORM-E.
N 'NA 9189
b.
C.
d.
15. Special Handling Instructions and Additional Information
1:,_GSX Work Order No.: 71937
,.i ·~,
12. Containers 13. Total Quantity U. Un~ L Wasta tbtJbeir:: .... ;.,
No. Type 'MNd :/(\:::("-';}t;\~}'~'}fj
1 D T 2 0 Y
15. GENERATOR'S CERTIFICATION: I hereby dec1arethal Iha contents olthls conslgnmentare lullyand accurately described abov• by proper shipping name and a,e cla-fle<S.
p.cked. marked. and 111.beled,and are in all respecls In proper condition for transport by highway according 10 app11ca.bla lnlarn11lion11I and nat1on11I governm•nl re-gulatlons al'ld
trie laws ot the SIJl.le ol Soulh Caroline.
111 am a large qu■nliry generator, I cer1lty that I have a program In place to reduce tho valumeand 1oxlcltyolwHtegenerated lo the degree I have determined to be economleally
practicable and that I have selected 1he prac1icabla method of lreelmant. storage, or dlspoaal currently avallable to ma which mlnlmlua the preMnt and tuture thrut to tluman
tleallh and the environment: OR, 111 am a smn11 quantity generator, I have mado a good falth effort to minimize my waste generation and ,elect tha best wuta management m-etnod
that is available 10 me and lh11t I can allord.
Printed/Typed Name RO.CER L COATS
17. Transporter 1 Ac.:Kno~l~gement ol Receipt ol Materials
18. Transporter 2 Acknowledgement of Receipt of Materials
Prinled/Typ_ed Name
19. Discrepancy lndication Space
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19.
Prinltd/Typtd Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions ore Obsolet_e [DHEC 1988 (Rev. 10/86)]
11 ~ ............ , ... ·, _._.Pto. 'c ,_l .............. ~l1trs.
b I I I libs. d I l1bs.
Month Day YNI
I .
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wute Mgt
2600 Bull Street. Columbia. SC 29201
Phone: [phone]
. UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
. . WASTE MANIFEST N c D O 7 o I
1 Generator's Name and Mailing Address
Channel Master
P. O. Box 1416,
.C. Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
CSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
NC 27577
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Crass. and JO Number)
L, 1.,-• Hazardous Waste, Solid, nos ORM-:E ' NA 9189
15. Special Handling Instructions and Additional Information
;'·,CSX Work Order No. : 71938
Form A
2. Page 1
ol
Emergency & Holidays: (803)734-5,424
roved. 0MB No. 2050-0039 Ex 'res 9-30-88
lnformalion in the shaded a,eas is not
required by Federal law, but is by State law.
~1~~~i:~{~_~{'.:.7:HJ~l!~~t~:r
il~~i11/.lt~;f %f:~t tIJff;}~~t~li~~~
12. Containers 13. Total Quantity 14. una =:L':Watll~::+
No. Type · 'MNd %\:i~f(>~f:f~.:j~i?;~
l D T 2 0 Y
,e. GENERATOR'S CERTIFICATION: I hereby declare lhet Iha contents olthl:i conalgnmantara lully and accuratelyde■crlbod above by proper ■hipping name and ara ct••.,ned,
packed, marked, and la.baled, and are in all respect:i In proper condition for transport by highway according to applicable lntornallonal and national government ra,gulat1on1 af\d
ttoe law1 ot 1ru1 SU!te of Soutt'I t;arolino,
tfl am a large quantity generator, t certify that I have a program In ptaco to reduce the volume end 1oxlcltyol wHte generatod lo tho dogrM I have datormlnod to be oconomk:ally
practicable and that I have 1a1acted the practlcabte fflethod of trealment. storage, or dl1poaal currently avaUable to ma which mlnlmlr.as Iha praNnl and hJtura thrul to P'tuman
haallh and the environment OR, 111 am a small quantltygonorator,I have mado a good foilh effort to ri,lnimlza my was\o ganorallon and HI act tho boat wuta managamanl rT>elt'ood
lhal 11 available 10 mo and thtlt I can allord .
.,, Printed/Typed Name RO.CER L. COATS Signature· Month Day Yw
17. Transporter 1 Ac.:Knowledgemenl of Receipt of Materials
Print /Typed Name Day Yoat
/" -f /l (.) A.-t ·J. F.7
18. Transporter 2 Acknowledgement of Receipt ol Materials
Printed/Typed Name Signature Month Day Yoat
19. Discrepancy Indication Space
a I Jlbl. e I Jibs.
b I jibs. d I jlbo.
20. Facility Owner or Qperalor; Certilica!lon of receipl ol hazardous materials covered by !his manifesl except as noted In Item 19.
Prinled/Typed Name Signature Month Day y..,
EPA Form 8700-22 (Rev. 9/86) Previous Editions nre Obsolete (DHEC 1_988 (Rev. 10/86))
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haz.ardous Wute Mgt.
2600 Bult Street, Columbia. SC 29201
Phone: (803)73"-5200
E PRINT or TYPE (Form desi
UNIFORM HAZARDOUS
WASTE MANIFEST
l Gtnerator's Name and Mailing Address
Channel Master
.,P. 0. Box 1416, Smithfield, NC 27577
•· Generato(s Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Oesctlplion (including Proper Shipping Name, Hazard Cfass, snd fD Number)
a. Hazardous Waste, Solid, nos ORM-E
N NA 9189
b.
:1·.·,.
C.
d.
'/?
15. Special Handling Instructions and Additional lnlormalion
.GSX Work Order No.: 71939
Form A
2. Page 1
ol
Emergency & Holidays: (803)73-C-5"'24
roved. 0MB No. 2050-0039 E.ipires 9-30-SS
Information in the shaded a<eas is n01
required by Federal law, bul is by State law.
;1■~t10?~;~~trit;}t:tifrJ~;~:r~tJ&:i.~;i ... ;: .. , ·.,., .. , .... ·a·o fi<:\1=:,::,.t=:-.. ):-t:,i-~'.,:ftt\:-.::~1~
12. Containers 13. Total Quantity ,~. Un~ =.'L'. w&Stll ~'~;
No. Type 'MNd. \\'.\~/:~:;.:,.•}j:(f,(.~\)f~
l D T
16. GENERATOR'S CERTIFICATION: I hereby declare th•t the con1ents of this con•'9nm•nl ar• fully and accuratalyd••crlbocl ■bov• by proper •hipping n ■m• and are c1a ... fl<ec1.
packed. marked, and laheled,and are In all respacla In proper condition !or transport by highway according to appUcable lntarn■ tlonal and national goV•rnmenl re,gulaUon• al'ld
u,• la .... s ct th• State of South Caroline.
111 am a large qu111r1llty generator, I certify that I havaa program In place 10 reduce Iha volume and loxlcltyofwaste generated lo the degree I hav• datarmlno,d 10 be oconom.caJfy
practicable and that I have :selected lhe practicable method of treatment. storage, or dlspoaal currently available to ma which mlnlmlr.es the pres.ant and future U'lreat to human
health and the environment; OR, 111 am a small quantity generator. I have made a good feilh enortto minimize my wasteoanaration and salact th• boat wa1ta managam•nl ,,...thod
th■! i1 available 10 ma and that I can allord.
Printed/Typed Name RQ,CER L COAr!i
r 1 At.:1mowledgement ol Receipt of Materials
ped Name "?a,/ c:f /6 7J'JJ/p-
Prinled/Typed Name
19 .. Discrepancy Indication Space
Signature
Signature
Signature
., ....... ._._ .......
b)L...WL...WW
20. Facility Owner or Operator; Certification of receipl ol hazardous materials covered by this manifest except as noted In llem 19.
Printed/Typed Name Signature
EPA Form 8700•22 (Rev. 9/86) Previous Editions are O~solete (DHi::c 1988 (Rev. 10/86))
Month
(J
Month Day Year
Month Day Year
Jibs. C I )lbs.
)lbs. d I )lbs.
Month Day Year
I South Carolina Departm_ent of Health
and Environmental Control
Buroau ol Solid & Ha.z.ardous Waste M¢
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
E PAINT or TYPE (Form desl ned for use on e11te 12-itch ewriler
UNIFORM HAZARDOUS 1: Generator's U.S. EPAID No.
WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
._P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, I Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
..
Form A
2. Page 1
of
Emergency & Holidays.: [phone]
roved. 0MB No. 2050-0009 E., ·res 9-30-M
Information in the shaded a<eas is not
required by Federal law. bu! is by State law.
12. Containers 13. Total Quantity 14.Unit =liWalatunbiiit:f:
No. Type WI/VrJ (~tf;;.'::~;}\t:i·/};~
Hazardous Waste, Solid, nos ORM-E
N NA 9189 I D T 2 0 Y
b.
C.
:· r·
d.
15. Special Handling Instructions and Additional Information
,, GSX Work Order No. : 71940
11. GENERATOR'S CERTIFICATION: I hereby declare that !ho conlenls ol lhls conalgnmont are lullyand accuratelydeacrlbod above by proper shipping name and are cla..,ned.
pa.eked. marked, and 18beled,and are In all respecls In proper condition tor transportbyhlghway according to appllcabla lntarnatlonal and national govarnman1 ritgulatlOl"I• and
tr,a laws cl tho Slate ot South Carolina.
It I am a largo c:iuanlity generalor, I certify that I have a program In place to roducathavoluma and toxlcltyofwaaleganaraled totha dog,_ I have determined 10 be oconoro,QJty
practicable and lhal I have selected.the practicable malhod ol treatment, storage, or dlspoaal currenlly available lo ma which mlnlmlzH tho proaont and future thrMI io 1'1umat\
heetth and ttle environment: OR, 111 am a smoll quontltygenerator, I have meda a good faith ol1or1 to minimize my waste generation and select the baal waata mat\agemenl method
!{ thal is available to ma and ttial I can al1ord,
Printed/Typed Name
~!:,. ROGER(: COATS
17. Transporter 1 At.:1<nowledgemenl of Receipl of Materials
. Printed/Typed Name
I• ~v-~-~ ~
18. Transporter 2 Acknowledgement of Receipt of Materials
Printe<J/Type<J Name
19. Discrepancy lndicalion Space
Signatur~
Signature
20. Facility Owner or Operator. Certilicalion ol receipt or hazardous malerials covered by !his manifest except as noted In Item 19.
Prinle<I/Typed Name Slgnalure
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
Monlh Day Yw
t)
Monlh Day Year
I I pbs. C I litzs.
b I pbs. d I pbs.
Monlh Day y..,
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Street, Columbia, SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7 o
l Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
,. Generator's Phone 919
Smithfield,
934-9711
NC 27577
1
Form A
2. Page 1
ol
Emergency & Holiday,.: (803)734•5'24
roved. 0MB No. 2050·0039 Ex ·res 9.30.ga
lnformallon in !he shaded areas is not required by Federal law, but is by State law.
~2~~;:~ttt:t:'.IttiH}K~~>:.,
1~1i~~~%~Wt;i¥?W-~~I~~li~f(fif:~{I;;l;
5. Transporter 1 Company Name
Willms Truckin Co Inc. -~.-:,·f
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address 10. ~J.S. EPA ID Number
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125 SC DO 7 0
11. U.S. DOT Description (includi~g Proper Shipping Name, Hazard Class. and ID Number)
Hazardous Waste, Solid, nos ORM-E
NA 9189
~~Elt1ttt:fu}~it~li1tJllllltltl\C:'"'
L 1!'..M.1-lo 12171714!-!1i110,2!~1,1::i;li1l\l11c.LLJ-I
b.LLJ:1. 1-1 J~;!!!i!ii!ii!!lit~W:J
15. Special Handling Instructions and Additional lnlormalion
-~SX Work Order No.: 71941
12. Containers
No. Type
1 D T
:•.:/~.~;,b7:,/ •:··;"j.
· t~iief~~,-:: ·,~,;,.:. ~:~: ,:::-.. ,':..,.-i"4i~~-''i:<·r..=-~~;
13. Tola! Ouantily 14. Unrt
WW~
2 0 y
is. O!N!RATOR'S CERTIFICATION: I hereby docl•ro lh•I !ho contonls olthla con•lgnmonl aro fully end eccur•l411ydo•crlbed •bovo by prop,sr ■hipping n•m• ond •r• claa .. fled,
packed. m•rkod. and ta."beled,end a.re In all respects In proper condl!lon lorlransport by highway according toappUcable lntom■Uonel and national go.,,ornmont rogulatlon• and
tho laws ol the State ot South Carolina. ·
II I am a large quantity generalor, I certify that I have a program In place to reduce the volume and loKlcltyofwastaganeraled to 1h11 degree I have determined lo be economic.ally.
practicable and that I h11Ye selected !he preclicable melhod ol trealmonl. slorage, or disposal currently available to mo which mtnlmlzaa tho pre Mn! and lutura tnrNI to hum,in
health and lhe en.,,ironment:OR. II I am a small quantity generator, I have mado • good lailh effort to_mtnimlze my waste generation and select !ho be,t wa,10 managomonl metnod
that is &Yailable lo me arid lhal I can afford.
Printed/Typed Name Slgnalure
Prinled/Typed Name Signature
19. Discrepancy Indication Space
~ Year
Month Day Y oar
• ... I .................. l'bs. c 1 ................ _,11bs.
b I !lbs. d I l'bs.
20. Facility Owner or Operator; Certilicalion of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Oay YNI
PA Form 8700•22 (Rev. 9/86) Previ_ous E~itions are Obsolele [DHEC 1988 (Rev. 10/86)}
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haurdous Wule Mgt.
2600 Bull Stt~~ Columbia, SC 29201
Phone: (80J) 73-4-5100
Emergency & Holidays: (803)73"-5-42'
E PRINT or TYPE (Form desi ned lor use on ellle 12· ilch ewriter Form A roved. 0MB No, 2050-0039 E.i ires 9.30.a3
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N C D O 0 1
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
6. U.S. EPA ID Number
S C D O 7
8. U.S. EPA ID Number
M11nlroa1 2. Page 1
Oocumenl No. ol rnrormallon in the shaded Meas is n01
required by Federal law, but is by State law. 0 0 1 7 8 ~~;~=;:~,':;.:: :·t:~;::;~~:!(it:,(~:.\·:•:~~:·
'.ll&J~,0~~i1~11:::f IJ'.t{i}~/~(;::~1/~Jt~;:::!tt/;
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
Hazardous Waste, Solid, nos ORH-E
NA 9189
ti~~r=::::::;;:~-~:~i+; i)I:·;::::: ::)?:JiI:/t:: : << j: .
a. lf....1l:1.J-IO 12 17 17 14 I-I l 111 O 1 2 lii'v,v:,wn c.LL.J-~I-~~~
b. Li_j-I 1 1 1 , 1-1 1 , 1 d!~(~~!!;i;,~~~it~-LL.J-I 1 1-1
1 S. Special Handling Instructions and Additional Information
GSX Work Order No.: 71942
12. Containers 13. Total Ouaiitity 14. Unit L<W&1t1l~''~f·
No. Type 'MN~ :'.{\:,~r,:,:-'·}:':;}/}/i'.{t
1 D T 2 0 Y
'.f iF j ci'rl ji,C,'~
::j1F ,a ,a, 51~·
18. OENEAATOA'S CEATI_FICATION: I hereby deelero that tho eontonts oltr,ls conalgnmentara lully and accuratolydoscrlbod above by proper •hipping name and are cla..,tla<S.
paclo.ed, marlo.e-d, and labeled, and are In all respecla In proper condiUon for transpor1 by highway according to appllcable lntarnatlonal and nallonat government r09ulat1oni al'\d
U'le law1 cl Iha SUiia ol Soult! Carolina.
111 am a large quan11ry generalor, I certify th11l I havo a program In place to reduce u,avolume and to,:lcltyol waste ganaralod to the da,gr-1 have determlna-d to be economic.ally
practicable and th al I have selecled the practicable method ol lreatment. sloraga. or disposal currently avol1ablo to me which mlnlmlz.os the present and lut'I.Jra thrNI to hum.al'!
heallh end lhe environment; OR, II I am II small quontirygonorotor, I hove mado a good laith eNor1 to mini mite my waste generation and select tho be•t wa•ta management mo(N)d
thol is available to me and lhnl I con ollord.
Printed/Typed Name RO.C£RC COATS Signature
ement of Receipt ol Materials
·Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operalor; Certification of receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Prinled/Typed Name Signature
cPA Ferm 8700-22 (Rev. 9/86) Previous Editions nro Obsoloto {DHEC 1988 (Rev. 10/86))
a L-1 .L..L...L..L..I.
b .... l ~ ..........
Month
t)
Montn
Month
pbs. C I
pbs. d I
Month
Year
Day Year
Day Year
!lbs.
jibs.
Day Year
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haz.ardou.s Wa.sle Mgt.
2600 Boll Street, Columbia, SC 29201
Phone: (803) 7>4-5200
E PRIHT or TYPE (Form desi ned for use on elite 12-itch ewriter
UNIFORM HAZARDOUS 1. Generator"sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7 o
1 Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
(. Generator"sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co
7. Transp0rter 2 Company Name
Inc.
9. Oesignaled Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
Emergency & Holidays.: {803)734-5-42,
Form A roved. OMS No. 2050-00J9 Expire., 9.30.ga.
2. Page 1 lnlormstion in the .shaded a<eas is n01
of required by Federal law, but is by State law.
'FX·f··,~··A· .,,.~-,-" -~ ~Y/0-.;•::.-. -_,.;,:-,.,:~ /, ~~-/~~~;t,,:,r..= ;~:
i~~,~i~ti~'.i'.~J'.It=(~]i~/1;k.t:0\~ji~ilit,tt::
12. Containers 13. Total Quantify U. Uni! l'Wa3latMtlb«\":'·
No. Type 'M.Nd i:·\'->i: :·:.:-,~?}~)·~<~i
a. Hazardous Waste, Solid, nos ORM-E ~pF'j·o,J'","g",';i
d.
1· t1,~r:ttttt"~~,i~wk~itr~1tl!fr\ij!li1ili!!:1
:'""'
a. lDli.]-10 ,2 ,7 ,7,41-11, 1,0, 21,wuyy:,}c.L.i_J-
b. LL.J-1 1-1 ... 11~1n1'!!iif!t~ b+,,,tJ
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71943
,e. CENERATOR'S CERTIFICATION: I hereby declare !hat tho conlonls of this consignment are fully and accurately described above by proper shipping name and Are clas .. tled.
packed. marked. and labeled.and are In n11 respects In proporcondillon lor transport by highway according to applicable lnterna1lonal and national government re,guLation, at\CI
U'le laws ol tr•• Sla1o ol Soulh C.::arollna.
If I am a largo ciuanury generolor, I cor11ty !hat I have a program In place 10 roduco tho volume and 1oxlcltyofwas1egoneralod to the dog,_ I have determlne<:110 be ecOt'Omte.Ally
practicatile and that t have aolocted tho practicable method ol troatment. storage, or dlapoaal curronlly available lo mo which mlnlml:r.a, tha present and lutur• ltlr-1 to human
heallh and the environment; OR. II I am a smoll Quantity gonerator, I have mado a good laith offor1 lo mtnlmtzo my waste gonorallon and aelecl tho baa! w11te man•;•rn•nl me~
trial is availat>le to mo and lhel I con ollord.
Printed/Typed Name
RO.GERL. COATS
Signalure Month y..,
17. Transporter 1 Ar.:.Knowle-dgemenl ol Receipt ol Materials a o~
18. Transporter 2 Acknowledgemenl ol Receipl ol Malerials
Printed/Typed Name Signature Month Day Year
, 9. Discrepancy Indication Space
'I p1io. ' I l'bo.
bl jibs. d I l'bo.
20. Facility Owner or Operator; Certificalion of receipt ol hazardous materials covered by this manilest except as noled In llem 19.
Prinled/Typed Name Slgnalure Montt\ Day YNI
PA Form 8700-22 (Rev. 9/86) Previous Edllions nrc Obsoloto (DHEC 1988 (Rev. 10/86))
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SOUTHERN TESTING AND RESEARCH LABORATORIES, INC.
P.O. BOX 1849 -607 PARK. AVE. -WILSON, N.C. 27893
PHONE [phone]
ANALYSIS REPORT
SAMPLE NO.: 388A1
RECEIVED FROM
DATE OF REPORT: 87/08/20
DATE RECEIVED: 87/08/10
CHANNEL MASTER
BOX 1416
SMITHFIELD, N. C. 27577
: ATTN: MR. ROGER COATS
ACCOUNT NO.: 12600
CLIENT SAMPLE DESIGNATIONS
A:· FILTRATE SAMPLE -OXFORD PLANT
C:
A: 3.88A1 B:
pH :
TOTAL RESIDUE (mg/Ll :
TOTAL VOLATILE RESIDUE (mg/Ll :
TOTAL NONFILTERABLE RESIDUE (mg/Ll: 14
TOTAL DISSOLVED RESIDUE (mg/Ll : 984
BOD (mg/Ll : 38
COD (mg/Ll : 104
AMMONIA AS N (mg/Ll
TOTAL K.JELDAHL NITROGEN (mg/Ll
NITRATE AS N (mg/Ll
TOTAL PHOSHF'ATE AS P lmg/Ll : .52
CHLORIDE AS Cl (mq/Ll :
OIL• GREASE (mg/Ll : 12
FECAL COLIFORM U 100 ml l
TOTAL COLIFORM (CFC/100 mll :
TOTAL HARDNESS (mg/Ll :
TOTAL ALKALINITY (mq/Ll :
TOTAL CYANIDE (mq/Ll : .CJ7
ARSENIC (mq/Ll. <.1
SELENIUM (mg/Ll : <. 1
CADMIUM (mg/Ll ,(.02
CHROMIUM (mg/Ll 7= • CJ
COPPER (mg /Ll .. 45
LEAD (mg/Ll : • c!,6
NICKEL (mg/Ll : 4.8
ZINC (mg/Ll .. 13
MERCURY ( mg /L l : <' .., ., • ,l..
HEXAVALENT CHROMIUM lmg/Ll <.. 05
SILVER (mg /L l <.05
BARIUM (mrJ/Ll <. 1
BORON lmg/Ll
. <. • 1 .
MANGANESE (mg/Ll : <. .. 05
: PHENOL lug/Ll : <. 5
TOTAL ORGANIC CARBON (mg/Ll : 4
:
* (ug/Ll
·ll-
:
:
:
:
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c: D:
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SOUTHERN TESTING AND RESEARCH LABORATORIES, INC .
P.O. BOX 1849 -607 PARK AVE. -WILSON, N.C. 27893
PHONE [phone]
ANALYSIS REPORT ------------------.
SAMPLE NO.: 448A1
RECEIVED FROM
DATE OF REPORT: 87/08/20
DATE RECEIVED: 87/08/17
CHANNEL MASTER
BOX 1416
SMITHFIELD, N. C. 27577
: ATTN: HOGER COATS
ACCOUNT NO.: 12600
CLIENT SAMPLE DESIGNATIONS
A: FILTRATE SAMPLE
c:
pH
TOTAL RESIDUE (mg/LI
TOTAL VOLATILE RESIDUE (mg /LI
B:
D:
A: 448A1 B: C: D: -----------------------------
: : : :
: :
TOTAL NONFILTERABLE RESIDUE (mg/LI:
TOTAL DISSOLVED RESU)UE lmg/LI : : : :
BOD lmg/L I
COD l mg/LI
AMMONIA AS N lmg/LI :
TOTAL KJELDAHL NITROGEN lmg/L)
NITRATE AS N (mg/LI :
TOTAL PHOSHPATE AS p (mg /Ll : :
CHLORIDE. AS Cl (mg/LI
OIL ~ GREASE C mg /L) :
FECAL COLIFORM (/100 ml) :
TOTAL COLIFORM CCFC/100 ml) : :
TOTAL HARDNESS (mg/LI :
TOTAL AU(ALINJ.TY (mg/LI
TOTAL CYANIDE (mg/Ll
ARSENIC lmg /LI :
SELENIUM tmg/LI
CADMIUM (mg /LI
CHROMIUM ( mg /Ll :
COPPER (mg/LI : .28
LEAD lmg/Ll : :
NICKEL (mg/LI : : :
ZINC (mg/LI
MERCURY (mg /LI
: :
: :
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:
: : : :
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SOUTHERN TESTING AND RESEARCH U-)BORATORIES, INC.
CONSULTING ANALYTICAL CHEMISTS
P.O. BOX 1849 -607 PARK AVE. -WILSON, N.C. 27893
PHONE [phone]
WATER ANALYSIS REPORT
ANALYSIS NO.: 298Al
RECEIVED FROM
DATE OF REPORT: 87/08/18
DATE RECEIVED : 87 /07 t:,o
CHANNEL MASTER
P.O. BOX 1416
SMITHFIELD, NC 27577
: ATTN: · ROGER COATS
ACCOUNT NO.: 12600
MARKED
A:
c:
B:
D:
A: 298Al B: c:· D:
--------------- --------------
pH : :
.TOTAL. RESIDUE lmg/U :
TOTAL VOLATILE RESIDUE lmg/U :
TOTAL NONFILTERABL.E RESIDUE lmg/Ll:
TOTAL DISSOLVED RESIDUE (mg/LI
BOD (mg/LI : 51
COD lmg/Ll
. AMMONIA AS N (mg/U
TOTAL. KJELDAHL NITROGEN (mg/LI :
NITRATE AS N (mg/LI
TOTAL PHOSHPATE ASP (mg/LI
CHLOR.IDE AS Cl (mg/U
OIL &. GREASE 1mg /U
FECAL COLIFORM 1/100 ml)
TOTAL COLlFOF:M ICFC/100 ml l
TOTAL HARDNESS lmg/U
TOTAL ALKALINITY lmg/U
TOTAL CYANIDE lmg/LI
ARSENIC lmg/LI
SELENIUM (mg/LI
CADMIUM lmg/Ll
CHROMIUM (mg/LI
COPPER lmg/Ll
LEAD lmg/LI
NICKEL lmg/L)
ZINC lmg/LI
MERCURY I mg/ LI
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I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Wa,te Mgt
2600 Bull St,ee~ Columbia, SC 29201
Phone: [phone]
Emerg~ncy & Holidays: [phone]
I PLEASE PRINT or TYPE (Form desi ned for use on elite 12-ilch writer
UNIFORM HAZARDOUS 1. Generetor's U.S. EPA ID No.
Form A
Manileat 2. Page 1 Document No. ol
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded a<eas is not
required by Federal law, but is by State law.
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WASTE MANIFEST N c D o 7 o 1400039
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. GeneratofsPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
d.
15. Special Handling lnstructio~s and Additional Information
GSX Work Order No.: 71343
;~('.:=l~i:~i~'.:;:\l[:~(t~l9:~iif}i
-~J;f1~~~1/J~tl~~;6flJ}!t~::~{:~¥~~I~41f-!~:~%4
12. Containers
No. Type
13. Total Quai,tity 1~. Uni! {q~i#~.Jti
wvvrJ. ?ttW.iW?.!1<5$}\'}J:f
16. GENERATOR'S CERTIFICATION: I herebydee1are that the contents of this consignment are lullyand accurately described above by proper shipping name and are clas.Mfled,
packed, mark CK!, and 18beled,and are In all respects in proper condition !or transport by highway according to appUcable lntarnatlonal and natlonat government r9oQulaUona and
the laws of the State ol South Carollna.
111 am a large Quanlity generator, I certify that\ have a program In piece to reduce the volume and 10,dcltyol waategenereted to the deg,_ I ha~ determined lo be, economlcalty
practicable and the I l have selected Iha practicable method ol treelment, storage, or dlapoaal currenl1y avallable lo me which minimizes the present and luture thrNt lO human
health and the environment;OA, II I am a small quantity generator, I have made a good faith effort to minimize my waste genarelion end select the beat wa11a management method
that la available to me and that I can afford.
F a .._l ............ .....,jibs. c l !lbl
I ~~ bl '-· ._._.._.__._,Jibs. d J Jibs.
11-----------.....:.---~ 20. ,1clll Owner or Optrator: Ctrtlllc1llon or receipt or huardouI ma1erlalI cover~ by 1h11 mantfe11 except 11 noted In ttem 19. I Printed/Typed Name Signatu,e
EPA Form 8700-22 (Rev. 9186) Previous Editions are Obsolete [DHEC 1988 (Rev. 10186)]
Month Day YNJ
STATE OF SOUTH CAR.~i.1NA·1iisi~t{~;~~·~<it~~;i:~';"~6RM HAZARDOUS WASTE MANIFEST . J
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ·\ fLL COPIES MUST BE LEGIBL . ,
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage. or disposal hcll1t1es to use the US. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)) and, 1f necessary, the continuat1on sheet US EPA For
8700-22A Rev 9/86 (OHEC 1988A) for both inter-state and mtra-state transportation. Transporters who transport hazardous waste into the United States Ira
another country are responsible for·completing the manifesl Federal and State regulalions also require generators and transporters of hazardous waste and
owners or operator~ ·or haza.rdous waste treatment. storage, or disposal facilities to complete the fol!owin·g information. I Generator's U.S. EPA 10 Number. Manifest Document Number: Enter the generalor's U.S. EPA twelve digit identification number and the unique five dig,t
GENERATOR SECTION ,.
number assigned to this manirest by the generator beginning with 00001. If your company does not have a U.S. EPA ld.entilication Number. please contact S.C.
OHEC at [phone] about obtaining an ldentilication number. • I
1-•• 2:. Page 1 of: Enter the total number of pages used to complete this manifest, i.e .• the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] plus t
~,.. ... · number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
J I
A. Slate Manifest Oocume.nt Numbei-: .. Leave blank. · ·
B:
3.
4.
5.
6.
, C.
0.
Slate Generator Identification Number: Leave blank. · · · 'J
Generator's Name and Maillng Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
Generator's Phorie Number: . Enter a telephone number with are~ code where an aulhorized agent ot the generator can be reached in the event ol
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of !he lirst transporter identified in item 5.
Slate Transporter's ID Number: Leave blank. I
Transporter's Phone Number: Enter a teteph0ne number including area code where an authorized agent of the lirst transporter can be reached in the event of
an emergency including nights, weekends, and holidays. ·
7:. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. ti more than 2 transporters WI
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and_ lisl the transporters in the order they will be transoorting the was•
U.S. EPA ID Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. 8 ..
I
E ..
F ..
9 ..
10:
G:.
H;.
11:
12..
Slate Transporter's 10 Number: Leave blank. · · · .
Transporter's Pho~e Number: Enter a telephone number including area code .w~ere an authofized agent of the second transporter can be reached in 'I
event of an emergency including nights, weekends, and-holidays. ·
Oeslgnaled Facility Name and Sile Address: Enler the company name and site address ol the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be !he sile address, which may di!fer from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment. storage. or disposal lacility identified in item 9. I
Slate Facility's ID Number: Leave blank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends. and holidays.
U.S: DOT Descriptions: Enter Rropershipping name, hazard class and ID Number(UN/NA) lor each waste as identiried in 49 CFR 171-177.11 additional spal
is needed. use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
Containers (no. and type): Enter number or containers for each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I
· OM = Metal drums, barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons. cases. roll otts I
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Ouantily: Enter total quantity of waste described on each line, rel8tive to the units used in Hem 14. I
14. Unit {weighl/vorume): Enter !he appropriate abbreviations from Table II (below) for the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61 • 79.261 Subparts C and DI
identify the hazardous waste on each line.
-J:-· Additional Descriptions lor Materials LI sled Above: In the spaces provided, enter the authorization number (from the S.C. OHEC Authorization Request For
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted lor treatment. storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment. storage or disposal facility.
K. Handling Codes lor Wastes Listed Above: Leave blank. I
15. Special Handling Instructions and Addilional Information: Generators may use this space to indicate special transportation. treatment. storage or dispos
information or Bill of Lading Information. For international shipments, generators must enfer in this space the point of departure (city and s:ate) tor those
shipments destined !or lreatment. storage. or disposal outside the jurisdiction ol the United States.
16. Generator Certilicalion: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. If a mode other than highway is used.11
word "highway" should be lined out a~d lhe appropriate mode(rail. water.or air) inserted in the sPace below. II another mode in addition to the highway mode
used, enter the appropriate additional mode (e.g .. and_ rail) in the space below.
TRANSPORTER SECTION
17: Transporter l Acknowledgement: Enter the name al the person accepting th_e waste on behall ol the first transporter, That person mus! ac~nowledl
acceptance of the waste described on lhe manifest by signing (BY HANO IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgement: Enter. ii applicable, the name ol lhe person accepting the waste on behalf or the second transporter. That person must
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized represenlalive of the designated lacility'S owner or operator must note in this space any discrepancy bet we
the waste described on the manifest and the waste actually received at the facility. Owners and operators ol facilities who cannot resolve signilicant
discrepancies within 15 doya receiving lhe waste muat submit lo the Department a ·1et1er with"a copy of the manifest describing the discrepancy and anempts to
reconcile il The treatment,'storage, or dlsposal facility muat enter the aclual weight of waste in pounds in the spaces provid. ed if the amount varies any tram th.'
apecllied by lhe generator in llem 13 or II the generator uses a unit ol measure other than pounds.
20. Facility Owner or Operator Certification: Print or type the name ol the person accepting the waste on behalf of the owner or operator of the facility. That perso .
must acknowledge acceptance ol tho waste described on lhe manilesl by su::.NINQ (DY HANO IN INK) and entering the DATE al receipt.
IF ASSISTANCE 19 NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY OESIGNATEO Tl
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (803) 73•-~WO WEEKOAYS FROM 8:00 am TO 5:00 pm.
-.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Bull Street Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
I Pl.USE PRINT or TYPE (Form desi ned for use on elite 12· itch writer
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1
of Information in the shaded areas is nol
required by Federal law, but is by State law.
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WASTE MANIFEST N c D o 7 6 o
3. Generato(s Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
10. U.S. EPA 10 Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
d.
~~~~
,, .••. -,.••,•,❖ .::~:-:,,•,n <» .n· ., .,., .. Y ..
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71344
16. CENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are lully and accurately described above by proper shipping name and are clu.ained.
packed. marked. and 18beled, and are in all respects In proper condition for transport by highway according to applicable lntamalional end national govarnmen1 regulatlons arid
tr,a laws ol the State <;>f South Carolina.
111 am a large quantity generalor, I certify Iha! I have a program In place to raducethavo1umeand toxicity ofwastage_mmr.tad to the dagr&a I have determined to be economically
practicable and that I have selected Iha practicable melhod ol treatment. storage, or disposal currently available to ma which minimizes the preMnl and luture thrNt to human
health and the environment: OR, lfl am a small quantltygoneralor, I have made a good faith effort to mlnlmtz.a mywastegeneraUon and select the be11 wute management method
that is available to me and Iha! I can afford.
I k--1-..,...,Pr-int_ed_lT-yp_ed_N_am_• _t,12::;:,~-'a.• _:::er~:::,l:;·~C,;:::,~c:i;:::;:f:5~...1....,,.....,.L~l&:Jt...~_,:~::::=::-:...!C:..!'~,tv6~~✓ ;._ ____ .l.5[EL"?.fi.J£'.
~ 17. Transporter 1 Ac.:Knowledgement ol Receipt of Materials
Month Day Year
o.~ z. 7
I j Prinled/Typed Name Monlh Day Year
~ 1-'c.:8:.. :::Tc.:ra:.n:.spo:.::.rt=•:.r :.2::A::ck:::n=o:::w:.l•=d:,9•::m:.•::n:.t::.o:.I Rcc•::c=e::.iP::.lo::fc:M::a::le::r::ia:::ls:.· ___ ,-J,.. __ _,~--------------'---------------1 f-i-+--P-rin_l_ed_l_T_y_ped_N_a_m_e ______________ _., _________________________ _,_._.._..__.._.
19. Discrepancy Indication Space
Month Day Year
• I jibs. C I libs.
b I jibs. d I jibs.
F .~ I ,_ _____________ _
~ 20. Facltlty Owner er Operator: Certlflcatlon ol receipt ol hazardous materlal1 covered by.this manifest except as noted In Item 19.
Month Day Year I Printed/Typed Name . Signature . .
EPA Form 8700-22 (Rev. 9186) Previous Editions are Obsolete [DHEC 1988 (Rev. 10186))
IMPORTANT:
. l'l~~• ... rf:\·~\t...,~ft:t .... ~,.~il
STATE OF SOUTH CAROLINA INS~{~~;;~~~ -~~;~,•~~;:~R·~ HAZARDOUS WASTE MANIFEST ·I
TYPE [on a 12-pilch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEG I BL .
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators of hazardous waste treatmel
storage. or disposal licilities to use the U.S. EPA Form 6700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)) and, II necessary, thf:I continuation sheet U.S. EPA Fo
8700-22A Rev.-9/86 (OHEC 1988A) foi b·oth inter-state and intra-slate transportation. Transporti?rs who transport hazardous waste into the United States Ir
another country are responsi01e for completing the manifesl Federal and State regulations also require generators and transporters al hazardous waste and
owners or operators of hazardous waste treatment. storage, or disposal rac1llt1es to comp.lete the rollowmg mformat1on.
GENERATOR SECTION · 1
1. Generator's U.S. EPA ID Number -Manifesl Document Number: Enter the generator's U.S. EPA twelve d1gIt 1dent1f1cat1on number and the un,que five d1
· number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA ldentification Number. please contact S.C.
· · OHEC at [phone] about obtaining an Identification number. I
~ 2; Page 1 al: Enter the total number of pages used to complete this manilest, i.e., the lifst page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)] plus t
r,"-·· · number al continualio".1 sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any.
A:. State Manifest Document Number': .. Leave blank.
B:
4.
State Generator ldenlificallon Number: Leave blank. · · I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who wilt manage the returned manifest !arms.
< ' t ..... -
Generator's Pholle Number: Enter a telephone number with area code where an authorized agent al the generator can be reached in the event al
emergency including nights, weekends, and holidays.
: . 5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I ,s.· U.S. EPA ID Number: Enter the U.S. EPA lwelve d1g1t 1dent1f1cat10n number of the hrst transporter 1dentil1ed In Ilem 5.
:':" ~ C.' · Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number:
0
Enter a teteph0ne number including area code where an authorized agent of the first transporter can be reached in the event of
I ' ,. I· i
an emergency including nights, weekends, and holidays.
Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste.11 more than 2 transporters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transpor.ing the wa
U.S. EPA 10 Number:lf applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. · 8 .•
E .. State Transporter's ID Number: Leave blank.
F:. Transporter's Phone Number: Enter a teteph!)ne number including area code .w~ere an authoiized agent al the second transporter can be reached in ti
event al an emergency including nights, weekends, and holidays. ·
Designated F;cilily Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal laci!ily designated to receive the
waste listed on this manifest The address must be the site address, which may differ lrom the mailing address.
9 ..
10;
G:.
H;.
11:
12..
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number al the designated treatment. storage, or disposal facility identified in item 9. ,
Slate Facility's ID Number: Leave blank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of n
emergency including nights, weekends, and holidays.
U.S; DOT Descriptions: Enter Rroper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFA 171 • 1 77. If additional spa I
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
Containers {no. and type): Enter number al containers !or each waste and the appropriate abbrevialion from Table I (below) for the type of containers.
TABLE I
OM·= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons, cases. roll otts
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks portable · CY= Cylinders BA= Burlap. cloth. paper or plastic bags
13 .. Total Ouanlity: Enter total quantity of waste described on each line, relative to the units used in item 14. I t4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit al measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and DI
identity the hazardous waste on each line.
J.--Additional Descriptions lor Materials Listed Above: In the spaces provided, enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listP.d in section 11 above. Nole: Belo re any hazardous waste can be accepted lor treatment storage or disposal in South Carolina. the
generator must obtain prior authorization from the treatment. storage or disposal facility.
K. Handling Codes lor Wasles Listed Above: Leave blank. .-I
TS. Special Handling lnslructlons and Additional lnlormalion: Generators may use this space to indicate special transportation, treatment. storage or dispo
information or Bill al Lading Information. For international shipments. generators must enter in this space the point ol departure (city and s:ate) !or those
shipments destined for treatment. storage. or disposal outside the jurisdiction or the United States. . .
16. Generator Certification: The9ener!1tor must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used.,
word "highway" should be tined out and the appropriate mode{rail, water.or air) inserted in the space below. II another mode in addition to the highway mod
used, enter the appropriate additional mode (e.g., and rail) in the space below.
TRANSPORTER SECTION , .
1z: Transporter 1 Acknowledgement: Enter th~ name al !he person accepting the waste on behalf of the first transporter. That person mus! ac~nowledl
acceptance al the waste described on the·manilest by signing (BY HAND IN INK) and entering the DATE al receipt. • .
18. Transporter 2 Acknowled9emenl: Enter, if applicable. the name of lhe person accepting the waste on behalf al the second lransporter. That person must
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE ol receipt.
FACILITY SECTION I
19. Discrepancy lndicalion Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy bet we
the waste described on the manirest and the waste actUally received at the f~cility. Owners and operators of racjlities who cannoI resolve significant
discrepancies within 15 days receiving the waste mus I submil to !he Department a lener with a copy ol the manifest describing !he discrepancy and ar.emp1s 10
reconcile it The trealment.·storage, or disposal lecllily mus I on tar the actual weight of waste in pounds in the spaces provided ir the amount varies any !ram ti
ai,ecllied by !he generator in Item 13 or II the generator uses a unit al measure other than pounds.
20. Facility Ownei-or Operator Cerlillcatlon: Print or type !he name ol lhe person accepting the waste on behalf of the owner Or operator of the facility. That pers
must acknowledge acceptanc·e of the waste described on the manifest by SIGNING (BY HAND IN INKf and entering the DATE or receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OA DISPOSAL FACILITY DESIGNATED I
~BCt,vd THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (803) 73•-~~00 WEEKDAYS FROM _8:00 am TO 5:00 pm.
. . .
I . ,4 '
IS;;!:!2~~-·'ff
-r-~
South Carolina Department of Health
. and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bun Street. Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: (803)73-4-5424
IPL.EA.SE PRINT or TYPE (Form desl ~eel for use on elite 12· Itch writer
UNIFORM HAZARDOUS 1. Generator'• U.S. EPAID No.
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. P8ge 1 Information in the shaded Meas is not
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WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smitl1field, NC 27577
~-Generator's Phone [phone]
5. Transporter 1 Company Name
Wiilms Truckin Co Inc.
7. Transponer 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, .Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71345
of required by Federal law. but is by State taw.
12. Containers 13. Total Quantity U. Unit il\Wa:iee'Numbei"(:#.
No. Type Wt.NrJ. }itWt??~f}-zj=;•>ff~Yf
16. GENERATOR'S CERTIFICATION: I hereby declare 1tiet the contents of this cOnslgnmentare fully and accuralolydescrlbed above by proper shipping name and are ctaS9<in8'd,
packed, marked. and r&beled, and are In atl respects in proper condlllon tor lrenspor1 by highway ecc:ordlng to appllcab1e lntarnatlonal and natlonal government re,gulatlona a/'\d
l/'le taws ol the S1.ate al S_oulh.Carotlna.
If I am a large quantity generator, I cei1ify lhat I have a program In place to reduce the volume and toxicity of waata ga·nerated lo the d&gree I have determined lo be economically
practicable and that l have selected the practicable method of trealment, storage, or disposal currently avallable 10 me which minimizes the pres.ant and future lhrNI 10 human
health and the environment: OR, II I am a small quanllty gonoralor, I hove mad a a good faith eNor1 to minimize my wa,1o generation and a elect the beat waste management method
that is available to me and !hat I can al'ford.
lk-l-...,P,..rin-ted-/T-yped--N-•m_•_!_~~]..'.:e:!r.:,.;L:.:_~G,~~"-::;1f>~·:.,.. __ .J.s_ig_n_atu_r_•...:_~~~:::;:__·.'.:;o-':·j/__:G~-;,!B<t~~·i;.,:::: ______ _;L:M0:;on~&,t:i;"l..~Di::aylJil':Y..,i:~~
T 17. Transporter 1 Ac;Knowledgement of Receipt of Materials RF~=::;:::..:..:..:==========---,,.:::-,-c=-,-----------,,..-------::;---..,;=;----;=:::--=--=-f
li~'flli!LJ1!..!...,;,bU:H.1.'.:f-£e~~t,~,.e~L~dl.LD!~~~uuJ4.1~~-~'frY::t.~----1_.!!lL~rfA ~ i-:-:·:...;.:;::::::;::.::::..:.:::::::::;:::c:::::::::~:..::::::::!::.;I o::l.:;M::•::i•::.:ria::l:.s ---=----....!../ ________ !../_.2:_ ______ -,,,.:--,:---:::--cc---i
•~i..:.+--P-,i-nt_ed_,_r_y_ped--N•_m_• ______________ ...1.S.ig•n-•t_u_r•----------------------...IMl-onL,th...l-OL.ay...l..Y.lear""""'I
19. Discrepancy Indication Space
F a ._! .._._.._....._,!lbs. c L..I LJ..J-L..LJ!lbi
I ~l bl L... .._.._._....__,Pbs. d I jibs.
I 1-::-::-::--:,---::---::----:---:-::--,--~ 20. Facility-Owner or Operalor; Certification or receipt ol hazardous malerials covered by this manifest except as noted in hem 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous E_dllions are Obsolete (DHEC 1988 (Rev. 10/86))
..--·
j..
"'
IMPORTANT:
STATE OF SOUTH CAR~'LINA 1Nsflt~~i~t:{;i
1
t~J~RM HAZARDOUS WASTE MANIFEST ... ,
TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBL •
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatm)
storage. or disposal licilities lo use the U.S. EPA Form 8700-22 Rev. 9186 [OHEC 1988 (REV 10/86)] and, if necessary, tha continuation sheet U.S. EPA Fo
8700-22A Aev .. 9/86 (OHEC 1988A) ior b·oth inter-state and intra-state transportation. Transport8rs who transport hazardous waste into the United States Ir
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters of hazardous waste and
owners or operators ol hazardous waste treatment. storage, or disposal facilities to complete the following information. . I
GENERATOR SECTION .
1. Generalor's U.S. EPA ID Number. Manifesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live di ,
number assigned.to this manifest by the generator beginning with 00001. If your comp"any does not have a U.S. EPA ldentilication Number, please contact S.C.
OHEC at [phone] about obtaining an Identification number. I
2; Page 1 of: Enter the total number of pages used to complete this manifest. i.e., lhe lifst page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 plus t
number al continuatio~ sheets EPA Form 8700-22 Rev. 9/86A {OHEC 1988A) ii any .
k
a:
3.
Slate Manifest Document Number: .Leave blank.
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage lhe returned manifest forms.
Slate Generator ldenliflcallon Number: Leave blank. · · · I
4. Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event al
emergency including nights, weekends, and holidays.
5. Transport 1 Company Nam_e: Enter the company name of the first transporter who will transport the waste.
\ 6.·' U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of lhe first transporter identified in item 5.
·,. C.'. State Transporter's ID Nu'!Jber:, Leave blank: I
, .. D. · Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the e11en1 ol
en emergency Including nights,·weekends, and holldays. . ·
· 1:. Transporter 2 Company Name: -II applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters I
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa
8 .. U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7. ·
E.. State Transporter's ID Number: Leave btank. · · ·
F:. Transporter's Phone Number: Enter a telephone number including area code _w~ere an authorized agent al the second transporter can be reached in ti
event ol an emergency including nights, weekends, and holidays. · , .
. 9., Designated Facility Name and Sile Address: Enter the company nnme and site address of the lreatment, storage, or disposal lacility designated to receive rhe
waste listed on this manilesl The address must be the site address, which may dilfer from the mailing address:
10~ U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment. storage, or disposal facility identilied in item 9 .•
G:. Slate Facility's ID Number: Leave btank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends, and holidays.
11~ U.S; DOT Oescriplions: Enter proper shipping name. hazard class and ID Number (UN/NA) for each waste as identilied in 49 CFR 171 •1 77. H addition.al spa.
is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. ·
12.. Containers (no. and type): Enter number ol containers !or each waste and lhe appropriate abbreviation !ram Table I (below) tor the type of conta1ne!S-
TABLE I
0~ = Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM = Metat boxes, cartons, cases. roll oHs I
OW= Wooden dr~ms, barrels. kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes, cartons_ cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
· 13 .. Total Ouanlity: Enter total quantity of waste described on each line, relative to the units used in Hem 14. · I
14. Unit (weight/volume): Enter the appropriate abbreviations !ram Table II (below) ror the unit of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons · N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61 • 79.261 Subparts C and 01
identify the hazardous waste on each line .
... J:· Additional Descriptions lor Materials Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request For
for each waste stream listP.d in section 11 above. ~le: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. the
generator musl obtain prior authorization from the treatment, storage or disposal facility. •
K. Handling Codes for Wasles Lisled Above: Leave blank. , I
15 .. Special Handling Instructions and Additional lnlormalion: Generators may use this space to indicate special transportation. treatment. storage or dispo
information or Bill al Lading Information. For international shipments, generators must enter in this space the point of departure (city and state) for those
shipments destined !or treatment, storage, or disposal outside the jurisdiction ol the United States.
16. Generator Certilicalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode otherttian highway is used.I
word .. highway .. should be lined out arid the appropriate mode(rail, wa·ter,orair) inserted in the space below. If another m6de in addition to the highway mod
used, enter the appropriate additional mode (e.g.,.and_ rail) in the space below. ·
TRANSPORTER SECTION
11: Transporter 1 Acknowledgement: Enter the name ol the person accepting the waste on behalf al the first transporter. That person must acknowledl
acceptance cl the waste described on the manile~t by signing (BY HAND IN INK) and entering the DATE al receipt. ,
18. Transporter 2 Acknowledgement Enter, ii applicable, the name or the person accepting the waste on behaH al the second transporter. That person must
acknowledge acceptance al the waste described on the manilest by SIGNING (BY HAND IN INK} and entering the DATE ol receipt
FACILITY SECTION . . . I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in this space any discrepancy_ betwe
the waste described on the manifest and the waste actually received at the f~cility. Owners and operators of facjlities who cannot res_ot11e significant
discrepancies within 15 days receiving the waste must submil to the Department a letter with·a copy ol the manifest describing the discrepancy and anemp1s to
reconcile il The treatment;slorage, or disposal lacilify must onter the actual weight al waste in pounds in the spaces provided ir the amount varies any lrom 11
speclried by lhe generator in Item 13 or If !he generator uses a unit al measure othei than pounds.
20. Facillty Ownef or Operator Cerllficatlon: Print or type lhe name of the person accepting the waste on behalf of the owner Or operator of the facility. That pers .
must acknowledge acceptanc·e of the waste described on the manifest by SIGNING (BY HANO IN INK}" and entering the DATE al receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT. STORAGE, OR DISPOSAL FACILITY DESIGNATED 1
~,c~,v~ me WASTE OR THE s.c. DHEC MANIFEST SECTION AT (803) 73d-5200 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
PLEASE PRIHT or TYPE (Form desi ned for use on elite 12-itch writer Form A roved. 0MB No. 2050-0039 E, ires 9-30-83
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No. Manlreat Oocument No. WASTE MANIFEST N c D o 7 6 1400042
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416_, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. U.S. EPA 10 Number
S C D 0 7 0 3 7
2. Page 1
of
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number/ 12. Containers
No. Type
a.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71346
1 D T
Information in the shaded areas is not
required by Federal law, but is by State law.
2 0 y
16. GENERATOR"S CERTIFICATION: I hereby declarethet the content, ofthl1 con1lgnmentare fully and accuratelyde1crlbed above by proper •hipping name and are clas.ined.
packed, marked, and labeled. and are in all respecls in propercondillon fortran1port by highway according to appllcabta International and national government r9gulatlon• and
the laws ot the State ol South Carolina.
If I am a large quantity generator, I cortify that I havo a program In placo to reducathavolumoand toJ11ICltyofwa1togonoraled to the degree I have determined to be economically
practicable and lhat I have selected tho practicabto method ol ltealmont sloroge, or dlspoaal currently available lo mo which minimizes tho present end future threat to human
health and lhe environment: OR, lfl am a small quaotitygonerator, I have made a good failh effort to minimize my waste generation and select the boil waa!o management m-ethod
that is available to mo and that I can afford.
Printed/Typed Name Signature
Signature
Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certirication of receipt of hazardous materials covered by lhis manifesl except as noled In Item 19.
Prinled/Typed Name Signature
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 (Rev. 10/86)]
Month Day
Q fJ 2. l
Month Day Year
a ._I .._......_._._..,jibs. c lu...L.J....L.J..J!lbs.
b I jibs. d I jibs.
Monlh Day Year
.... ! · :1)ht~-t/1i?_i};.':::}t't·;;.
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ',·1
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter! OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters al hazardous waste and.owners or operators of hazardous waste treatmel
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev, 9/86 (OHEC 1988 (REV 10/86)) and, ii necessary, the continuation sheet U.S. EPA Fo
8700-22A Rev: 9186 {DHEC 1988A) loi both inter-state and intra-state transportation. Transpor1ers who transport hazardous wasle into the United States tr
another country are responsiDle !or completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operators ol hazardous waste treatment, storage, or disposal lac1l1tres to complete the rollowmg 1nformatton. 1 GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve dIgIt 1dent1l1catIon number and the unique hve d1g1t
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please contact S.C.
"OHEC at [phone] about obtaining an identification number. I
·-2; Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] plus I t--•' .. · number ol continuatior:i s_heets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
_.__ A:. State Manifest Document Number. .. Leave blank.
~-
B:
3,
4,
5 .
6,
C.
D.
7:.
8 ..
E ..
F ..
9 ..
10:
G:.
H;.
11'.
State Generator ldenlitlcallon Number: Leave blank. · · I
Generalor's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identHication number of the firs! transporter identified in item 5.
Slate Transporter's 10 Number:. Leave blank: .
Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays.
Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. II more than 2. transporters I
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 {DHEC 1988A) continuation sheet and list the transporters in the order they will be transoorting the wa
U.S. EPA ID Number:lf applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identiried in item 7.
State Transporter's ID Number: Leave blank. · ·
Transporter's Phone Number: Enter a telephone number including area code _where an authoiized agerit of'\iie second transporter can be reached in ti
event ol an emergency including nights, weekends, and holidays. · · ,..
Designated Faci1ily Name and Sile Address: Enter the company nr.ime and site address ol the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing address.
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identllication number al the designated treatment. storage, or disposal facility identified in ite~ 9 .•
Stale Faclllty's ID Number: Leave blank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent al the facility can be reached in the event of an
emergency including nights, weekends, and holidays.
U.S: DOT Descriptions: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identified in 49 CFA 171 -1 77. !f additional spa.
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation !ram Table I (below) !or the type of containers ..
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. roll oHs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity al waste described on each line, relative to the units used in item 1 4. I
14. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the uni! of measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers asspecilied in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpans C and □,
identity the hazardous waste on each tine.
J:-Additional Descriptions lor Materials Listed Above: In the spaces provided, enter the authorization number(lrom the S.C. DHEC Authorization Request For
tor each waste stream list~d in section 11 above. Note: Belo re any hazardous waste can be accepted for treatmenl storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. .
K.; Handling Codes tor Wastes Lis led Above: Leave blank. · · I
15 .. Special Handling Instructions and Addilional Information: Generators may use this space to indicate special transportat1on. treatment. storage or d1spo
information or Bill or Lading lnrormation. For international shipments, generators must enter in this space the point of departure (city and state) for those
shipments destined for treatment, storage, or disposal outside the jurisdiction Or the United States. ~-. .
16. GeneralorCer1illcalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is Used .•
word "highway" should be lined out and iheappropri2te mode (rail. wa·ter.or air) inserted in the sp3ce below. II another'mod!? in addition to the highway mod
used. enter the appropriate additional mode (e.g .. and_ rail) in the space below.
TRANSPORTER SECTION
11: T~ansporter 1 Acknowledgement: Enter the name or the person accepting the waste on behall or the first transporter. That person must acknowledl
acceptance of the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behall of the secorid transpor1er. That person must
acknowledge acceptance of the waste described on the manilest by SIGNING (BY HAND IN INK) and entering the DATE of receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative of the designated lacility's owner or operator must note in this space any discrepancy bet we
the waste described on the ·manilest and the waste actUally received al the f~cility. Owners and operators of facjlities who cannot resolve significant
discrepancies within t S days receiving the was le must submil to the Department a letter with·a copy of the manifest describing the discrepancy and attempts to
reconcile it The trealment·storage, ordlsposal lacllity muul onter the actual weight ol waste in pounds in fhe spaces provided ii the amount varies any from ti
specified by the generator in Item 13 or II the generator uses a unit ol measure other than pounds.
20. Facility Ownei-or Operator Cerlilleatlon: Print or type the name of the person accepting the waste on behalf ol the owner Or operator al the facility. That pers n .
must acknowledge acceptanc·e ol the waste described on the manirest by SIGNING (BY HANO IN INK)and entering the DATE of receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
P!,C(•VE me WASTE OR THE s.c. DHEC MANIFEST SECTION AT (803) 734-5~00 WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt.
2600 Boll Streel Columb;a. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
IPLE.&.SE PRUIT or TYPE (For·m desi ned for use on elite 12-itch writer ·
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No. Manlreat
Document No.
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1 Information in the shaded areas is not
of required by Federal law, but is by State law.
I
I
I
I
I
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I
I
I
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
,. Generalor's Phone 9 1 9 9 34-' 9 711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S."EPA ID Number
10. U.S. EPA ID Number
0 0 4 3
S C D O 7 0 3 7
11. U.S. oor·oescription (including Proper Shipping Name, Hazard Class, and ID Number}
d.
15. Special Handling Instructions and Addilional Information
•,GSX Work Order No.: 71347.
16. C EN ERATO R'S CERTIFICATION: I hereby declare that Iha contanla ol lhla consignment are fully and accurately described above by prop,er ahlpplng nam• and ara clasaiflad.
pack ad, marked, and 1Bbaled,and ara in all raspacla In proper condition lortranaport by highway according to appllc.abla lnhm,allonal and national governmanl r~ulatlon, and
the laws of the Slate ol South Cerollne.
111 am a large quanlity generator, I certify th al I have a program In ph1ca lo reduce Iha volume and toxicity of waata ganaratad to the dogr-I have datarminad to be aconomlc.Jty
pract1cabla and that I have ,elected the practicable method ol treatment. ,torago, or dl1poaal currenlly available to ma which minimizes the prasenl and lutura thr-t to human
health and the environment: OR, II t em a small quantity generator, I have made a good la!th artort to minimize my waste ganeraUon and select Iha bast wall a management rr,ethod
that is available to ma and !hat I con afford.
11-➔--P-rin_•_ed_,_r_yp_ed_N_•_m_• __ .... d'-"7--"-...;-?...;...;;;;;;;..;;~-... si_g_na_t_ur_• __ A?_...,,,,._ ___ . _ __/_. __ r;.;·_a"'-'I;,; .... , ________ ....................... .. 'j-'(_.o/-Je.,,-, .Gl ev-& I~ 7---. U
T 17. Transporter 1 At:1<nowfedgement of Receipt of Materials
Month Day Year
6? Z !?7
A 1--'-'---=='-'-==========.::.:..--....,-,,,----------------------.,.,---,----::---:-c-l 0~ ~-p..::W::'.;n:::ted,:::'._/T .. y-ped-'s~N:.:~:::m::.ect,:::!,:...'.'.!of\11.~9.=,_-------...LS_ig_n..::~:::tu,.reL.!....:.....Y:.....1&:::::::::====---.:.__L_L ___ ..l(:LJ.j:U"1.2'..Jl.QL
1,. Transporter 2 Acknowledgement of Receipt of Malerials Rl-',---'--...:.C..:.--'-'-'-------'-'-------~--------------------------------T Printed/Typed Name Signature
11-4~ --,--------"---,,--------~...i....L , 9. Discrepancy Indication Space
F
I tt--------~-------~ 20. Facility Owner or Operator; Certificalion of receipl ol hazardous malerials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature
Month Day Year
Month Day Year
• I I Jibs. C I jibs.
bJ I jibs. d I pt><
Month Day y..,
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev.10/86))
IMPORTANT:
STATE OF SOUTH CA:~:LINA INSt:ii~~f~t;-;t;,•~~,iRM HAZARDOUS WASTE MANIFEST I
TYPE [on a 12-pitch (elite) typewriter] OR USE Fl~M POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEG I BL"
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or ope~ators of hazardous waste treatml
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] and, if necessary, Iha continuation sheet U.S. EPA Fo
8700-22A Aev .. 9/86 (DHEC 1988A) lor b·oth inter-state and intra-state transportation. Transporters who transport hazardous waste into the United s·tates Ir
• another country are responsible !or completing lhe manifest Federal and State regulations also require generators and transporters al hazardous waste anCl
l · ·•·owners or operators of hazardous waste treatment, storage, or disposal facilities to complete the followif'lg information.
GENERATOR SECTION · 1
1. Generator's U.S. EPA ID Number• Manllesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique tiv~ dig1
. 2;
•--·' A.;
e:
3.
•• l. : 5.
6.
. , C.
' ' D. r
1:. -· ' 8 ..
E ..
I F:.
9.
10;
G:. ' ' H;.
' l 11: '. '
number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number, please contact S.C.
OHEC at [phone] about obtaining an Identification number. I
Page 1 of: Enter the total number of pages used to complete this manifest, i.e .• the first page EPA Form 8700-22 Rev. 9/86{0HEC 1988 (REV 10/86)] plus
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any. ,
State Manifest Document Number: .. Leave blank.
Slate Generator ldentiflcalion Number: Leave blank. · · · · I
· Generator's Name and Mailing Address: Enter the name and mailing address of lhe generator who will manage the returned manifest forms.
Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the event of
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
Slate Transporter's ID Number: Leave blank .
Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays.
Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 transporters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa
U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
State Transporter's ID Number: Leave blank. ·
Transporter's Phone Number: Enter a telephone number including area code .w~er.e an authofized agent of the second transporter can be reached In I
event ol an emergency including nights, weekends, and holidays. ·
Designated Facility Name and Site Address: Enter the company name and site address of the treatment. storage, or disposal facility designa!ed to receive the
waste listed on this manifest The address must be the site address, which may dilfer lrom the mailing address.
U.S. EPA ID Number: E. nler the U.S. EPA twelve digit identification number ol the designated treatment, storage. or disposal facility identified in item 9. ,
Slate Facility's ID Number: Leave btank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the even! ol
emergency including nights, weekends, and holidays.
U.S: DOT Descriplions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identilied in 49 ~FR, 71-177.11 addition.al sp1
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation lrom Table I (below) lor the type ol containers.
TABLE I
OM = Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes, cartons, cases. roll otts I
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF = Fiberboard or plastic drums, barrels, kegs OT = Dump truck CF .= Fiber or plastic boxes. car1ons. cases
t, TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
f~ .. · 13 .. Total Quantity: Enter ;otal quantity of waste described on each line, relative to the units used in item 14. · , I
14. Unit (weight/volume): Enter lhe appropriate abbreviations from Table II (below) for the uni! ol measure:
Table II
P = Pounds L = Lilers K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specilied in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and]
identify the hazardous waste on each line.
J; · Additional Descriptions lor Malerials Listed Above: In the spaces provided, enter the authorization number (lrom the S.C. DHEC Authorization Request Fo
for each waste stream HstP.d in section 11 above. Nole: Before any hazardous waste can be accepted !or trealment. storage or disposal in South Careolina. the
generator must obtain prior authorization lrom lhe treatment, storage or disposal racility.
K.. Handling Codes lor Wastes Listed Above: Leave blank. I
15. Special Handling Instruction~ and Additional Information: Generators may use this space to indicate special transport~tion. treatment. storage or dispo
information or Bill ol Lading Information. For international shipments, generators must enter in this space the point of departure (city and s:ate) for those
shipments destined !or treatment, storage, or disposal outside the jurisdiction ol the United States. ·
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE thecertilication statement. II a mode other than highway is used .•
word ''highway" should be lined out and the appropriate mode{rail, waier.or air) inserted in the space below.If another niode in addition to the highway mod
used. enter lhe appropriate additional mode (e.g., and_ rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter lhe name of the person accepting the waste on behalf ol the first transporter. That person must acknowlel
acceptance of the waste described on the manifest by Signing (BY HAND IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, if applicable, the name ol the person accepting the wasle on behalf or the second transporter. That person mus1
acknowledge accepiance of the waste described on lhe manifest by SIGNING (BY HANO IN INK) and entering lhe DATE ol receipt
FACILITY SECTION . • . I
19. Discrepancy lndicalion Space: The allthorized represenlative ol the designated facility's owner or operator must note in this space any discrepancy betw
the waste described on the manilest and the waste actually received at the f~cility. Owners and operators of facjlilies who cannot resolve significant
discrepancies within 15 doya receiving the waste mus I submit to the Oepartmenl a letter with· a copy of the manifest describing the discrepancy and artemp!s to
reconcile iL The lrealment;storage, or dlsposol lacllity must enter lho acluat weighl ol waste in pounds in the spaces provided if the amount varies any lrom ti
apeclried by ll'le generator In llem 13 or If the generator uses a uni! ol measure 01he; than pounds.
20. Facility Ownei or Operator Cerlllicallon: Print or type the name of the person accepting the waste on behalf ol the owner Or operator ol the facility. That pers ,
must acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INKJ°and entering lhe DATE of receipl
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
REcr,vE THE WASTE OR THE s.c. DHEC MANIFEST SECTION AT (803) 73•-~~oo WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Street Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Pl.EASE PRINT or TYPE writer Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
I
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UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No. Mllnireet
Document No.
3. Generatots Name and Mailing Address
Channel Master
N C D 0
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
0 0 0 4 4
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number.
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shfpplng Name, Hazard Class, and ID Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Orqer No.: 71348
2. Page 1
ol lnlormation in the shaded areas. is not
required by Federal law, but is by State law.
16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are lully end accurately described abOve by proper shipping name and are classified,
packed. marked, and 18beled, and are In atl respects in proper condl!lon !or transport by highway according to applicable lnlarnational and natlonal government ra,gulatlons and
the laws ot the Slate ol Soulh Carolina.
II I am a large quantity generator, t cer1ify that I have a program In place to roducethevolume and toxlcltyol waste generated to Iha dogr-I have dalermln~ 10 M econornlcally
prac11cable and that l have setected the practicable method ol treatment, storage, or disposal currently avallable to me which minimizes the present and future threat to human
health and the environment OR, II I am a small Quantity generator, I have made a good laith eHor1 to minimize my waste generation and select tho bast waala management method
that is available to ma and !hat I con afford.
li-,-+-,,-P,,-ri-nt_ed_/_T_yp_ed_N•_m_•_.:.~ _ _.·.i.;.e,;:i-_..,L....;_G,;;;;;· ~<-\..;::· :t5;:a::;_--1_s_ig_n•-tu_r• __ 1<-;_..;.,~~---~;;;__'_~...;.7_....;;_ ______ 1,M;;;,1.n;:U.:;;;i•.J.Y~:..r..;-I
T 17. Transpor1er 1 AtKnowledgement ol Receipt of Materials V Rf----'-------'-----....,C-------~---------------------------------1 I ~~ Pri~ped_Na'!''c..-J ./J, ;/_ Signature fl ,-, ,4' /7~-' -orv,o;!t:,; ro7::-·rr:YZ._. c:;. ~ / ~
O l-1-8-."T,..ra.::n=,e:po:_rt.::er:..2_A.:.ck_n.:.o_w_led:_g_e.:.m_e_n_t_ol_R_e_c_e_ip_t_o_l_M_a_te..:ri=•=l,.L---'---..:::.=----=::::.:.._.:....::::::::::.. ____________ _.~i.e;...1<:....LL.UUL~ Rf---...:....-'----'""'--'-----"-'---'-----~---------------------------------1
l1-i-+--P-ri-nt_ed_/T_y_p_ed_Na_m_• ______________ -1_s_ig_n_atu-re ______________________ .... M._on'-th-'-Dl..ay_._Y_.ear~
1 9. Discrepancy Indication Space
F a ._i ....... ....._.._.__.! lbs. c I !'bs.
I ~~ bl w. LI..J...J..J....Jllbs d I jibs.
I 1-:---,,--------------~ 20. Facility Owner or Operator. Cer1iflcallon of receipt or hazardous materlals covered by this manifest except as noled In Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700-22 (Rev. 9/86) Previous Edilions are Obsolete (DHEC 1988 (Rev. 10/86)]
IMPORTANT:
STATE OF SOUTH CARlLNA INS~~ig~~~t;t~'G
1
~liRM HAZARDOUS WASTE MANIFEST I
TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEG I Bl .
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators of hazardous waste trealmel ·
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [OHE.C 1988 (REV 10/86)] and, ii necessary, tha continuation sheet U.S. EPA Fa
8700-22A Rev.-9/86 (DHEC 1988A) fof bo!h inter-state and intra-stale transportation. Transporters who transport hazardous waste into the United States fr
another country are responsi01e for completing the manifest Federal and State regulations also require generators and transporters al hazardous waste ana
owners or operator~ of haza.rdous waste treatment. storage, or disposal racilities to complete the followiiig information. I
GENERATOR SECTION · ,
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five di
i number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number, please contact S.C.
2;. Page 1 of: Enter the total number of pages used to complete this manifest. i.e., the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] plus t
· 'OHEC at [phone] about obtaining an idenlification number. . . I
f ....... : ,\ number ol continuation sheets EP_A Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
1 •• k Slate Manifest Document Number: .Leave blank. ·
• ' •
I.
;
I
1
a: . ''3_
4 .
5.
6.
, C.
D.
1:.
8 ..
E ..
F:.
. 9.
10:
' G:.
H;.
1L
Slate Generalor ldenliffcailon Number: Leave blank. · · · I
· Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
Gene·rator's Phorle Number: Enter a telephone number with area code where an authorized agent of the generator can be reached i,a the event ol
emergency including nights, weekends, and holidays.
Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
U.S. EPA IC Number: Enter the U.S. EPA twelve digit identHication number of the first transporter identified in item 5. I
Slate Transporter's ID Number: Leave blank.
Transporter's Phone Number: 'enter a teleph0ne number including area code where an authorized agent of the lirst transporter can be reached in the event of
an emergency including nights, weekends, and holidays.
Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the or~er they will be transporting the wa
U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
Stale Transporter's 10 Number: Leave blank. · · · ·· :
Transporter's Phone Number: Enter a telephone number including area code .w~ere an authofized .agent ol the second transpor1er can be reached in ti
event ol an emergency including nights, weekends, and holidays. · .
Oesignaled Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal lacifity designated to receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing address.
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit iden!Hication number ol the designated treatment, storage, or disposal facility identified in item 9. ,
Slate Facility's ID Number: Leave btank.
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event ol .
emergency including nights, weekends, and holidays.
U.S: COT Descriptions: Enter proper shipping name, hazard class and ID Number(UN/NA) for each waste as identified in 49 CFR 171-177.11 additional spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
" 12.. Conlainers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation rrom Table I (below) for the type ol containers.
TABLE I
OM = Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes, cartons, cases. roll otts
OW= Wooden·drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic bo,:;es. car1ons. Ci."lses I
TP = Tanks portable . CY= Cylinders BA= Burlap, cloth, paper or plastic bags
.... 13 .. Total Quantity: Enter total quantity or waste described on each line, relative to the units used in item 14.
Unit (weight/volume): Enter the appropriate abbreviations rrom Table 11 {below) for the unit ol measure:
Table II
14. •• P = Pounds L = Liters ~=Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (tiQuid Onty)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and DI
identify the hazardous waste on each line. .
J: Additional Descriptions for Malerials Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization ReQuest For
· · for each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted !or treatment. storage or disposal in South Carctina. lhe
"generator must obtain prior authorization from the treatment. storage or disposal facility.
K. Handling Codes for Wastes Listed Above: Leave blank. 1 I
15. Special Handling Instructions and Additional Information: Generators may use this space to indicate special lranspor1ation, treatment. storage or dispo.
information or Bill of Lading Information. For international shipments, generators must enter in this space the point of departure (city and s:ate) for those .
shipments destined for treatment, storage, or disposal outside lhe jurisdiction of the United Slates.
16. Generator Certilication: The generator must READ, SIGN (BY HAND IN INK), and CATE the certification statement. If a mode otherthan highway is.used .•
word "hi(Jhway" should be lined out and lhe appropriate mode (rail, wat€!r,or air) inserted in.the space below.II anothe.r.mode in addition :a the highway mod
used, enter the appropriate additional mode (e.g., and. rail) in the space below. .
TRANSPORTER SECTION
17: Trans~ort,er 1 Ac.knowledgemenl: Enter the name of the person accep~ing the waste on behall ol the first transpor1er. That person must acknow!edl
acceptance of the waste described on the manileSt by signing (BY HAND IN INK) and entering the DATE ol receipt. · · ·. ·
18. Transporter 2 Acknowledgement: Enter, ii applicable, lhe name ol the person accepting the waste on behalf al the second transporter. That person must
acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INK) and entering lhe DATE or receipt.
FACILITY SECTION I
19. Discrepancy lnd1calton Space: The authorized representative of the designated lacihty's owner or operator must note in this space any discrepancy bet we
the waste described on the manifest and the waste actually received at the r~cility. Owners and operators of racjlities who cannot resolve significant
discrepancies within 1 5 days receiving the waste must submil to the Department a letter with a copy of the manifest describing the discrepancy and anempts to
reconcile it The treatment:storage. or dlsposal lacility must enter the actual weight ol. woste in pounds in lhe spaces provided ii the amount varies any lrom ti
1p1cllied by the generiuor In Item 13 or ll the generotor uaes a unit ol measure other than pounds. .
· 20. F1clllty Ownel' or Operalor Cerl/1/c.atlon: Print or type the name ol lhe person accepting the waste on behalf ol the owner Or operator of the facility. Thal pers
must acknowledge acceptanc'e or the waste described on the manifest by SIGNING (BY HANO IN INK)and entering the CATE al receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED lil
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (803) 734-5:!00 WEEKDAYS FROM 800 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau ol Solid & Hazardous Wa,te Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
wriler Form A roved. 0MB No. 2050-0039 Ex ires 9-30·813
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D
Manltea1 Document·No. 0 0 0 4 5
2. Page 1 ol Information in the shaded areas is no1
required by Federal law, but is by State law.
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
.Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
S C D O 7 3
8. U.S. EPA 10 Number
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
a. Haza·rdous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71349
12. Containers 13. Total Quantity 14. Unit
No. Type '1/Wd
1 D T 2 0 Y
16. GENERATOR"S CERTIFICATION: I hereby declare that the content!I ofthl!I conaignmentare futlyand accurataly de!lcribed above by proper shipping name and are clesa1fled.
packed, marked, and 1a·bo1cd, and a_re In RII ro!lpects In propercondlllon for1ran!lpOrt by highway according lo appHcable International and naUonal government r~ulationa and
Iha taw!I ol the State 01 South Ca.rotlna.
If! am a large Quantity generator, I certify that I have a program In place to reduce the volume and toxlcltyolwaalaganarated 1othe de-.,roe I have determined lo be aconomlcally
practicable and lhal I have selected the practlcabla method ol treatment. storage, or disposal currently availeble to me which minimize, the prelM!lnt and lutura threat lO human
health and the environment OR, 111 am a small Quantity generator, I have made a good faith effort 10 minimize my waste generallon and select the beat w111ta managemanl methOd
that is available to me and that I cari afford. ·
Printed/Typed Name Signature
17. Transporter 1 At:t<nowledgemenl of Receipt ol Materials
Printed/Typed Name Signature
~ .,..,. ,1,.,. -L .,,,.,., <~~ .::1~......., 7-, r
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt ol hazardous materials covered by this manifeSt except as noted In llem 19.
Printed/Typed Name Signature
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
•,...! .1.,J....L.L..L
bl~~~.
Month Year
0 l?
Month
Month Day Year
!Ibo. C I !Ibo.
jibs. d I jibs.
Month Day Year
IMPORTANT:
STATE OF SOUTH CA:l~1~A-1Nsiit~~;~~i~~~1~~~0RM HAZARDOUS WASTE MANIFEST I
TYPE (on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEG I BL'
GENERAL INFO AMA TION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators al hazardous waste treatmel
~lorage, or disposal ficililies to use the U.S. EPA Form 6700-22 Rev. 9/86 (DHEC 1988 (REV 10/66)) and, ii necessary, th1;1 continuation sheet U.S. EPA Fa
8700-22A Rev: 9/86 (DHEC 1988A) foi b·oth inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
another country are responsiOle !or completing the manifest Federal and State regulations also require generators and transporters ol hazardous waste and
owners or operators of hazardous waste treatment, storage, or disposal lacilities to complete the following information.
GENERATOR SECTION I
1. Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five di 1
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please contact S.C.
OHEC at [phone] about obtaining an identilication number. I
2; Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the lifst Page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10186)] plus
~ •• __ . · number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any. ·
' /·
' \
I
A. State Manilest OocumE:!nt Number. .. Leave blank.
;.3. Generalor's Name and Malling Address: Enter the name and mailing address ol the generator who will manage the returned manifest lorms.
e: State Generalor Identification Number: Leave blank. · · · · I
••
5.
6. . C.
D.
7:.
' 8 ..
Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol
emergency including nights. weekends. and holidays.
Transport 1 Company Name: Enter the company name ol the rirst transporter who will transport the waste. I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the first transporter identified in Hem 5.
Slate Transpor1er's ID Number:. Leave blank:
Transpor1er's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends. and holidays.
Transpor1er 2 Company Name: II applicable, enter the company name ol the second transporter who wilt transport the waste. II more than 2 transporters I
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa
U.S. EPA ID Number:II applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
-E .. Slate Transpor1er's ID Number: Leave blank. ·
Transpor1er's Phone Number: Enter a telephone number including area code_where an authoiized agent ol the second transporter can be reached in I
..
F •.
9.
,a:
G:.
H;.
11:
12..
event of an emergency including nights, weekends, and holidays. · .
Oesignaled Facitily Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be the site address. which may di lier lrom the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment. storage. or disposal facility identified in item 9.1
Stale Facility's ID Number: Leave blank.
Facility's Phone Number: Enter a.telephone number including area code where an authorized agent of the facility can be reached in the event or an
emergency including nights, weekends, and holidays.
U.S; DOT Oescriplions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 171-177. If additional sp1
Is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
Containers (no. and type): Enter number ol containers lor each waste and the appropriate abbreviation rrom Table I (below) for the type ol containers.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. roll otts • •
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to the units used in Hem 14. I
14. Unit (weighl/volume): Enter the appropriate abbreviations rrom Table II (below) for the unit ol measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specHied in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpans C and l
identify the hazardous waste on each line.
J: Addilional Descriptions tor Materials Listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request Fo
tor each waste stream listP.d in section 11 above. Note: Belo re any hazardous waste can be accepted for treatment. storage or disposal in South Carclina, the
generator must obtain prior authorization from the treatment, storage or disposal facility.
K., Handling Codes for Wastes Listed Above: Leave blank. r • I
15 .. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or dispo
information or Bill or Lading Information. For international shipments. generators must enter in this space the point of departure (city and slate) for those
shipments destined for treatment, storage, or disposal outside the jurisdiction or the United States. · .
16. GeneralorCertilication: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used .•
word "highway" should be lined out and the appropriate mode (rail, w.iter.or air) inserted in thesP.ice below.If another mode in addition 10 the highway mod
used, enter the appropriate additional mode (e.g., and_ rail) in the space below. -
TRANSPORcER SECTION
11: Trans~orter 1 Acknowledgement: Enter the name ol the person accepling the waste on behalf ol the first transporter. Thal person must acknowle1
acceptance of the waste described on the manilest by signing (BY HAND IN INK) and entering the DATE al receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the narne of the person accepting the waste on behall of the second transporter. That person must
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE or receipt.
FACILITY SECTION . I
19. Discrepancy Indication Space: _The authorized representative of the designated facility's owner or operator must note in this space any discrepancy betw
the waste described on the manifest and the waste actl.ially received al the lacility. Owners and operators or lacjlities who cannot resolve signilicant
discrepancies within 1 S days receiving the waste must sub mil to the Department a letter with a copy of the manifest describing the discrepancy and anempts to
reconcile iL The treatm1nt.·1toraga, or dlsposnl locililV must ontar the actual weight olwosta In pounds in !he spaces provided ii the amount varies any from 11
apecltled by Ine genernlor In Item 13 or II the generator uses a unit ol measure other than pounds. ,
20. Facility Owner or Operator Certification: Print or type !he name ol the person accepting the waste on behalf ol the owner Or oper.itOr of the facility. Thar pers .
must acknowledge acceptanc·e of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECE>VE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbie. SC 29201
Phone: (803)734•5200
Emergency & Holidays: (803)734•5424
PLEASE PRINT or TYPE (Form desi ned for use on ellte 12-itch writer Form A roved. 0MB No. 2050.0039 Ex ires 9.30.58
I
I
I
I
I
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D O 0 l
3. Generator's Name and Malling Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Na~e
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
C D O 7 3
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (incfuding Proper Shipping Name, Hazard Cfsss. and ID Number)
d.
15. Special Handling Instructions and Additional Information
GSX Work Order. No.: 71350
2. Page 1
of Information in the shaded Meas is not
required by Federal law, but is by Stale Jaw.
16. CENERATOR"S CERTIFICATION: I hereby declare that lhe contents otlhis conalgnmenl era fully and accurelelydascrlbed above by proper shipping nama and are claaaina<t,
packed, ma,ked, and labeled, and are In nll respecta In proper condlllon for tran1port by highway according to applicable lnlarnatlonal and natlonal govarnmant r~ulaUon• aod
tna laws of Iha State of Soulh qarollna.
If I am a largo quantity generelor, I certify that I have a pre>Qram In place to reduce the volume and toxicity of wHte generated to the d~rae I have dalarmlned lo be economically
practicable and that I have selected the practlcabla method of treatment. storage. or dlspoaal currently available to me which minimizes Iha praaanl and lutura thtNI to human
health.and Iha environment;OR.lfl am a small quantltygeneralor, I have m11de a good faith effort to minimize my w11ste generation 11nd select the beat wa11a managemant method
that Is available lo ma and Iha! I can afford. ·
·~--Pr-in-•ed_'_Ty-ped_N_•m_•_....:..~.::::.:12::er:c..:.L::;;:,,~c:;;!:'-<-;!;;. iir!:;_ _ _Ls_ig-na_,u_re_?2~~!!!~--"c/.~::.:·...!diat,::!-'.;!;~:_-----...l~~~~~
T 17. Transporter 1 At:1<nowledgement of Receipt of Materials
Month Day Year
0 lr.Z.. </, ~ 7 I ~ i-.:.:.:.,_P;.:r::.in::ted:::::/T::y::.ped_;,:.,N::.a::m::e.::::~:.::.::::.:.:::.:.:::::!'.:.::..::::.:::::::::#;:...._~--rS"ig-n""a'"tu-re-----------::o-===l-----,,-----:-:-c--=----,,-Month Year
.6
o 18. Transporter 2 Acknowledgement of Recei Rf-----'-------'------'-------~--------------------------------
lf-i-+..,,.-,p,-,rin_\_ed_/_T_yp_ed_N_,,a_m_e,--------------...I.-S-ig-na_t_ur_e ________ ..,.. _____________ ...1_1....L...l....1.-1
19. Discrepancy Indication Space
Month Day Year
• I jibs. C I jibs.
b I I pbs. d I jibs.
Month Oat YU/
F ·~ 11----,-------------~ 20. Facilily Owner or Operator; Certificalion of receipt of hazardous melerlels covered by this menifest except ea noted In llom 19.
Prlnttd/T)'P~ Name Signature
EPA Form 8700•22 (Rev. 9/86) Previous Edllions are Obsolele {OHEC 1988 (Rev. 10/86))
r:' . , .'.:;-!: ~~;,_,;:•:··}•~ ~1.•,'-_ l'j•fi'i ,
IMPORTANT:
STATE OF souTH CAROLINA 1Ns~;~c~;~~~:;,;;~,,~~1;!~RM HAZARDOUS WASTE MANIFEST I
TYPE [on a 12'.pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEG I BL •
GENERAL INFORMATION; Federal Regulations require generators and transporters of hazardous waste and owriers or operators ol hazardous waste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fo
8700-22A Re..,:9/86 (OHEC 1988A) tor b·oth inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
another country are responsible for completing the manifest Federal ·and State regulations also require generators and transporters ol hazardous waste ana
owners or operator~ of hazardous waste treatment. storage, or disposal facilities to complete the fo1Jriwil1g i~formation. I 1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
GENERATOR SECTION
number assigned to this manirest by the generator beginning with 00001.11 your company does not have a U.S. EPA Identification Number. please contact S.C.
OHEC at [phone] about obtaining an Identification number. I
-2: Page 1 of: Enter the total number of pages used to complete this manifest. i.e .. the lifst page EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 plus l.,._! ~ number al continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any. •
i-'.
, .
' \
A:. Slate Manifest Document Number": .. Leave blank.
B: Slate Generator ldenlrflcatlon Number: Leave blank. · . · · I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest !arms.
4. Generator's Phorie Number: · Enter a telephone number with area code where an authorized agent al the generator can be reached in the event al
emergency including nights, weekends. and holidays.
5. Transport 1 Company Name: Enter the company name of the first transPorter who will transport the waste.
6. _ U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the lirst transporter identiried in item 5. I ·t C. Slate Transporter's ID Number: Leave blank.
O. Transporter's Phone Number: ·enter a teleph0ne number including area code where an authorized agent of the lirst transporter can be reached in the event' ol
an emergency including nights, weekends, and holidays. I
· 7:. Transpor1er 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. If more !han 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa
U.S. EPA ID Number:II applicable, enter the U.S. EPA twelve digit 10 number ol the second transporter identified in item 7. l. ·e.'.
~E ..
'· F:.
Slate Transporter's ID Number: Leave blank. · ·
Transporter's Phone Number: Enter a telephone number including area code.where an authoiized agent of the second transporter can be reached in I
event of an emergency including nights. weekends. and holidays. ·
·+ 9.. Designated Facility Name and Site Address: ' Enter the company nnme and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manilesl The address must be the site address, which may diller from the mailing address.
10; U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment, storage, or disposal facility identified in item 9: I
1 G:. Slate Facility's ID Number: Leave blank. ,
H;.
11:
Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event ol an
, emergency including nights, weekends, and holidays.
U.S: DOT Descriptions: Enter proper shipping name, hazard class and 10 Number (UN/NA) for each waste as identilied in 49 CFA 171-177. Jf additional sp1
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Conlainers (no. and type): Enter nur,nber of containers for each waste and the appropriate abbreviation from Table I (below) for the type al containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases. roll offs
OW= Wooden drums. barrels. kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF = Fiberboard or plastic drums. barrels, kegs OT = Dump truck CF = Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap. cloth, paper or plastic bags
r ·~· -13 .. Tolal Ouanlily: Enter total quantity of waste described on each line, relative to the units used in item 14. I 14. Unit (weight/volume): Enter the appropriate abbreviations from Ta_ble II (below) for the unit al measure:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I.. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and l
identity the hazardous waste on each line.
J:-Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number (rrom the S.C. OHEC Authorization Request Fo
for each waste stream listed in section 11 above. Nole: Bel ore any hazardous waste can be accepted for treatmenl storage or disposal in South Carc,lina. the
generator must obtain prior authorization from the treatment. storage or disposal facility. I
K. Handling Codes lor Wastes Usled Above: · Leave blank. ,
l 5.: Special Handling lnstrucllons and Additional lnlormalion: Generators may use this space lo indicate special transportation. treatment. storage or d1spo
information or Bill ol Lading Information. For international shipments, generators must enler in this space the point or departure (city and s:ate) lor those
shipments destined for treatment, storage. or disposal outside the jurisdiction of the United States.
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement II a mode other than highway is used .•
word "highway" should be lined out and the appropriate mode(rail, w.iter.or air) inserted in the space below. II another mode in addition to the highway mod
used. enter the appropriate additional mode (e.g., and_ rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgemenl: Enter the name of the person accepting the waste on behall·of the lirst transporter. That person must acknowlet
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE ol receipt.
18. Transporter 2 Acknowledgemenl: Enter. ii applicable. the name ol the person accepting the waste on behalf of the second transporter. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipL
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative ol lhe designated lacility's owner or operator must note In this space any d,screpan~y betw
the waste described on the manifest and the waste actUally received at the f~cility. Owners and operators of facjlities who cannot resolve significant
di5crepancies within 15 dnys receiving the waste musl submit to the Departmenl a rener with a copy of the manifest describing the discrepancy and anemots 10
reconcile iL The treatment;storage, or disposal facility must enter the actual weight ol waste in pounds in the spaces provided ii the amount varies any !ram 11
s~eclried by lhe generator in Item l 3 or JI !he generator uses a unit ol measure other than pounds.
20. Facility Ownei-or Operator Cerllllcalion: Print or type the name ol the person accepting the waste on behalf of the owner Or operator of the facility. Thal pers n .
must acknowledge acceptance ol the waste described on the manifest by SIGNING (BY HAND IN INKf and entering the DATE or receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT, STORAGE. OR DISPOSAL FACILITY DESIGNATED I
REC[IV= THE WASTE OR THE s.c. DHEC MANIFEST SECTION AT (803) 73•-~~oo WEEKDAYS FROM 8:00 am TO 5:00 pm.
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South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Genorator"sU.S.EPAIDNo.
WASTE MANIFEST N c D o 7
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
.C. Generator's Phone 919
5. Transporter 1 Company Name
Smithfield,
934-9711
Willms Truckin Co Inc.
7. Transporter 2 Company ~ame
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8, U.S. EPA 10 Number
10. U.S. EPA ID Number
S C iJ O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d,
Form A
2. Paga 1
of
Emergency & Holidays: [phone]
roved. 0MB No, 2050-0039 E.t ires 9-30-88
Information in lhe shaded ateas is not
required by Federal law, but is by State law.
-~;~~J=;;~:~~:;;;~:1:~~t;{::::~~J~~~f7~:'.t
]~;,:;~~'.0i;~:;;;~r:t!::::;r;~:;'.i'0~: .. ,,. -./:~~-.:_~;:=.:Z~~;f~~
12. Containers 13. Total Quantity 14. Uni fl~ISll~ti.i
No. Type WVVrJ ~'.,hllfhY~lWWi:ff
tit:t~;ii~Jilllt:r::;i· , .. ,
a. ILJR.J-Io , 2 , 1 , 1 , 4 1-I 1 , 1 , o , 21 til;,1,.. .__,__L..JL..JL....1-L-L..J'--''--'
b. LLJ.-::: I ,, .. ', ... 1:.! ... L .... ,'., .. ,.' ... tl~fil!'!;,i;;t!J~:.W:J,,,!., !,,,!w.L,!=J,,1,.,,,
15. Special Handling Instructions and Addilional lnlormation
GSX Work Order No.: 71351
1 e. OEN ERA TOR"S CERTIFICATION: I hereby declare that tho conlont• ol this conalgnment are fully and accuratelyde•crlbed above by proper ahlpplng name and are clasalfl.C,,
packed. marked. and 1ahe1ed, and are In all respects Jn proporcondlllon for transport by highway according to app1Jcabla International and national government regulation• and
the 1aws ol tho Stale ol South Carolina.
tr I am a largo Quanliry generator, I certify that I have a program In place to reduce the volume and toxicity or waste ganoraled to tho degree I have determined to be eeonomlcalty
practicable and thal I have selected the practicable method ol treatment. slorage, or dlapoaal currently available to me which minimizes the pr11-n1 end future 11'\teat to human
heallh and the environment: OR, If I am a small quantity generator, I have made a good la Ith effort lo minimize my waste generation and select 11'\e bell w1111e management ""9th0d
that is available to me and that I can afford.
Prinled/Typed Name Signalure Month Day Year
of" 2-, .P.
Month Day Year
1~1---------------
• I pbs. C I !lbs.
b I Jibs. d I Jibs.
~ 20. Facility Owner or Operator; Certilication of receipt or hazardous malerials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature Month Day Year
EPA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete {DHEC 1988 (Rev. 10/86))
IMPORTANT:
STATE OF souT~'~A~l
1
~1~A 1Ns9~t~~[~~;·i~it)tt!i:AM HAZARoous WASTE MANIFEST · I
TYPE [on a 12-pitch (elite) typewdter] OR USE FIRM POINT PEN -PRESS OOWN HARD ALL COPIES MUST BE LEGIB[ .
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators of hazardous waste treatml
··storage. or disposal licilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Fa
r · · 8700-22A Rev:9/86 {DHEC 1988A) lei both inter-state and intra-state transportation. Transporters who transport hazardous waste into !he United States tr
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters al hazardous waste and
owners or operators ol hazardous waste treatment, storage, or disposal facrhl1es to complete the following 1nformatron. 1 .• GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manilesl Document Number: Enter the generator's U.S. EPA twelve d1g1t 1dent1f1cat1on number and the un1que five d1g1t
number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA Identification Number. please contact S.C.
·-OHEC at {803) 734-5200 about obta1n1ng an ldentillcation number. I
t 2: ". Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the hrs! page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)1 plus
; ... _.; ~ number of cont1nuat1on sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) 11 any.
~ A:. State Manifest-Document Number: .. Leave blank.
B: State Generator Identification Number: leave blank. · · · I
'3. · Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
4. Generator's Pholle Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ot
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. ·: U.S. EPA 10 Number: Enter the U.S. EPA twelve digil identification number of the first transporter identified in item 5.
c.', Slate Transpor1er's 10 Number:, Leave blank: I
0. Transpor1er's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the even! al
an emergency including nights, weekends, and holidays.
1: . .;. Transpor1er 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 transporters I
be used. use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the wa ~ L ·a .. U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit ID number al the second transporter identHied in item 7.
;.. '"E'.. State Transpor1er's ID Number: Leave blank. · ·
F:. Transporter's Phone Number: Enter a telephone number including area code.wh.ere an a.uthoiized agent of the second transporter can be reached in I t event ol an emergency including nights, weekends, and holidays. ·
r 9.. Designated Facility Name and Site Address: Enter the company nnme and site address ol the treatment, storage, or disposal racility designated to receive the
waste listed on this manifest The address must be the site address. which may dilfer from the mailing address.
10; U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment, storag~e, or disposal facility identified in item 9. ,
G:: Slate Facility's ID Number: Leave blank. _.,
H;.· Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the facility can be reached in the event ol
emergency including nights, weekends, and holidays.
11·. U.S'. DOT Oescriplions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 171-177.11 additional spl
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) tor the type of containers ..
TABLE I
OM = Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes. cartons, cases. roll oHs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons, cases
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or p!as1tc bags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
14. Unil (weighl/volume): Enter the appropriate abbreviations lrom Table II (below) for the unit of measure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters -Y = Cubic Yards G = Gallons (liQuid only)
I.. Waste Number: Enter hazardous waste numbers as specilied in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subparts C and l
identify the hazardous waste on each line.
·J.-Additional Oescriplions for Materials listed Above: In the spaces provided. enter the authorization number (from the S.C, DHEC Authorization Reciuest Fo
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted !or treatment. storage or disposal ir1 South Carolina. the
·generator must obtain prior authorization from the treatment, storage or disposal facility.
K. Handling Codes for Wastes lisled Above: leave blank. r-I
15 .. Special Handling Instructions and Addilional Information: Generators may use this space to indicate special transportation. treatment. storage or dispo
information or Bill ol Lading Information. For international shipments, generators must enter in this space the point of departure (city and s:ate) for those
shipments destined lor treatment, storage, or disposal outside lhe jurisdiction of the United Slates.
'16. GeneralorCertilication: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. If a mode other than highway is used .•
word "highway" should be lined out a·nd the appropriate mode (rail, water.or air) inserted in the space below. II another modE? in addition to lhe highway mod
\ used. enter the appropriate additional mode (e.g., and_ rail) in !he space below. ·
.-·· TRANSPORTER SECTION
· 17: Tran~porter 1 Acknowledgement: Enter the. name of the person accepting. !he waste on behall of the lirst transporler. That person mu,st acknowle1
• acceptance al the waste described on the manilest by signing (BY HANO IN INK) and entering the DATE ol receipt ·
18. Transporter 2 Acknowledgement: Enter. if applicable. the name ol the person accepting the waste on behall of the second transporter. That person must
acknowledge acceptance of the waste described on the manilest by SIGNING (BY HANO IN INK) and entering· the DATE of receipt
FACILITY SECTION I
·,. 19. Discrepancy Indication S
0
pac_e: The authorized representative of the designated lacility's owner or operator must note in this space any discrepancy belw
the waste described on the manifest and the waste actually received at the f~cility. Owners and operators of facjlities who cannot resolve signilican
discrepancies wilhin 15 days receiving the was le musl submit to the Department a letter with·a copy of the manilest describing the discrepancy and anempts to
, I reconcile it The lreatment.·storage, or disposal facility mus! enter the actual weight ol waste in pounds in the spaces provided if the amount varies any !ram ti
specified by the generator in Hem 13 or U the generator uses a unit of measure other than pounds.
20. Facility Own el' or Operator Certification: Print or type the name ol the person accepting the waste on behalf ol the owner Or operator of the facility. That pers .
must acknowledge acceptanc"e of lho waste described on the manifest by SIGNING {BY HAND IN INK)and entering the DATE of receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
P.ECE>VE THE WASTE OR THE s.c. DHEC MANIFEST SECTION AT (803) 73•-s~oo WEEKDAYS FROM BOO am TO 5:00 pm.
I ~outh Carolina Department of Health
' and Environmental Control
Bureau of Solid & Hazardous Waste_ Mgt
2600 Bull Street COiumbia. SC 29201
Phone: {803)734-5200
Emergency & Holidays: {803)734-5424
I PLEASE PRINT or TYPE (Form desi ned for u;e on elite 12· itch writer ·
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No. Menlfeet Document No.
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1
of Information in the shaded a,eas is nol
required by Federal law, but is by State law.
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WASTE MANIFEST N c D o 7 o
3. Generator's Name and Mailing Address
Channel-Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
0 0 0 4 8
-~\li:l;=::~(tti/:fi:;:~l*~:~; ttt~;.t:fr
~irff:~~1!~:;:~;;j"\~~!l:~,:'.:f:t;fl3:;tJt0i/\<t~·
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. containers 13. Total Quantity 14. Unit =::t:N~ ~}k
No. Type WI.Nd. '.\}NfV?d)YN>WWJ
d.
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71352
,e. GENERATOR'S CERTIFICATION: I herebydecl■rethal lhe conlents of this conalgnmentere fully and eccuretelydescribed above by proper shipping nama and ara claaained.
packed, marked, and libeled, and are In all respects In proper condition for transport by highway eccordlno to appllcable lnternellona1 and nation el governman1 r--.iulationa and
the lawa ol lhe Slate ol Soulh Carolina.
111 am a 1arga Quantity generator, I certity that I have a program In place to reduce the volume and toxicity of waale genaralod to the d9i:!r-1 have determined to M oc:onomlcally
practicable and that I have aelected the practlcabla method ol treatment. storage, or d\apoaal currenlly available to mo which mlnimLtes the preMtnt and lutura lhrNt to human
health and Iha environment OR. II I am a small Quantity generator, I have mado a good lo Ith effort lo minimize my waste generation and select the beat waste management rnolhod
Iha! is availab!e 10 me and that I can attord.
·~l--,P,,-ri-nt_ed_l_Ty_p_ed_N_•_m_• __ ,.;.JZ_c.J':i..:14-:;_.,..:L:..,:....G,-,'.:.:,ds:::.;::.....1...Si-gn_•_tu_re_..;_...,.,;z._..:;,_-;/..:;;:._;'_..;~:::;;.,;.:;:;;:.:i.::, _____ .J.M;:~,i:n~::..l~~;l,a,!.Y.i.:;h.1ear~
~ 17. Transporter l AtKnowledgement ol Receipt of Materials
I j'.'.: Prinled/Typed /, ~ '-fl.
~ 18. Transporter 2 Acknowledgement of Receipt of Materials
~ Printed/Typed Name Signature· Month Day Yea, •~R ---------'-------~~ 19. Discrepancy Indication Space
F a l,J....1..,j..J....1...Jpbs. c I libs.
I A~: 1--.,,.----,,----------b I
.L...J..LJ.....L...J..Jpbs. d I jibs.
;:: 20. Facility Owner or Operator, Certification of receipt ol hazardous materials covered by this manifest except as noted in Item 19. I Printed/Typed Neme Signature
EPA Form 8700-22 {Rev. 9/86) Previous Editions are Obsolete [DHEC 1988 {Rev. 10/86)1
, Month Day YMI
IMPORTANT:
,· 4 'h•,ll,, ',·Vi \ ,1_,,_ 1~ <i-•,_ir?
STATE OF sourH ~~·~oLINA tNsi~~~~ib:;-;:~!t1~·~';'6RM HAZARoous WAsrE MANIFEST · I
TYPE [on a 12-p;tch (eMe) typewdter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIB •
GENERAL INFORMATION: Federal Regulations require generators and transporters ol hazardous waste and owners or operators of hazardous waste treatml
storage. or disposal licifities to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/66)} and, ii necessary, the continuation sheet U.S. EPA Fo
8700-22A Aev:9/86 (DHEC 1988A) for both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
t . · _another country are responsible for completing the manifest Federal and State regulations also require generators and transporters of hazardous waste and
;.-..... ;::;;n~:;~:;:;~,_;;:~::ouu~b::~
1
::::~:~:~:~o~:::· :~::::s•~:::i:~•: ~:::,::,~:e~:e :o~l:~~ne:~::~:~::::;1;ca1;on. number and the unique 1;~~ ·d1
1 number assigned to this manilest by the generator beginning with 00001. U your company does not have a U.S. EPA Identification Number, please cont.let S.C. f ~·--~,... · DHEC at [phone] about obtaining an Identification number. · .• r ·-2:.~ Page 1 of: Enter the total number of pages used to complete ttiis manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86{DHEC 1988 (REV 10/86)1 plus f---1• "number ol continuatiory sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any. .
! ............ A. Slate Manifest Document Number: .. Leave blank. ·
, . B: Slate Generalor ldenliflcallon Number: Leave blank. · · · · I
;~ ··•3. Generator's Name and Mailing Address: Enter the name and mailing address ol lhe generator who will manage the returned manifest lorms.
i , ' 4. Generator's Phor1e Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of l . . . . . t •· .... , emergency including nights, weekends. and holidays.
•f 5. Transport 1 Company Name: Enter the company name ol the first transporter who will transport the waste. ~ . 6.;_: U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the first transporter identified in item 5. . I
,, _ ~ C .. Slate Transporter's ID Number:. Leave blank: . · 1 · · -O. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the fir's! transporter can be reached in the event of
r'" · , an emergency 1nclud1ng nights, weekends, and holidays.
' 7: Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste II more than 2 transporters I ' . be used. use a US. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the lransporters m the order they will be transoort1ng the wa
1,-· l 8 ••.. U.S. EPA ID Number:!! applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. j · ,., e:: State Transporter's ID Number: Leave blank. . · · .
f LF: ... Transporter's Phone Number: Enter_a telephone number including area code _w~ere an authorized agent of the second transporter can be reached in I 1,~· 1 event ol an emergency including nights, weekends, and holidays. · .
· ~-~ 9::-; Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
r .. :_. 1~: ~~t~~~~? ~nu:~e;an~f~t:\ J:ee i.~~r;;~ ~::1~:ed~:~ ~~~n:i~~~~~s~ ;~~:e~~r t~i::e':~~~:~ ::~\:;e~1d:1:::·ge. or disposal facility id~ntilied in item 9. ,
t-1 G •. Stale Facility's ID Number: Leave blank. £ ~ H;;: Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of I emergency including nights, weekends, and holidays. i 11~ U.S; DOT Descriplions: Enter proper shipping name. hazard class and ID Number(UN/NA) for each waste as idenlilied in 49 CFR 171 • 1 77. rr additional spl
{ _ .. is needed. use a.U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Conlinuation Sheet.
1 ' -12.. Containers (no. and type): Enter number of containers !or each waste and the appropriate abbreviation from Table I (below) tor the type of containers.
r.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons, cases. roll otts
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels. kegs DT = Dump truck CF= Fiber or plastic boxes. cartons. cases .I
TP = Tanks portable CY = Cylinders BA = Burlap, cloth. paper or plastic bags
13 .. Total Ouanlily: Enter total quantity ol waste described on each line, relative to the units used in item 14.
14. Unit (weight/volume): Enter the appropriate abbreviations rrom Table II (below) for the unit al measure;
Table II I
F3 = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons {liQuid only)
L Wasle Number: Enter hazardous waste numbers as specHied in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subparts C and I
identify !he hazardous waste on each line.
· · .. ,J.--Additional Descriptions for Materials Listed Above: In the spaces provided, enter the authorization number {from the S.C. OHEC Authorization Request Fo
' for each waste strea·m listed in section 11 above. Note: Belo re any hazardous waste can be accepted for treatment. storage or disposal in South Carolina. the
generator must obtain prior authorization from the treatment, storage or disposal facility.
K. Handling Codes for Wastes Lisled Above: Leave blank. r, · · · I
; . '..-1~ 15." Special Handling Instructions and Additional Information: Generators may use this space lo indicate special transportation. treatment. storage or dispo
information or Bill ol Lading Information. For international shipments, generators must enter in this space lhe point of departure (city and state) !or those
shipments destined for treatment. storage. or disposal outside the jurisdiction of the United States. · ~ 16. GeneralorCertillcation: The generator mus! READ, SIGN (BY HANO IN INK), and DATE lhecertilicalion statement. II a mode other than highway is used .•
word "highway .. should be lined out and lhe appropriate mode{rail, water.or air) inserted in the space below. H another mode in addition to the highway mod
\ used, enter the appropriate additional mode (e.g., and_ rail) in the space below.
: _, TRANSPORTER SECTION •
·· 11: Tran~porter 1 Acknowledgem~nt: Enter the ~ame al _the_ person accepting the waste o~ behalf al the lirst tr~nsporter. That person musl acknowlel
: ... , acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entermg the DATE of receipt. .
-· 18. Transporter 2 Acknowledgement: Enler. ii applicable. the name of !he person accepting the waste on behalf al the second transporter. That person must
·~" acknowledge acceptanc'e or the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt
j FACILITY SECTION I
;~ ! -19, Discrepancy Indication Spac.e: The authorized representative ol the designated lacility·s owner or operator must note in this space any d1screpancy betw
, the waste described on the manirest and the waste actually received at the f~cility. Owners and operators al facjtilies who cannot resolve signific t
,.~ discrepancies within 15 days receiving the waste must submit to !he Department a letter with a copy ol the manifest describing the discrepancy and anempts to
• ; reconc:ite it The treatment,·slorage, or disposal lacility must enter the actual weight of waste in pounds in the spaces provide_d ii the amount varies any !rom ti
specllied by the generalor in item 13 or II the generator uses a unil of measure olhei than pounds. .
20. Facility Ownel' or Operator Certlllcallon: Print or type the name of the person accepling the waste on behalf al the owner Or operator ol the facility. Th3:t pers .
must acknowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HANO IN INK)' and entering the DATE al receipt.
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
RECEIVE THE WASTE OR THE s.c. DHEC MANIFEST SECTION AT (803) 73,.swo WEEKDAY~ FROM 8:00 am TO 5:00 pm.
' .
I South Carolina Department of Health
and Environmental Control
Bureau or Solid & Haz.ardous Waste Mgt
2600 Bull Stre-e~ Columbia, SC 29201
Phone: (80.'.l) 734-5200
Emergency & Holidays: [phone]
PLEASE PRUIT or TYPE ewriler Form A roved. 0MB No. 2050-0009 E, ires 9-30-Ba
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UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA ID No.
N C D 0
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield,
,. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
SCD070
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
2. Page 1
ol Information in the. shaded a<eas is not
required by Federal law, but is by State law.
~:;re_,_;_•·_._·_,_-_-F~ Niimi,«;: ,,Y,,_iP>aN+
w , +~/':~
12. Containers 13. Total Quantity
No. Type
14. Unit (LW&1l8Numbeift
'MN,j '.Jf->rn:~t<~fY<t<rt~f
al.E.Jl:l..J-I012171714l-ll1l10121:{f:@,t 0·LLJ-I 1-1 Iii{
b. LLJ-1 1 1 1 1 ,-, 1 1 1 Jilf,!ii~~'.t,1Hd:l,+J-I I J,,J:J I\~!
15. Special Handling lnstructio_ns and Additional Information
GSX Work Order No.: 71380
16. GENERATOR'S CERTIFICATION: I hereby declare thellhe contents olthls consignment ere fully end accurately described above by proper •hipping r,.ama ar,.d are clas•illed.
packed, marked, ar,.d ta'beled.end are Ir,. all respects in proper condition lor transport by highway according to appl!cable lnlernallonat and national governmenl r99ulatlons an<I
U'I0 laws ol the Stale ol South (;arotina.
JI I am a large quantity generator, 1 certify that I have a program In place to reduce the volume and toxlcltyol waste generated to the degree I have determlnod to b-e economically
practicable and that I have selected the practicable method of treatment, storage, or dispose! currently avallable to me which minimizes tho present and future threal to hum.en
health and the environment: OR. ii I am a small Quantity gonoralor. I have mado a good laith eNor1to minimize mywaslit generation and select the be•t waste management method
that is availab!o to me and that I can attord.
Month Day Year
C) ,f,Z,.
T 17. Transporter 1 Ac.;Knowledgement ol Receipt of Materials R,---.:..:..'--'----='-'--'----'--'-------~------------------------------
A Printed/Typed Name Signature ~ 1---u."..L.,~~/l.,:...;':.:fJ!:.::,,.,___.=::~-1....-L.X:..:::.-:.:,; ... ~_/c._c....::.. _____ _,._..L.L-'--'"'~<~· ::::~o'---=.....,"'--l..o..:::::..=::..:::....--=----------'-"CJ:...L.;:J::
Montti
0
g ~1 ... e:.. __ T_r;.•n.cs;::po.:...rt;.erc..2:..c.A;.c __ kn_o:..w_l;.ed:oga;e:..m.ce:..n:..t;.oc..l R ... •.cc:..e"ipc;t..:o:..1 ... M..:•:..'•:..r..:i• ... ls'----~---------------------------------
1 T Printed/Typed Name Signature
H~ ..,.....,----,------.L...---------1...1-....
19. Discrepancy Indication Space
Month Day Year
F a I jibs. °I jibs.
b I jibs. d! jibs.
Month Day Yeas
If I f-:-,-::-,-,---,,-----,,-,,--,---~ 20. Facility Owner or Operator, Certification of receipt ol hazardous materials covered by this manifest except as noted In /!em 19. I Printed/Typed Name Signalure
EPA Form 8700-22 (Rev. 9/86) Previous Editions arc Obsolote [DHEC 1988 (Rev. 10/86)]
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations ·require generators and transporters of hazardous waste and owners or operators al hazardous waste treatmel
storage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Aev.-9186 (OHEC 1988A) foi both inter-stale and intra-state lransportation. Transporters who transport hazardous waste into the United States Ire ,
another country are responsiO!e !or completing the manifest Federal and State regulations also require generators and transporters of hazarCous waste and
owners or operators or hazardous waste treatment, siornge, or disposal racilities to complete the !allowing information. •.
GENERATOR SECTION
1. Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manifest by the generator beginning with 00001. II your company does not have a U.S. EPA Identification Number, ;::lease con:act S.C.
OHEC at [phone] ·about obtaining an Identification number. · · I
2: Page 1 ol: Enter the total number of pages used to complete this maniresl, i.e., the first page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)j i;lus t
number al continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEG 1988A) ii any.
A. State Manifest Document Number: . Leave blank.
e: Slate Generator ldenUficallon Number: Leave blank. I
3. Generator's Nam~ and Mailing Address: Enter the name and mailing address of the generator who will manage the returned maniles: forms.
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol an
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the first transporter who wilt transport the w8ste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the lirsl transporter identiried in item 5.
C. Slale Transporter's ID Number:. Leave blank: I
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event o)
8 •.
E ..
an emergency including nights, weekends, and holidays. 1·
1:. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters w
be used, use a U.S. EPA Form 8700-22A Rev, 9/86 (OHEC-1988A) continuation sheet and fist the transporters in the order they will be trarispoli.ing the was: •.
U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit 10 number ol the second transporter identified in item 7.
Slate Transporter's ID Number: Leave blank. • • - · · I
F .. Transporter's Phone Number_: Enter a telephone number including area code where an authorized agent ol thE! ~eCond transporter can be reactH:id in th
9.
10.
G:
event ol an emergency including nights, weekends, and holidays. · ·
Design a led Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be the site address. which may differ from the mailing address. ' · -,
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilicalion number ol the designated treatment, storage, or disposal facility identified in item 9.
State Facility's ID Number: Leave blank. ' -·
H;. Facility's Phone Number: Enter a telephone number _including area cod8 where an authorized agent o:I the facility can be reached in the event al ari
,,._ emergency including nights, weekends, and holidays. · I
U.S: DOT Descriptions: Enter proper shipping name, hazard class and 10 Number (UN/NA) !or each waste as identHied in 49 CFA 171 -177. II additional spa
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. .
12.. Containers (no. and typ·e): Enter number of conlainers !or each waste and the appropriate abbreviation from Table I (below) tor the type cl containers.
TABLE I r OM = Metal drums, barrels. kegs TT = Cargo tanks (lank trucks) CM = Metal boxes. cartons. cases. roll otfs
OW= Wooden drums, barrels. kegs TC= Tank cars CW= Wooden boxes. cartons. cases I
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Ouanlily: Enter total quantity of waste described on each line, relative lo the units used in item 14.
r.s. Unil (weighl/volume): Enter the :1ppropri:1te nbbrcvi:-itions from Tnble II (below) for lhe unil ol mcnsure: I Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquii;l onll
I. Wasl_e Number: Enler haznrdous waste numbers as specified in South Carolina Hnznrdous Waste Management Regulalion R.61-79.261 Suboar1s C and DI
identity lhe hazardous wasle on each line.
J. Additional Descriplions lor Materials Li sled Above: In the spaces provided, enter the authorization number (lrorn !he S.C. DHEC Authorization Request Farm)
!or each waste stream listed in section 11 above. Note: Before any hazardous waste ca·n be accepted !or treatmenl storage or disposal in South Carc-lina. the
generator must obtain prior authoriziltion lrom the treatm_ent, storage or disposal facility. - • . -. ..,, i ·
K. Handling Codes lor Wastes Listed Above: Leave blank. · · · .
15. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or dispos
information or Bill of Lading Information. For international shipments, generators must enter in this sPace the point of departure (city and state) for those
shipments destined !or treatment, storage. or disposal outside the jurisdiction ol the United States. · , ~ 'I
16. Generator Certilicalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used, t
Word "highway" should be lined out and the appropriate mode (rail. water. or air) inserted in the space below. II another mode in addition :o the highway mode 1
used, enter the appropriate additional mode (e.g .. _and_ rail) in the space below.
TRANSPORTER SECTION ·
17: Transporter 1 Acknowledgement: Enter the name of the person accepting lhe waste on behalf al the first transporter. That person mus: acknowledi;I
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE o_f receipt. . , ;,,1 18. Transporter 2 Acknowledgement: Enter, ii applicable, the name ol the person accepting the waste on behalf ol. the second transpo11er. That person must
acknowledge acceptance of !he waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt. .,1 FACILITY SECTION ·
19. Discrepancy Indication Space: The authorized representative of the designated facility's owner or operator must note in this space any discrepancy be twee .
the waste described on the maniresl and lhe-wasle acllially received at the lacility. Owners and operators of facilities who cannot resolve significant
Q'i1CH}i:IAnc.lt11 w1H1ln 1s daya ,c,cel¥1ng tho wtuuo mua1nuem/110 tM oepeMmen1 a letter wun a copyo! lhe mnnu"es1 d·e9crlblng lhe dlscre~ancy and ar.emc,ts I
reconcillJ it. The treatment, storage, or disposal facility mus I enter the actual weight al waste in pounds in the spaces provided ii the amount varies any !ram tr.
specified by the generator in ilem 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Ownef or Operator Cerllticalion: Print or type the name of the person accepling the waste on behalf ol the owner or operator of the IJcility. Thai person
must acknowledge acceptance al Iha wasle described on the manifest by SIGNING (BY HAND IN INK)and entering the DATE al receipt.
Ill' AS~!STANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TP.r.• ·•.1ENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED Tl
RECEI' .. THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKu,:., :; FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree( Columb;a. SC 29201
Phone: [phone]
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, I Box 255
Pinewood SC 29125
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and JO Number)
a.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71381
Emergency & Holidays: (803)7.34-5424
Form A roved. 6MB No. 2050-0039 Ex ires 9-30-88
2. Page 1
ol
Information in the shaded a,eas is no!
required by Federal law, but is by State law.
;i1;:=:;~:~::~1:::\~~:'.~);ttr~~t:~)?(
lt;;;~~~z.~:;~'.f~i!N~;'.~t:~:'.i:,:!:0_:!!~~~:;i~f :'.;.;:::f~:y~~~-
12. Containers 13. Total Quantity 14. Unit
No. Type 'MNd
1 D T 2 0 Y
16. GENERATOR'S CERTIFICATION: I horobydoclara that tho contents ol lhlsconslgnmontara lully and accuratolydaacrlbod abova by proper 1hlpplng name and are claH1lled.
pack ad. marked, and laheled, and are in a11 respects in propercondilion tor lransportbyhlghway according to applicable lnlernationat and naUonal gov11rnm11n1 reQulaUona 1od
ttia laws of the State ol Soulh Carolina.
111 am a large quantity generator, I certify (hat I have a program In place to rodueathavoluma and toxlcltyol wastaganara1ed to Iha degree I have datarmina-d to be economically
practicable and that I have salecled the praclicable method ol treatmanl, storaga, or dlsposal currently available lo ma which minimizes tha preuml and future uir .. 1 to human
health and the environment; OR, Ill am a smoll quantity generator, r hove medo a good faith aMor1 lo minimize my waste generation and select the beat waala managemanl rnetnocl
that is available to me and that I can aHo,d. ·
_Printed/Typed Name Month Day
()lr,2
o 18. Transporter 2 Acknowledgement of Receipt of Materials Ri-'--==.::..:cc.:.:..c..:..C..:====.:.c.:::..:c.c.c:=:.:...---,--,----------------'--------,-,-,--:---::--t Month Day Year T Printed/Typed Name Signature
l.....i-~ ------'-------_........_.~ 19. Discrepancy Indication Space
F
A
C
I
L 11---------------~ 20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by this manifest except a, noted in Item 19.
PrinledtTyped Name Signature
EPA Form 8700-22 (Re11. 9/86) Previous Editions ore Obsolete (OHEC 1988 (Rev. 10/86)1
'I
b I
Jibs. C I Jibs.
!fbs. d I Jibs.
Mon!/\ Dey y..,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST -I
IMPORTANT; TYPE [on a 12-pilch (elite) typewriter} OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and lransporters of hazardous waste and owners or operators ol hazardous was:e lrea:meJ
slorage. or disposal ricili!ies to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA For
8700·22A'Aev.-9186 (DHEC 1988A) for both inter-state and intra-stale lransporta!lon. Transporters who lransp0rt hazardous waste into the United States lror
another country are responsiDle lor compleling the manifest Federal and State regulations also require generators and transporters ol hazardo'-!.s wa:ae ana
owners or operators ol hazardous waste treatment. storage, or disposal racililies to complete the lollowing information. I GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manilesl. Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
2:
number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA ldentilication Number. please contact S.C.
OHEC at [phone] about obtaining an identification number. · · · ■
Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the riist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10186)1 plus :ra
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A. Slate Manilest Document Number: .Leave blank.
B: Stale Generator ldentificallon Number: Leave blank. I
Generator's Nam~ and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest rorms.
Generalor's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of an
3.
4.
emergency including nights, weekends. and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Stale Transporter's ID Number:. Leave blank: I
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol the first transporter can be reached in the event of
an emergency including nights. weekends. and holidays. I
7: Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 transporters~
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC .1988A) continuation sheet and list the transporters in the order they will be transporting the wast
8 .. U.S. EPA ID Number:!! applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E State T,.iinsporter's ID Number: Leave blank. · · ·
F.. TransPorter's Phone Number: Enter a telephone number including area code .where an authOriz"ed agent 'Orlhe" ~e'Cond transporter can be reached in thl
event ol an emergency including nights, weekends, and holidays. · _
9. Des_ignated Facility Name and Site Address: Enter the company name and site address ol the treatment, storage, or disposal racility designated :o receive the
waste listed on lhis manHest The address must be the site address, which may differ from the mailing address:··
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the designated treatment, storage, or disposal facility iden:ified in item 9.
Slate Facility's ID Number: Leave blank. I
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol !he facility can be reached in the event al an
emergency including nights, weekends, and holidays. · _
U.S: DOT Descriptions: Enter !.'.)roper shipping name, hazard class and ID Number{UN/NA) for each waste as identified in 49 CFR 171-1 ii. If ac'diticnal spacl
is needed. use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. . . . ., .•
11:
12.. Conlainers (no. and type):· Enter number ol containers tor each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I .
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons. cases. roll o!ls
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck _CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks-portable CY= Cylinders . BA= Burlap. cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line. relative to the units used in item 14.
T-t. Unit (weight/volume): Enter the nppropri,110 ,1bbrevintions rrom T.ible II {below) for the unit ol mcnsurc:
Table II •• P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Wasle Number: Enter hazardous waste numbers .is specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C ar:d DJ
identity the hazardous waste on each line. .
J. Additional Oescriplions lor Materials Listed Above: In the spaces provided. enter the authoriza1ion number (lrorn the S.C. DHEC Aulhor1zation Request For
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatment storage or disposal in South Carclina. ;·he
generator must obtain prior authorization from the treatment, storage or disposal lacility. " . · ..• -···1
K. Handling Codes for Wastes Listed Above: Leave blank.
l 5. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or dispos
information or Bill or Lading Information. For international shipmenls, generators must enter in this space the point ol departure (city and state) for those
shipments destined lor treatment. storage, or disposal outside th~ jurisdiction ol the United Slates. · 1·
16. Generator Certilicalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. ti a mode other than highway is used. I
Word "highway" should be lined cul and the appropriate mode(rail. waler.or air) inserted in the spate below. If another mode in addiiion to the highway mode 1
used, enter the appropriate additional mode.(e.g.,.and. rail) in the space below,
TRANSPORTER SECTION
n: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalf of the lirst transporter. That person must ackn~wleds;I
acceptance al the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt. .
18. Transporter 2 Acknowledgemenl: Enter, ii applicable, the name of the person accepting the waste on behalf of the second transporter. That person mus:
acknowledge acceptance or the waste described on the manifest by SIGNING {BY HAND IN INK) and entering the DATE of receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative ol the designated facility's owner or operator must note in this space any discrepancy betwee
the waste described on the manifest and the waste actually received al the facility. Owners and operators of racilities who cannot resolve significant
discre.pancies wilhin 15 d;:iy. s receiving.lho w;:iste musl submil to the Oep. artmenl a letter with a copy ol the manifest describing the discrepanc;· ar.d a.:em~:s I
reconcil~ il The treatmenl storage, or disposal facility must enter the actual weight of waste in pounds in the spaces provided ii the amoun! ,,aries any trcm tr.
specil1ed by the generator 1n item·13 or ii the generator uses a unit or measure other than pounds. · ·
20. Facilily Owner or Operalor Certification: Print or type the name of the person accepting the waste on behalf of the owner or operator or the facility. That person
must ac~nowledge acceptanc'e or the waste described on the manilest by SIGNING (BY HANO IN INK)° and entering the DATE of receipt.
ur ASSISTANCE JS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE Tri.r ,• . ',lENT, STORAGE, OR DISPOSAL FACILITY DESIGUA TEO Tl
RECEI'. . THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT (8031 734-5200 WEEKur,., :; FROM 8:00 am TO 5:00 pm.
I
I
I
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 2920t
Phone: [phone]
Emergency & ·Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9.30.aa 1
UNIFORM HAZARDOUS 1. Generetor'sU.S.EPAIDNo. Manlfeet
Document No. WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
,. Generator's Phone [phone]
5. Transporter l Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
14000 l
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
a.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
2. Page 1 Information in the shaded a<eas is not
of required by Federal law, but is by State law.
l· D T
1~i;1'·f :·,;o,,:i·~,:-g~r~~
2 0 Y ~•f1Q1Q161~
-.. · ... -··,.d,•',,',,.,. }!; lc....L-..L-....L-··,1·it·
==:} I 1l~ ,·:. . ~~
1:t~;~j~t,mlii&iiiilliiilr1itiiitllitijii1lliI1i■iiiii
a.~-I012171714l-llr110121' c.LL.J-1 1-1 FW
b. LL.J-1 1-1 1~llf1i!,m;,t~W~I 1-1
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71382
16. GENERA TOR"S CERTI_FICATION: I horebydeclare lhRI tho conlonl:s ot lhi:s consignment are lullyond occurelely de:scrib&d above by proper 1hlpplng name and are claH1lled,
packed. marked. and labeled. and ore in nil ro:spects in proper condition tor transpor1 by highway according lo applicable International and natlonal govornmanl regulations and
ltla laws ol the State ol South Carolina.
111 am a large quantity generator, I cor1iry !hot! have a program ln place to r&duca Iha volume and todcltyof wastagonaralod to the degroa I have determined to be oconomlcally
practicable and that I have :selected tho practicable method ol lreatmont, storage, or dl:spoaal currently avallabla to mo which minim I.tea tho present and lurvre tt\r-t to l'luman
health and the environmenl;OR, irl am a small quantity gonorotor, l have made o good leilh effort to minimize my waste generation and select tho boat waste management method
thal is available to me and that I can atford.
Printed/Typed Name Year
P7
T 17. Transporter 1 At;Kn·owledgemenl ol Receipt of Materials I ~ ~~P""r::in:::ted'7./~Ty::::...:.;::..:::.::::::.:::::!!::::::::::..:::..:.::7 :!'.:..:::..::'.:;f:::::::::...-,...--r;:,::c:-:---tY-------;£-;..;.-;:::-7'7--';f-,/-,~----;;::::::--;:::--:;:::-i
0 ~ 1--''--=-=.:,..c"-''-'-C:..C:..:C:s.:.;..:.:c..:.c.......c.cc:..::.c.:;_;..:;,:;;.cc.;__ ___ T::S7ig_n_a-tu-re---f-------------------------:-:--::---::----:::--1 Month Day Year
l ... ~-1----------------L------------------..................... ~-i
19. Discrepancy Indication Space
F
"A
I ~ 1--,--.,.,.....,,--------,--..,...-~ 20. Facility Owner or Operator; Certificalion of receipt of hazardous materials covered by this manifest except as noted In llem 19.
Printed/Typed Name Signature
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete [OHEC 1988 (Rev. 10/86)]
• I !fbs 'I !fbs
bl 11"'-d I jibs
Month Day Year
STATE.OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZAROOUS WASTE MANIFEST I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEG_IBL~_!
GENERAL INFORMATl<;)N: · Feder'al Regulations require generators and transporters of hazardous waste and owners or operators of ha_zardous waste treatmerl ·
s1orage, or disposal ficililies to use the U.S. EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)] and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Rev.-9186 (DHEC 1988A) for both inter-stale and intra-sfate transportation. Transporters who transport hazardous waste into the United States lro
another country are responsiOle !or completing the manilesl Federal and Slate regulations also require generators and transporters of hazarCous waste anc
owners or operators ol hazardous waste lreatmenl. storage, or disposal facilities to complete the lo!lowing information. I GENERATOR SECTION ,.
2;
Generator's U.S. EPA ID Number• Manllesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
number assigned to this manifest by the generator beginning with 00001. llyourcompanydoes not have a U.S. EPA Identification Number. please con:act S:~-
OHEC at [phone] about obtaining an Identification number. · · · I
Page 1 of: Enter ~he total number of pages used to complete this manifest, I.e., !he first page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10186)1 plus t
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A. Slate Manifest Document Numbei-: .Leave blank.
8: Slate Generator Identification Number: Leave blank. · · · '
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest forms.
4. Generator's Phor'le Number: Enter a telephone number with area code where an authorized agent al the generator can be reached in the event ot a
emergency including nights, weekends, and holidays. ·. --
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I 6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: "enter a teleph0ne number including area code where an authorized agent of the first transporter can be reached in the event ol
an emergency including nights, weekends, and holidays. · I
1:. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. II more than 2 transporters w
a ..
E..
F ..
9.
10.
G:
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC-1988A) continuation sheet and list the transporters in the order they will be transpor:ing the was:
U.S. EPA ID Number:1I applicable. enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7.
Slate Transporter's ID Number: Leave blank. I
Transporter's Phone Number: Enter a telephone number including area code_where an authorized agen·t ol ii,'e ~econd transpor1er can be reached in th
event ot an emergency including nights, weekends, and holidays. ~. ~ ~·
Designated Facility Name and Sile Ad!1ress: Enter the company name and site address of the treatment, storage, or disposal facility designated 10 receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing address." ·
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatmenl. storage, or disposal facility identified in item 9. I
State Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the evEint ol an
emergency including nights, weekends, and holidays. · ·
U.S: DOT Descriptions: Enter Rroper shipping name, hazard class and ID Number{UN/NA) for each waste as identiried in 49 CFR 171-1 i7.1I additional spat
is needed, use a U.S. EPA Form 8700·22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. , . ., _
11·.
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation rrom Table I (below) lof the type of containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases. roll otts
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes, carlons, cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks porlab!e CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to !he units used in iteni 14.
14. Unit (weighl/volume): Enter !he :tpproprintc nbbrevi:ttions from T;ible II (below) for the unit ol mensure:
Table II
I
I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)_
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C ar.d O t'
identify the hazardous waste on each line. · .
J. Additional Descriplions !or Materinls Listed Above: In the spaces provided, enter the authori.zation number (frorn the S.C. DHEC Authorization Request Forn
for each waste stream hstP.d in section 11 above. Nole: Before any hazardous waste can be accepted for treatment storage or disposal in South Carc!ina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. ~ 1·
K. Handling Codes !or Wasles listed Above: Leave blank.
15. Special Handling Instruction, and Addillonal Information: Generators may use this space to indicate special transpo_rtation. treatment. storage or dispos
information or Bill of Lading Information. For international shipments. generators must enter in this space lhe ,point ol departure (city and s:ate) for those
shipments destined !or treatment, storage. or disposal outside !he jurisdiction ol the United States. , · · t
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE thecertilication statement. ti a mode other than highway is used. t
word "highway" shou!d be lined out arid the appropriate mode (rail. water.a~ air) inserted in the space below. II another mode in addition to the"hi9hway mode,
used. enter the appropriate additional mode (e.g.,_and_ rail) in the spa'ce below. ·
TRANSPORTER SECTION
l T Transporter 1 Acknowledgement: Enter the name ol the pei-son accepting the waste on behall or the first transporler. That person must acknowtedgl
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the OATE'of receipt.
18. Transporter 2 Acknowledgement: Enter, ir applicable, the name of the person accepting the waste on behalf ol the second transporter. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering lhe DATE of receipt. ..
FACILITY SECTION I
l 9. Discrepancy lndicalion Space: The authorized representative ol the designated facility's owner or operator must nole in I his space any discrepancy betwee
the waste described on the rrianilest and the waste actUally received at the facility, Owners and operators of facilities who cannot resolve signilican:
discreciancies within 15 d·oya racoiving Iha woala mual aubmil 10 the Oopor1mon1 o le"erwllh a copy of Iha monirestdescribing lhe discrePancy and a.:em;:its 1·
reconcit~ it The treatment. storage. or disposal facility mus! enter the actual weight of waste in pounds in the spaces provided if the amount varies any from tr. .
specified by the genera!or in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facility Ownei-or Operalor Cerlification: Print or type the name of the person accepting the waste on behalf of the owner or operator of the kicility. That ;:ierson
must aci<nowledge acceptanc·e al !ho wasle described on lhe manifest by SIGNING (BY HANO IN INKfand entering the DATE al receipt
i, AS!il~TANCE IS NEEOEO IN COMPLETION OF THIS MANIFEST, CONTACT THE Tri.r .' · '.l!ZNT, STORAGE, OR DISPOSAL FACJUTY DESIGtJATED Tl
RECEIC _ THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT (803) 734-S200 WEEKlJ1,., ;; FROM 8:00 am TO 5:00 pm. .
I South Carolina Department of Health
and Environmental Control
LEASE PRINT or TYPE
UNIFORM HAZARDOUS
WASTE MANIFEST
ewriler
1. Generator's U.S. EPA ID No.
N C D O 7 6 0
Form A
2. Page 1
ol
Bureau of Solid & Hazardou.s Waste Mgt
2600 Bull Street, Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
lnformalion in the shaded a<eas is not
required by Federal law, but is by State law.
3. Generator's Name and Mailing Address
Channel Master ~:~=;': OocuiMnl Numboi
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone( 919 934-9711
5. Transporter l Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Oesignaled Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
ll. U.S. DOT Description (including Proper Shipping Name, Hazard Cfass, and ID Number)
a.
C.
d.
Haza·rdous Waste, Solid, nos ORM-E
NA 9189
12. Containers
No. Type
1 D T
;,:~~1~~~2~it:_~11~;~![~f l~!!~:~:~!t1i1!Itl1!~@ll~l~~lt~~!l~!~~ri!ll!lllll!~!l1~~,
alE..il:LJ-!012171714!-1ld1012LntM\ft!i 0·LLJ-1 I I I I ,-, I I I IW:
b.LLJ-1 1-1 1ifl!i!l!iiii'!l~w:1 ··'······· ,-1 ,r:1·:
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71383
13. Total Quantity u. u,;1 •l'.Wata~/C
'MNd \+l\4"\kL\A%J~fg1
'.l~ 1;r yo~ii·fY9Yt:~
2 0 Y ~1F1Q1Q161~
...... · .. · ,.,,,.,•,,,•,, ..... · \r·.i_· ~ ...... ~~··,·yr ,I
1 6. GENERATOR'S CERTIFICATION:· I harabydac1are that Iha conlants ol lhls conslgnmentara fully and accurately described abova by proper shipping name and are claHilled.
pack.ad. marked, and Lahelcd,and are in all respects in proper condition !or transport by highway according to appHcable international and national government regulations and
the laws ol the Slate ol South Carolina. ·
II I am a large quanltty generntor, 1 cor1ity that I havo e program In place lo reduce the volumo and todcltyol wastegeneratod IO the degr-1 have determined to be economlcally
practicable and thal I havo selected the practicable method of lreatmonl slorage, or dlspoaal currently available to me which minimizes the present and lutvre thr-110 hvman
health and the environment; OR, 111 am a small quantltygonerator, I holfe made a good laith aNortto minimize mywaslageneratlon and select tho bell waata manogem•nt method
that is avai!ab1o to me and thot I con alford.
Pr;nted/Typed Name /,/ L /'
. '/<J} . .er-, Cb o.,,iS Signature ~ Month Day Year
O cP-;z. </ ?-. 7
17. Transporter 1 Ac,;,cnowledgement ol Receipl of Materials
Printed/Typed Name ·•--;---.,
la v.Z~ .,
Month Day Year
0 ~~ \
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space .... , ..... _._ ..... jibs. C I jibs.
b IL...L.J...J..-"--1. jibs. d I jibs.
20. Facility Owner or Operator; Cer111icalion ol receipt ol hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature Month Day Year
PA Form 8700-22 (Rev. 9/86) Previous Editions are·Obsolete (DHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST .I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter) OR.USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatml
Slorage. or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)] and, if necessary, thE:! continuation sheet U.S. EPA Fa
8700-22A Aev:9186 (DHEC 1988A) ror both inter-state and intra-slate transportation. Transporters who transport hazardous waste into the United States fr
another country are responslOle !or completing the manifest Federal and State regulations also require generators and transporters al hazarCous was:e aM
owners or operators or hazardous waste treatment, storage, or disposal lac11Jt1es to complete the following 1nlormat1on. I GENERATOR SECTION
1.
2:
Generator's U.S. EPA 10 Number -Manifest Oocumenl Number: Enter the generator's U.S. EPA twelve d1g1t 1dent1f1cat1on number and the unique five d1g1t
number assigned to this manifest by the generator beginning with 00001. U your company does not have a U.S. EPA Identification Number. please contact S.C.
OHEC al [phone] about obtaining an ldenlilication number. · · · • I
Page 1 ol: Enter the total numb_er of pages used to complete this maniresl, i.e .• the ljist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REI/ 10/86)] plus
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEG 1988A) ii any.
A. State Manifest Document Numbel': .Leave blank.
e: Slate Generator Identification Number: Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned mani!est forms.
Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of ,
3.
4.
emergency iricluding nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the first lransporter identified in item 5. I C. Stale Transporter's ID Number: Leave blank.
D. Transporter's Phone Number: °Enter a telephOne number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. . •
1: Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC-1988A) continuation sheet and list the transporters in the order they will be transpo~ing the wa
U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit 10 number al the second transporter identili~d in item 7.
Slate Transporter's 10 Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code .where an authorized agent or the second transporter can be reached in ti
event ol an emergency including nights, weekends, and holidays. · .
8 ..
E ..
9.
10.
G:
Designated Facility Name and Sile Address: Enter the company name and site address of the treatment, storage. or disposal facility designated :o receive rr,e
waste listed on this manifest The address must be the site address, which may differ from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve d!git identification number ol the designated treatment. storage, or disposal facility identified in item 9 .•
Stale Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends, and holidays. ·
11: U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) loreach waste as identified in 49 CFR 171-1 77.11 additional spa.
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A)·Continuation Sheet
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
TABLE I .
OM= Metal drums. barrels, kegs TT= Cargo tanks {tank trucks) CM= Metal boxes. cartons, cases. roll otfs
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks portab!e CY= Cylinders BA= Burlap. cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line. relative to the units used in item 14.
14. Unit (weighl/volume): Enter !he ;,pproprintc nbbrcvintions from Tnble II (below) !or the unit ol mcnsure:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G =-Gallons (liquid only)
Waste Number: E.nter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C ar.d □,
identify the hazardous waste on each line.
J. Addilional Descriplions !or Materials Listed Above: In the spaces provided, enter theauthonznlion number (from the S.C. DHEC Author1zaI1on Request For
for each waste stream listP.d in s·ection 11 above. Nole: Belore any hazardous waste can be accepted for treatment storage or disposal in South Carc!ina, the
generator must obtain prior authorization from the treatment. storage or disposal facility. I
K. Handling Codes lo·, Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Additional lnlormation: Generators may use this space to indicate special transportation, treatment. storage or dispo
information or Bill or Lading lnlormation. For international shipments, generators must enter in this space the point al departure (City and state) for those
shipments deslir]ed !or treatment, storage. or disposal outside th~ jurisdiction or the United States. · I
16. Generator Cer1ification: The generator must READ, SIGN (BY HANO IN INK), and DATE lhecertilication statement. ti a mode other than highway is used. I
Word "highway" should be lined out .ind the appropriate mode (rail, water.or air) inserted in the space below. II another mode in addition 10 the highway mod
used; enter the appropriate additional mode (e.g.,.and_rail) in the space below.
TRANSPORTER SECTION .
17: Transporter 1 Acknowledgement: Enter the name·ol the person accepting the waste on behalf of the first transporter. Thal person 1;-ust acknowledl
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt. ·
18. Transporter 2 Acknowledgement: Enter. ii applicable, the name or !he person accepting the waste on behalf of the second transporter. That person mus:
acknowledge acceP1ance or !he waste described on the manilest by SIGNING (BY HAND IN INK) and entering the DATE of receipt.
FACILITY SECTION . I
19. Discrepancy Indication Space: The authorized ~epresentalive ol the designated facility's owner or· operator must nOte in this space any discrepancy betwe
the waste described on the manirest and the waste actually received at the facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15 days receiving the waste must submit to the Department a letter with a copy al the manifest describing the discrePancy and a.:emPisl
reconcil~ iL The treatment storage, or disposal lacility must ~nter the actual weight of waste in pounds in the spaces provided ii the amount varies any from 1
specified by the generator in item 13 or ii the generator uses a unil ol measure other than pounds.
20. Facility Owner or Operator Certilicalion: Prinl o;iype the name of the person accepting the waste on be~atf of the owner or operator of the lacility. Tha! person
must acknowledge acceptanc·e ol the waste d~scribed on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt.
i, ASSISTANCE IS NEEOED IN COMPLETION QF·THIS MANIFEST, CONTACT THE Tr.r.• ·0IENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED I
REGEi', .. THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKlm, ,; FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIONo.
WASTE MANIFEST N c D o 7 6 o
3. Generator's Name and Mailing Address'
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
•· Generalor'sPhone 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
CSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
S C D O 7 3 7
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper $hipping Name, Hazard ~lass, and ID Number)
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
CSX Work Order No.: 71384
Form A
2. Page 1
of
-l"DT
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Streel Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Exoires 9.30.sa
Information in the shaded a<eas is not
required by Federal law, but is by State law.
2 0 Y
ll~•·-r,:tcf1'+~1-91~~
\11E1010161{t
16. GENERATOR'S CERTI_FICA TION: I horeby declare' !hat the contents ol this consignment are fully end accurately described above by proper shipping name and ara cla ... iflad.
packed, marked, and labeled, and are In all respects In proper condition lor transport by highway according 10 applicable International and nauonal government r..._,utaUons and
U'le lews of tho Stale ol S0uth Carolina.
II tam a large Quantity generator, I certify thal I have a program In placo to reduce lhevolumeand toxicity ofwestagenerated to !he degree 1 have determined to be ec:onomlc.tty
practicable and that I have lletected the practicable method of treatment, alorage, or disposal curranlly available lo me which minimizes the present and luture tr'lrNI to numan
health and !he environment; OR. ii I am a small Quantity generator, I hove mode a good loith erfort to minimize mywasta generation and select the beat waste menegement mell'lod
that is available to mo and the.I I ce.n aNord.
Printed/Typed Name ,.,_,:7 L r--e, ...,.,... , Signature Month Day Yea,
Of?-Z-t/!?.7
Year "t".7
Signature Month Day Year
19. Discrepancy Indication Space
a I pt,,. C I 11t,,.
bl pt,,. d I llbo.
20. Facility Owner or Operator; Certificalion of receipt of hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signature . Moot/I Day Year
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
i 1 , ,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: n'PE (on a 1'2-pitch (elite) typewriterJ OR.USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste trea:mel
storage. or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 {REV 10/86)) and, ii necessary, th~ continuation sheet U.S. EPA For
8700-22A Rev: 9/86 (OHEC 1988A) foi both inter-stale and intra-state transportation. Transporters who transport hazardous waste into the United States Ira
another country are responsiCle !or completing the manilesl Federal and State regulations also require generators and transporters of hazardous waste ar:c
owners or operators ol hazardous waste treatment, stornge, or disposal facd1l1es to complete the f0Uow1ng 1nformat1on I
GENERATOR SECTION
1. Generator's U.S. EPA 10 Number -Manilesl Document Number: Enter the generator's US. EPA twelve d191t 1dent1l1cat1on number and the unicue t1ve d1g1t
number assigned to this manifest by the generator beginning with 00001. If yourcompanydoes not have a U.S. EPA ldentilication Number. please contact S.C.
OHEC at {803) 734-5200 about obtaining an Identification number. · · I
2: Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (P.EV 10186)] ~lust
number or continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) ii any.
A. State Manilest Document Numbei': .. Leave blank.
B: Slate Generator ldenliflcallon Number: Leave blank. J
3. Generator'• Name and Mailln9 Address: Enter the na~e and mailing address al the generator who will manage the returned manifes: forms.
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event of
emergency including nights, weekends. and holidays.
S. Transport 1 Company Name: Enter the company name ol the firs! transporter who will transport the waste. I
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identilication number 01 the first transporter identified in item 5.
C. State Transporter's 10 Number: Leave blank.
0. Transporter's Phone Number: Enter a teleph0ne number including area code where an authorized agent ol the first transporter can be reached in the event of
an emergency including nights, weekends. and holidays. I
7:. Transporter 2 Company Name: If applicable, enter the company name of the second transporter who will transport the waste. JI more than 2 trans.>orters w
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC .1988A) continuation sheet and list the transporters in the order they will be transoorting the was)
8 .. U.S. EPA ID Number:11 applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E State Transporter's ID Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code_where an authorized agent 0(1h·e ~econd transporter can be reached in tt
event or an emergency including nights, weekends. and holidays.
9. Oesignaled Facilily Name and Sile Address: Enter the company niJmc and site address of the treatment, storage, or disposal facility designated :o receive Ihe
waste listed on this manifest The address must be the site address, which may differ from the marnng ·address.
10. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the designated treatment, storage, or disposal facility identified in item 9. I
G: Stale Facility's 10 Number: Leave btank.
H;. Facilily's Phone Number: Enter a telephone number including area code where an i3Uthorized agent al the facility can be reached in the event ol an
emergency including nights, weekends. and holidays. · ·
1 r. U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 171-1 i7. lf additional spat
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. ,
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation from Table I (below) ror the type of containers.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons, cases. roll otls
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car:ons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each 1ine, relative to the units used in item 14.
l.t. Unit (weight/volume): Enter !he nppropric1te .ibbrevintions lrom Table II (below) for the unit ol rnec1surc:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters _ Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Haznrdous Waste Management Regulation R.61-79.261 Subparts C ar:d DJ
identify the hazardous wnsle on each line.
J. Addilional Descriplions lor Materials Listed Above: In !he spaces provided, enter the authoriz.ilion number (lrorn lhe S.C. DHEC Au!hor1z.:it1on Request For
for each waste stream listr.d in section 11 above. Note: Belore any hazardous waste can be accepted !or treatmenl storage or disposal in South Carc!ina, the
generator must obtain prior authorization from the treatment. storage or disposal facility. • · I
K. Handling Codes lor Wasles Listed Above: Leave blank.
15 .. Special Handling Instructions and Additional lnlormalion: Generators may use this space to indicate special transportation. treatment. storage or dispos
information or Bill of lading Information. For international shipments, generators must enter in lhis space !he point al departure (city and s:ate) for those
shipments destined lor treatment, storage, or disposal outside the jurisdiction or the United States. · I
16. Generator Cer1ificalion: The generator must READ, SIGN (BY HAND IN INK), and DATE thecertilication statement. II a mode other than highway is used, t
word .. highway" shou!d be lined out and the appropriate mode (rail, Water.or air) inserted in the space below. lf'another mode in addition :o the highway mode
used. enter the appropriate additional mode (e.g.,.and. rail) in the space below.
TRANSPORTER SECTION ·
\ 7: Transporter 1 Acknowledgem·enl: Enter the na'me ol .thc person accepting the waste on behalf of lhe first transporter. That person mus: acknow\edl .
acceptance ol !he waste described on the manifest by signing {BY HANO IN INK) and entering the DATE of receipt. ·
18. Transporter 2 Acknowledgement: Enter. ii applicable, the name of the person accepting the waste on behall al the second transponer. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and enIering the DATE al receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy bet we
the waste described on the manifest and the Wasle actUa!ly received at the facility. Owners and operators ot facilities who cannot resolve signiticanI
discrepancies within 15 days receiving the waste must submit lo the Department a le tier wilh a copy al the manifest describing the discrepancy and ar:emois I
reconcil\! it The treatmenl storage, or disposal facility musf enter the actual weight of waste in pounds in the s~aces provided if the amount varies any lrom th
specified by the generator in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facilily Owne'r or Operator Cerlilicalion: Print or type the name al the person accepting the waste on behalf ol the owner or operator ol the I.Jcil1Iy. Th.:it per Son
must acknowledge acceptanc'e ol lho waste described on the rrianifest by SIGNING (BY HANO IN INK)" and entering the CATE of receipt.
Ill' ,A.S:5!STANCe 1$ NEE OED IN COMPLETION OF THIS MANIFEST, CONTACT THE rr,r: ",\ENT, STORAGE, OR DISPOSAL FACILITY OESIGtJA. TEO Tl
PECEL . THE WASTE OR THE S,C, DHEC MANIFEST SECTION AT [phone] WEEKu,,, :; FROM 8:00 am TO 5:00 pm,
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Expires 9-30-88
UNIFORM HAZARDOUS
WASTE MANIFEST N C D 0
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,
4. Generator's Phone 919
Smithfield,
934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designaled 'Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number}
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Addilional Information
GSX Work Order No.: 71353
2. Page 1
ol
12. Containers
No. Type
l ti T
Information in the shaded a<eas is not
required by Federal law, but is by State law.
13. Total Quantity 14. Unit ;-:U Wasta ~>f
W1JV~ )~'\?0'il:~~'>/k\~~Ahtt
2 0 Y
~'.~fi~F :(6fft~f{~~!
M1F101016r(t
16. GENERATOR'S CERTIFICATION: I horobydeclare that tho contents olthl:!1 con,lgnmentare fully and accuratelydoscrlbod above by proper ahipplng name and are clasa1l1ed.
packed. marked, and raheled,and are in all respects In proper condition fortranspor1 by highway according to applicable International and national government re,gulatlon1 and
Uio lews ol the Slate ol Soult! Carolina.
If I am a largo quantity generator, I certify that I have a program In place lo reduce tho volume and IO)(lclty of waste generated 10 Iha d&groe I have datermln9'd to be .conomie.Hy
practicable arid ttial I h8VO selected the practicable method ol trealment. storage, or dlspoaal curronlly ovallablo lo mo which minimizes the present and future tnr-t to tluman
tlealltl and the environment; OR, ii I am a small quantlryoonorator, I hove made a oood lallh effort to minimize my waste gonera1lon and select the best waste managemanl m.tnOd
that is available to me and that I can afford.
Printed/Typed Name Signature Month Day Year
"? z. ":7
Month Day Year
_j/74
/ I -
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator; Certification of receipt of hazardous materials covered by !his manifest except as noled In Item 19.
Printed/Typed Name Signature
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (OHEC 1988 (Rev. 10/86))
Month Day Year
a l~~~~i'bs-c ... I .L..L..&....L-'-'pbs-
b J, jlbs-dj jibs-
Month Day Year
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFO,RM HAZARDOUS WASTE MANIFEST
' . I'.' ,,/ '•, r--; I
IMPORTANT: TYPE (on a 12-pitch (elite) typewriler] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
' GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REV 10/86)] and, ii necessary, th~ continuaIion sheeI U.S. EPA Fo"r
8700-22A Rev: 9/86 (OHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste Into the United States Ira
another country are responsiOle !or completing the manifest Federal and State regulations also require generatorS and transporters of hazardous wa5te ar:a
owners or operators ol hazardous waste treatment, stornge. or disposal facilities to complete the following information. '
GENERATOR SECTION
1. Generator's U.S. EPA ID Number. Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number ana the un1que live dig,
number assigned to this manifest by the generator beginning with 00001. If yourcompany does not have a U.S. EPA 1dentilication Number. please con:acI S.C.
OHEC at [phone] about obtaining an Identification number. · · · I
2: Page 1 of: Enter the total number of pages used to complete this manifest. i.e., the lifst page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REI/ 10/86)} plus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) ii any.
A. State Manifest Document Number: .Leave blank.
B: State Generator Identification Number: Leave blank. ··1
3. Generator's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage the returned manilest forms.
4. Generator's Phorli Number: Enter a telephone number wilh area code where an authorized agent al the generator can be reached in the event of
emergency, including nights, weekends, and holidays. ;i l
5. Transport 1 Company Name: Enter the company name of the firsl transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first lransporter identilied In item 5.
C. Stale Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: Enter a telephOne number including area code where an authorized agent ol the lirst transporter can be reached in !he event of
an emergency including nights, weekends, and holidays. ;I
1: Transporter 2 Company Name: If applicable, enter the company name ol the second transporter who will transport the waste. If more than 2 transporters
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC .1988A) continuation sheet and list the transporters in the order they will be transporting the was
S.. U.S. EPA ID Number:!! applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E State Transporter's ID Number: Leave blank.
F .. Transporter's Phone Number: Enter a telephone number including area code_where an authorized agent of th(! second Ir ans porter can be reachee! in ti
9.
10.
G:
event ol an emergency including nights. weekends, and holidnys. . _
Designated Facilily Name and Sile Address: Enter the company nnme and site address of the treatment, storage, or disposal facility designateo to receive the
waste listed on this manilesl The address must be the site address, which may differ from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identilication number of the designated treatment, storage. or disposal facility identified in item 9. I
Slate Facility's ID Number: Leave blank.
H;. Facilily's Phone Numbe'r: Enter a telephone number including area code where an authorized agent al the facility can be reached in the ever.I al an
emergency including nights, weekends, and holidays. ·
U.S: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 171-177. If additional spal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. · .
12.. Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) ror the type of containers.
1 r.
TABLE I •
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank. trucks) CM = Metal boxes. cartons. cases. roll otls
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases I
TP = Tanks portable CY= Cylinders · BA= Burlap. cloth. paper or plastic bags
13. Total Quantity: Enter total quantity of waste·described on each line, relative to the units used in item 14.
14. Unit (weight/volume): Enter lhc ;1ppropri,,Ic .,bbrevi.1tions from Table II (below) for the unit ol rne;-asurc:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters · Y = Cubic Yards G = Gallons (liquid only)·
1. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subparts C ar:d DI
identity the hazardous waste on each line. .
J. Addilional Descriptions for Materials Listed Above: In lhe spaces provided. enter theauthoriwtion number (from lhe S.C. DHEC Author1zJt1on ReQu~SI Forr
for each waste stream listed in section 11 above. Nole: Belo re any hazardous waste can be accepted tor treatmenl storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment. storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank.
15. Special Handling lnslructlons and Addillonal Information: Generators may use this space to indicate special !ransportation. treatment. storage or dispos
information or Bill ol Lading Information. For international shipments, generators musl enter in !his space the point of departure (city and s:ate) !or those
shipments destined !or treatment: storage. or disposal outside.th~ jurisdiction of the United States. · I
i6. Generator Certification: The generator must READ, SIGN (BY HANO IN INK). and DATE thecertilication statement. II a mode other than highway is used.1
word "highway" should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. II another mode in addition :o the highway mode
used. enter the appropriate additional mode (e.g.,.and. rail) in lhe space below.
TRANSPORTER SECTION _
17: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behatr of the first transporter. That person _iT:us: acknowledf
acceptance ol the waste described on the manifest by signing (BY HAND IN INK) and entering the DATE of receipt. · .
18 .. Transporter 2 Acknowledgement: Enter. ii applicable. the name of the person accepting the waste on behalf of the second transporter. That person mus:
acknowledge acceptance al !he waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy bet we
the waste described on the manirest and the waste actUally received al !he facility. Owners and operators of. facilities who canno! resolve signdicant
discrepancies ~ithin 15 days receiving the waste must submit to the Department a le"erwith a copyol the manifest describing the discrePancy ar:C a.:em~:s I
reconcH~ il The treatmenl storage, or disposal facility must enler the actual weight of waste in pounds in th. e spaces provided it the amount varies any rrom tr:
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Owner or Operalor Certification: Print or type the mime ol the person accepting the waste on behalf ol lhe owner or operator of the facility. ThJt person
must acknowledge acceptanc'e of the waste described on the manifest by SIGNING (BY HANO IN INK)and entering the DATE of receipt.
,,.. •ssISTANCE IS NEEDED IN COMPLETION OF THIS MANJFES,:-, CONTACT .. THE rrr: ··.,ENT, STORAGE, OR DISPOSAL FACILITY OESIGtJATEO Tl
AECEI'. _ THE WASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKlJ,,, :; FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: (BOO) 734-5200
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D o 7 6 o l 4
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
S. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
C D O 7 3 7
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
c.
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71354
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1 Information in the shaded a,reas ls not
of required by Federal law, but is by State law,
l D T 2 0 Y
i!P~F·yo1·rn1~,t~
,;j,f ,o ,o, 6 tfJ
/I LI __J......JC...'-.J'Ii
~)t 1 &
. :'·•; ,,:,,·•·•,C.w·•':v ,' ,,,
/): Li -'-'--'-.Jl)i~
16. GENERATOR'S CERTIFICATION: I hereby declare thal the contents ol lhlscons'9nmentera lullyand accurately described above by proper shipping name and ara cla.u1llad.
packed. marked. and la.beled. and are in all respects in proper condilion !or transport by highway according to applicable lnlernational and national government r~ulations and
tne taws ol !he State ol Soulh Carolina.
II I am a large quunt1ty gonmnlor, I c_ur1ify lhnl I t1nvo n progrnm In pluco lo roducotha volumo and tmdcltyol w111Jlaganoralad lolhe dograa I have determined lo be economlcany
prachcabte and that I have selecled lho prnct1cable method ol treatment. storage, or dlsposol currenUy available to mo which minimize, the pra1,9nt and lu1u,a thr-t t.o hunwin
heallh and Iha environment; OR, if I am a smnll quonlitygenorator, I hava made a good loilh 11Nort lo minimize my waste genaration and select the boat waste management meU\Od
that is available to mo and lhal I con oNord.
Printed/Typed Name Month
Printed/Typed Name Month Day Yw
19. Discrepancy Indication Space • I pbs. C I pbs.
bl pbs. d I llbs.
20, Facility Owner or Operator: Certlrlcatlon ol receipt ol haurdous muterlats covered by !his manilas! except as noted In Item 19.
Printed/Typed Name Signature Month Day y..,
PA Form 8700·22 (Rev. 9/86) Prevlous Editions are Obsolete [OHEC 1888 (Rev. 10/88))
STATE OF.SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST
I ,1 i
IMPORTANT: TYPE (on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require gemirators and transporters ol hazardous waste and owners or operators of hazardous waste trea:mel
storage. or disposal licilities to use !he U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Rev:9/86 (OHEC 1988A) lo,: both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ire
another country are responsiDle !or completing the manifest Federal and State regulations also require generators and transporters of hazarcous waste ar.d
owners or operators ol hazardous waste treatment. storage, or disposal facilities to complete the lo!lowing information. I GENERATOR SECTION
1.
2:
Generator's U.S. EPA ID Number-Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five digit
number assigned to this manifest by the generator beginning with 00001. lfyourcompany does not have a U.S. EPA ldentiflcation Number. please contact S.C.
OHEC at {803) 734-5200 about obtaining an Identification number. · · I
Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 {REV 10186)] ~lus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A. Stale Manifest Document Number: .Leave blank.
B: Stale Generalor ldentificallon Number: Leave blank. J
3. Generator's Name and Mailing Address: Enter the name and mailing address ol the generator who will manage the returned mani!es: lorms.
4. Generator's Phoiie Number: Enter a telephone number with area code where an authorized agent of the generator can be reacryed in the event or
emergency including nights, weekends. and holidays.
5.
6 ..
C.
D.
Transport 1 Company Name: Enter the company name ol the rirst transporter who will transport the waste.
U.S. EPA ID Numb or: Enter the U.S. EPA twelve digit identification number ol the first transporter identified in item 5.
Slate Transporter's ID Number:. Leave blank: I
Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in lhe event or
an emergency including nights, weekends, and holidays. I
1:. Transporter 2 Company Name: II applicable, enter the company name ol the second transporter who will transport the waste. II more than 2 lrans:,orters ·
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC-1988A) continuation sheet and list the transporters in the order they will be transoor:ing the was
U.S. EPA 10 Number:I1 applicable, enter the U.S. EPA twelve digit 1D number of the second trnnsporter identified in item 7. a ..
E St.ale Transporter's 10 Number: Leave blank. I
F .. Transporter's Phone Numb'er: Enter a telephone number including area code .where an authorized agent ol the ~econd trans_porter can be reached int
event ol an emergency including nights, weekends. and holidays. ~·
9. Designated Facility Name and Sile Address: Enter the company name and site address of the treatment. storage. or disposal facility designated to receive the
waste listed on this manifest The address must be the site address, which may diller from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage, or disposal facility identified in item 9. I
Slate Facility's ID Number: Leave blank.
10.
G:
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event ol an
emergency including nights, weekends, and holidays. ·
1 r. u.s: DOT Descriptions: Enter proper shipping name. hazard class and lO Number (UN /NA) for each waste as identified in 49 CFR 171-177. If additional spat
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. .
12.. Containers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation lrom Table I (below) foi the type or containers.
TABLE I
DM = Metal drums. barrels, kegs TT= Cargo tanks (lank trucks) CM= Metal boxes. cartons, case's. roll alls
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases· I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
i3 .. Total Quantity: Enter total quantity al waste described on each line, relative to the units used in item 14.
T4. Unit (weight/volume):. Enter the appropriate abbrevi:-itions rrom T:ible II (below) for the unit of mc:-isurc:
Table II I
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter haznrdous waste numbers as specilied in South Carolina Hazardous Wasle Management Regulation A.61-79.261 Subpans C ar.d OJ
identity the hazardous waste on each line.
J. Additional Descriptions for Malerials Listed Above: In the spaces provided. enter the authorization number (from the S.C. OHEC AuthonzaIion Request For
!or each waste stream listed in section 11 above. Not_e: Before any hazardous waste can be accepted !or treatmenl storage or disposal in South Carclina. tne
generator must obtain prior authorization lrom the treatment, storage or disposal lacility. · 1
K. Handling Codes !or Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Additional Information: Generators may use this space fa indicate special transportation, treatment. storage or dispos
information or Bill ol Lading lnlormation. For international shipments, generators must enter in this space the point of departure (city and ·s:aie) for :nose
shipments destined for treatment. storage. or disposal outside the jurisdiction ol the United States. · · I
16. Generator Certillcalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used. t
Word "highway" should be lined oul and the appropriate mode (rail: wilter~ or air) inserted in the spa Ce below. II another m~de in addition to the highway mode
used. enter the appropriate additional mode (e.g.,.and. rail) in the space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgement: Enter the name al the person accepting the waste on behalf ol the first transporter. That person _must acknowledl
acceptance ol the waste described on ttle manifest by signing (BY HAND IN INK) and entering the DATE or receipt.
18. Transporter 2 Acknowledgement: Enter. ii applicable. the name ol the person accepting the waste on behalf of the second transporter. That person mus:
acknowledge acceptance or the waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE ot receipt.
FACILITY SECTION J
19. Discrepancy Indication Space: The authorized representative of the designated lacility's owner or operator must note in this space any discrepancy betw·e
the waste described on the ma"nifest and the waste actUally received al lhe facility. Owners and operators of lacilities who cannot resolve signilicant
di1Cittcia"':io■ within 15 days rvcol\llMg !he wa110 mu11 Oub_mlt lo IP10 Oopor1man1 a lottar with a copy o_l tP1o moniloetdoacrlbing the discrePancy and a:-:emc:s I
reconcilf iL The freatmen~ storage, or disposal locifily mus I enter the actual weight ol waste in pounds in the spaces provided ii the amount varies any trom tr.
specified by the generator in item 13 or ii the generator uses a unit ol measure other than pounds.
20. Facility Owner or Operator Cerlllicalion: Print or type the name of the person accepting the waste on behalf of the owner or operator ol the l.:icili!y. That person
must acknowledge acceptanc·e ol lhe waste described on the manilesl by SIGNING (BY HANO IN INK)and entering the DATE ol receipt'.
Ill' AS!i!ST.ANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TP,r ,' · '.lENT, STORAGE, OR DISPOSAL FACILITY OESIGf~ATEO Tl
RECEI' .• THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKu,:., :; FROM 8:00 am TO 5:00 pm. .
I South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS 1. Generator's U.S. EPA ID No.
WASTE MANIFEST N c D o 7
3. Generato(s Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Genera1or's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
CD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
..
b.
c.
Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71355
Form A
2. Page 1
ol
12. Containers
No. Type
l D T
Bureau ol Solid & Haz.ardous Waste Mgt
2600 Bull SOee\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Expires 9-30-aa
Information in the shaded iH'HS is not
required by Federal law. but is by State law.
2 0 Y
a , · < i · , ·,·:r,~;
' i~;:: Ii ., ~-~~~, ~f:
16. CENERATOR'S CERTIFICATION: 1 hereby declare that the contents olthis conslgnmenl 11ra lully and 11ccuratelydescrlbod above by proper 1hlpping name and are clasa,1111<1.
packed, marked, and laheled. and are In all respects in propercondlUon for transport by highway according to applicable International and national government r.gulations al'\d
ttie laws of the Stale ol South Carolina.
II I am a large quanlily generalor, I certity that I have a program In place to reduce the volume and toxicity cl waste generated totha d&gree I have dalarmlned to be oc:onomlcally
pracl1cable and that I have selected the pracllcable method ol treatment. storage, or dlspoul currently available 10 ma which minimizes the pretenl and future tnreot to human
heatlh and !he environment; OR, 111 am a small quanlitygenerator, I have made a good faith etfort lo minimize my we,18 generation and select the beat waste management methOd
that is available to me and that I can allord. ·
Printed/Typed Name Signature Month Day
0 fl' 2
17. Transporter 1 Au:nowledgement of Receipt ol Materials
Day Year
ZS~)
Signature
Signature Monttl Day Year
• I ptis. C I ptis.
b I jibs. d I ptis.
20. Facility Owner or Operator; Cer1ilication of receipt of hazardous malerials covered by this manifest except as noted in Item 19.
Printed/Typed Name Signature Monttl Day Year
PA Form 8700:22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)1
! I
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pilch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators al hazardous waste trea:mel
storage. or disposal ficilities to use the U.S. EPA Form 6700-22 Rev. 9/66 (OHEC 1988 (REV 10/86)1 and, if necessary. the continuation sheet U.S. EPA For
8700-22A Rev:9/86 (OHEC 1988A) fof both inter-state and intra-state transportation. Transporters who transport hazardous was!e into the United States tro
another country are responsiOle !or completing the manHesL Federal and State regulations also require generators and transpOrters al hazardous waste anc
owners or operators of haza'rdous waste treatment. storage. or disposal facilities to co~plete the followirlg information. 1 I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manifest Document Number: Enter the generator's U.S. EPA twe!Ve digit identification number and the unfc;ue-f1ve dig1
number assigned to this manliest by the generator beginning with 00001. II your company does not have a U.S. EPA Identification Number. please con:ac1 S.C.
OHEC at [phone] about obtaining an Identification number. · · I
2: Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] ~lus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A. State Manifest Document Numbei: .Leave blank.
9; Slate Generator ldenlification Number: Leave blank. I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage !he returned mani!est forms.
4. Generator's Phorie Number: Enter a tele.phone number with area code where an authorized agent of the generator. can be reached in the event of
1
emergency including nights, weekends, and holidays. ,
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I
6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identirication number of the first transporter identified in item 5. .
C. State Transporter's ID Number:. Leave blank: •
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol lhe first transporter can be reached in the event or
an emergency including nights, weekends, and holidays. J
7:. Transpor1er 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 transporters
be used, use a U.S. EPA Form 8700-22A Rev. 9/66 (DHEC-1988A) continuation sheet and list the transporters in the order they will be transporting the was
8.. U.S. EPA ID Number:JI applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E State Transpor1er's ID Number: Leave blank.
F .. Transpor1er's Phone Number: Enter a telephone number including area code where an authorized agent or the second transponer can be reached in ti
event of an emergency including nights, weekends. and holidays. ·
9. Designated Facility Name and Sile Address: Enter the company name and site address of the treatment. storage, or disposal facility designatea 10 receive the
waste listed on this manilesl The address must be the site address. which may differ from the mailing address.
10. U.S. EPA ID Number: Enter t~e U.S. EPA twelve digit identilication nun:iber of the designated treatment, storage. or disposal facility identified in item 9. I
G: Slate Facility's ID Number: Leave blank.
H;. Facility's Phone 'Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the eve-nt of an
emergency including nights, weekef"!dS. and holidays. ·
11·. U.S: DOT Descriptions: Enter Rroper shipping name, hazard class and ID Number{UN/NA) for each waste as identified in 49 CFR 171-177.11 aCditicnal soal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. . .
12.. Containers (no. and type): Enter number or containers for each waste and the appropriate abbreviation from Table I (below) foi the type o! containers.
TABLE I
OM = Metal drums. barrels, kegs TT = Cargo tanks (tank trucks) CM = Metal boxes, cartons, cases. roll otls
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. canons. cases I
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Ouantity: Enter total quantity of waste described on each line. relalive to the units used in item 14.
14. Unit (weighl/volume): Enter !he :,pproprintc nbbrevi:itions from To1ble II (betow) for the unit of me:isure:
Table II I
P = Pounds L = Li!ers K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpans C ar,d DI
identity the hazardous wnste on e;ich line.
J. Additional Descriptions for Materials Usled Above: In the spaces provided. enter the authorization number (lrom the S.C. DHEC Authofll.Jt1on Request Fou
tor each waste stream listP.d in section 11 above. Note: Before any hazardous waste can be accepted for treatment storage or disposal in South Carclina. the
generator mus! obtain prior authorization from the treatment. storage or disposal facility. I
K. Handling Codes !or Wastes Listed Above: Leave blank. ·
lS. Special Handling lnslruclions and Additional lnlormation: Generators may use this space fa indicate special transportation. treatment. storage or dispoS
information or Bill of Lading Information. For international shipments, generators must enter in this space the point of departure (city and s:ate) lor those
shipments destined tor treatment, slorage. or disposal outside the jurisdiction ol the United Slates. · · I
16. Generator Cerlification: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. If a mode other than highway is used, t
Word "highway .. should be lined cul an'd lhe appropriate mode (rail. water. or air) inserted in the s·pace below. II another niode in addition lo the highway mode
used. enter the appropriate additional mode (e.g ... and_ rail) in the space below.
mANSPORTER SECTION
17: Transporler 1 Ackn'owledgemenl: Enter the name al the person ac_cepting the waste on behalf or the first transporter, Thal person mus! acknowledl
acceptance of the waste described on the manifest by signing (BY HANO IN INK) and enlering the DATE or ,e'ceipt. ·. ,
18. Transporter 2 Acknowledgement: Enter. ii applicable. the name ol the person accepting the waste on behall of the second lransponer. That person musr
acknowledge acceptance or !he waste described on lhe manifest by SIGNING (BY HANO IN INK) and entering the DATE or receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized rcpresentotive of the designated lacility's owner or operator must note in this space any discrepancy betwe
the waste described on the manirest and the waste actUally received al lhe facility. Owners and operators of facilities who cann_ot resolve sii;ndican:
c;ti1crepanc;ies wilhin 15 doys reQoiving lhe Wo1I0 mUal submll I0 lhe Copor1monI A 10110, wllh n copy of lhe moni/01I dooCribing tho di&crepanc:,· ar.c a~,m~!J I
reconcil~ iL The lreatmen~ storage. or disposal facility mus I enter the actual weight ol waste in pounds in the spaces provided ii the amount varies any trom t~
specitied by the generator in item 13 or if !he generator uses·a unit ol measure other than pounds.
20. Facilily Owner or Operator Certilicalion: Print or type the name of the person accepting the was le on behall or the owner or operator al the facility. Th.JI person
must acknowledge acceptanc'e of tho waste described on the manHest by SIGNING (DY HANO IN INK)°and entering the DATE of receipt
i, ASSl<;TANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE n,r,' ",IENT, STORAGE, OR DISPOSAL FACILITY DESIGtlATED Tl
REC Eh _ THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEK!J;:, :; FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
and Environmental· Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia. SC 29201
Phone: (BOO) 734-5200
Emergency & Holidays: [phone]
(Form desi ned for use on elite 12-itch ewriter Form A roved, 0MB No. 2050-0039 Expires 9-30-88
UNIFORM HAZARDOUS 1. Generalor'sU.S.EPAIDNo. Manlleal
Document No, 2. Page 1 Information in the shaded a<eas is not
WASTE MANIFEST N c D o 7 6
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416, Smithfield, NC 27577
4. Generalor's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7, Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7
10. U.S. EPA 10 Number
SCD07037
11. U.S. DOT Description (including Proper Shipping Name, Hazard Cfass, and ID Number}
a. Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional lnlormalion
GSX Work Order No.: 71356
0 5 7 of required by Federal law, bu! is by State law.
12. Containers
No. Type
1 D T 2 0 Y
16. GENERA TOR'S CERTI_FICATION: I horaby declare thot 1ho contan11 o1 thl:, consignment ero lully end accurotelydeacrlbod obovo by proper 1tilpplng nam• end are clos11l1ed.
packed. marked, and labeled.and oro in all rospacts In proper condition !or transport by highway according to applicable lnlornational and naUona1 govornment regutaUon1 and
the laws ol lho State ol South Carolina.
II Jam a large Quantity generator, I certify lhal t havo a program In place to reduce tho volume and toxlcltyol wastogonerated 1otho degree I have dalormlnod to~ economically
practicable and that I have selected tho practicable malhod ol lreatmanl storage, or dispose! curranlly avoUablo to ma which minimizes tho pres.ont •nd lut!Jre 111,-1 to human
heatu, and !he environ men!; OR, lrl am a small quantity generator, I have made a good faith eNort lo mlnimlz:e mywasla generation and select the best wute management melhOd
thal is available 10 me end that I can aNord.
Printed/Typed Name ,,.1-?
l,(_'1; er-
Signature
Printed/Typed Name
19. Discrepancy Indication Space
20. Facility Owner or Operator; Cer1ificalion of receipt of hazardous materials covered by this manifest except as noted In Item 19.
Printed/Typed Name Signalure
PA Form 8700•22 (Rev. 9/86) Previous Editions are Obsolete fDHEC 1988 (Rev. 10/86)]
al~~~.
b~I~~~
Day Year
Month Day Year
jibs. C I jibs.
jibs. d I jibs.
Month Day Yaat
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE jon a 12-pilch (elite) typewriter) OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous was:e treatml
storage. or disposal ricilities lo use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988·(REV 10/86)1 and. if necessary, the continuation sheet U.S. EPA For
8700-22A Rev.-9186 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport hazardous waste into lhe United States tr
another country are responsiO!e !or completing the manifest. Federal and State regulations also require generators and transporters al hazardous was1e and
owners or operators or hazardous waste treatmcn!, storage, or disposal ladlilics to complete the following information.
GENERATOR SECTION I
1.
2:
Generator's U.S. EPA ID Number• Manilest Document Numtier: Enter the generator's U.S. EPA twelve digit identification number and the unique tive digit
number assigned to this manifest by the generator beginning with 00001. !f your company does not have a U.S. EPA ldentirication Number, please con:act S.C.
OHEC at [phone] about obtaining an Identification number. · · I
Page 1 of: Enter the total number of pages used to complete this manifest, i.e., the Hist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)] plus:
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A {OHEC 1988A) ii any.
A. Slate Manifest Document Numbei-: .Leave blank.
s: State Generator Identification Number: Leave blank. J
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned mani!es: lorms.
4. Generator's Phone Number: Enter a telephone number with area code where an authorized agent ol the generator can be reached in the even: ol n
emergency including nights, weekends, and holidays.
5. Transport 1 COmpany Name: Enter the company name ol the first transporter who will transj:,ort the waste.
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve ~igit identification number al the first transporter identified in item 5.
C. Slate Transporter's 10 Number:, Leave '?lank: I
0. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event al
1:. Transporter 2 Company Nam~:· II applicable, enter the company name ol the second transporter who will transport the waste. If more than 21ransporters
an emergency including nights, weekends, and holidays. I
8 ..
E ..
F ..
9.
10.
G:
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHE<;; ,1988A) continuation sheet and list the transporters in the order they will be franspor.ing the was
U.S. EPA 10 Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
State Transporter's ID Number: Leave blank. 1 Transporter's Phone Number: Enter a telephone number including area code,'.where an authorized agerit of the second transporter can be reacr,ed int
event ol an emergency including nights, weekends. and holidays. t ,
Designaled Facilily Name and Sile Address: Enter lhe company name and site address of the treatment, storage, or disposal facility.designated :a receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing address. . I
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification num~er al the designated, treatm~nt, storage, or disposal facility identified in item 9.
Slate Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where·an alithorized agent of the facility can be reached in the event of an
emergency including nights, weekends, and holidays. ·
11'. U.S: DOT Descriptions: Enter i:;iropershipping name, hazard clasSand ID Number (UN/NA) for each waste as identified in 49 CFR 171-177. If ac'diticnal spa'
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. .
12.. Containers (no. and type); Enter number al containers !or each waste and the appropriate abbreviation from Table I (below) for the type al containers.
TABLE I
OM = Metal drums. barrels. kegs TT= Cargo tanks (lank trucks) CM= Metal boxes. c.irtons. coses. roll alls
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases I OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13. Total Quantity: Enter total quantity of waste described on each line. relative to the units used in item 14.
14. Unit (weighl/volume): Enter 1he npproprintc nbbrcvinlions lrorn T;1ble II (below) lor th1? uni! ol mcnsurc:
Table II I
P = Pounds L = Liter; K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons {liquid only)
I. Waste Number: Enler hazardous waste numbers as speciried in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subpans C ar.d OJ
identity the hazardous waste on each line.
J. Additional Descriptions !or Materials Lisled Above: In the spaces provided, enter the authori.znlion number (horn !he S.C. DHEC Authom.:it1on Request For J
for each waste stream listP.d in section 11 above. Nole: Beloreany hazardous waste can be accepted for treatment storage or disposal in South Carclina, the
generator mUst obtain prior authorization from the treatment. storage or disposal facility, . · · I
K. Handling Codes tor Wastes Listed Above: Leave blank.
15. Special Handling lnslruclion:s and Additional lnlormalion: Generators may use this space to indicate special lransportation. treatment. storage or dispos ,
information or Bill or Lading Information. For international shipments, generators must enter in this space the point or departure (City and s:ate) for those
shipments destined for trealment, storage, or disposal outside the jurisdiction of the United States. I
16. Generalor Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used. t
word "highway·· should be lined out and the appropriate mode (rail, water.or air) inserted in the space below. If another mode in addition to the highway mode
used. enter the appropriate additional mode (e.g.,_and_ rail) in lhe space below.
TRANSPORTER SECTION
17: Transporter 1 Acknowledgemenl: Ente~ th~ name of t~e person acc_epting the waste on behalf of the lirstyansporter. That person mus! acknowledl
acceptance of the waste described on the manifest by signing (BY HAND IN INK) and entering !he DATE of receipt.
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalf ol the second transponer. That person mus:
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt. I
FACILITY SECTION f
19. Discrepancy Indication $p_ace: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy betwe
the waste described on lfe manifest and the waste actUally received al the facility. Owners and operators of facilities who cannot resolve significant
discrepancies within 15day. s receiving the waste must submit to the Department a letter with a copyol the man.ilestdescribing the discrepancy ar.d a~emo:s I
reconcil{! iL The treatment.1storage, or disposal locility must enter the actual weight of waste in pounds in the spaces provided ii the amoun! varies any from ti",
specified by the generalor\/n item 13 or if the generator uses a unit ol measure other than pounds.
20. Facility Owner or Operalor,pertllic:alion: Print or type the name of the person accepting the waste on behalf of the owner or operJtor of the f.Jci!ity. Th.:it person
must acknowledge accep~nc'e ol tho waste described on the manifest by SIGNING (BY HAND IN INK} and entering the DATE ol receipt
Ill" •S~!STANCE IS ~eeoeo !~ COMPLETION OF THIS MANIFEST, CONTACT THE TP.r.•. '.\ENT, STORAGE, OR DISPOSAL FACILITY. DESIGUATEO Tl
AECEr .. THE WASTE OR THE, S.C. DHEC MANIFEST SECTION AT [phone] WEEKLJ,,., :; FROM 8:00 am TO 5:00 pm. .
:
I South Carolina Department of Health
and Environmental· Control
LfASE PRINT or TYPE (Form desi ned for use on elite 12-itch writer
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA JO No.
NCDO 760 1
3. Generator's Name and Mailing Address
Channel Haster
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
B. U.S. EPA 10 Number
10. U.S. EPA ID Number
11. U.S. DOT Description (including Proper Shipping Name,.Hazard Class, and ID Number)
a. Hazardous Waste, Solid, nos ORM-E
NA 9189
Form A
2. Page 1
of
1 D T
a. IE.ili..J-IO ) 2 ) 7 ) 7 ) 4 1-I 1 Jl ) 0 ) 2 hiifl:h!C:fr C LLJ-1 ) ) ) ) 1-I ) ) ) I 11:!
b. LLJ.:1 1-1 1J'.;/:;:;i11;;;:;'!~:W:.1._..,__ ........ --',-., ........ --'J:I )
15. Special Handling lnStructions and Additional lnformalion
GSX Work Order No.: 71357
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Streel Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0009 E.x ires 9-30-88
Information in the shaded areas is no1
required by Federal law, but is by Stale law.
:t~·~;f •:,::•0~1-:'1···-;:-9;,~:~
2 O Y ~1E1010161~
1 5. GENERA TOR"$ CERTIFICATION: I horoby doclnre lhnt !ho contents of this conslgnmont care lully nnd accurolelydoscrlbod above by propor 11hlpplng nam■ and are clauolled.
packed. marked. and Ja°beled, and are in alt respects In properc:onditlon tor transport by highway ac:c:ordlng to applicable lnlornaUonal and national government re,gulatlon.a and
u,e laws of tho St.at6 of South Carolina.
111 am a large quantity generator. I certity that I have a program In place to reduce the volume and toxicity of waste generated lo the de,gr-I have determined to be oconomlcatly
practicable and that I have :,elecled the practicable method ol treatment. storage. or dlspos.al currently available to me which minimizes the pres-ant and future threat to hum.an
health and the environment; QR, 111 am a small quanlitygonerator, I have mado a good railh effort to minimize my waste generation and select t:ho boal waato management rn.lhod
that is available 10 mo and thal I can allord.
Printed/Typed Name Signature
17. Transporter 1 Ac.:,mowledgement of Receipt ol Materials
Printed/Typed Name Signature
Tc< J\\, 11'l.-\..-l, )' \ ~ ,::;-.-o t:'7? ·•"--TV--"> '"'\-v 1
18. Transparter 2 AcknoWledgement of Receipt of Materials
Printed/Typed Name Signature
19. Discrepancy Indication Space
20. Facility Owner or Operator: Certification ol receipt ol hazardous materials covered by this manifest except as noted in Item 19.
PrinltdtTyptd Name Signature
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86)]
a~I ......... _._ .........
b~I .,__,__.__._....,_
Month Day Year
0 ?.2.
Month Day Year .,_, ,7
Monttl Day Year
pbs. CI pbs.
pbs. d I !lbs.
Montn Day YNI
•!' •. t. ;· .,.,
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT; TYPE [on.a 12-pitch (elite) typewriler) OR USE FIRM POINT PEN -PRES~ DOWN HARO ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators al hazardous waste treatm:I
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)1 and, if necessary, the continuation sheet U.S. EPA Fa
8700-22A Rev.-9t86 (DHEC 1988A) foi both inter-state and intra-slate transportation. Transporters who transport hazardous waste into the United States Ir .
another country are responsiDle !or comple!ing lhe manifest Federal and State regulations also require generators and transporters of hazardous waste ana
owners or operators ol hazardous waste treatment, storage, or disposal facilities to complete the following information. I GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique live digit
2:
number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA ldentification Number, please contact S.C.
OHEC at [phone] about obtaining an Identification number. · · · · I
Page 1 of: Enter th_e total numbei of pages used to complete thi~ manifest, i.e .. the lifst page EPA Form 8700-22 Rev. 9/86[DHEC 1988 (P:EV 10186)] i;:lus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A {DHEC 1988A) if any. ·
A. Slate Manilest Document Number. .Leave blank. ·
B: Stale Generalor Identification Number: Leave blank. · . I
3. Generator's Name and Mailing Address: Enter the name and mailing address al the generator who will manage the returned manifes: !arms.
4. Generalor's Phorie Number: Enter a telephone number with area code where an authorized agent ol lhe generator can be reached in the event of ·
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name ol the rirst transporter who wilt !ransport the waste.
6. U.S. EPA ID.Number: Enter the U.S. EPA lwelve digit identification number al the first transporter identified in item 5,
C. Slate Transporter'~ 10 Number:, Leave blank: I
D. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event of
an emergency i_ncluding nights, weekends, and holidays. I
7: Transporter 2 Company Name: II applicable, enter the company name al the second transporter who will transport the waste. II more than 2 transporters
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the orde·r they will be transporting the was
U.S. EPA 10 Number:1I applicable. enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7. a ..
E..
F ..
Stale Transporter's ID Number: Leave blank.
Transporler's Phone Number: Enter a telephone number including area code where an authorized agent ol thC second transponer can be reached in ti
event ol an emergency including nights. weekends. and holidays. · · ·
9. Designated Facility Name and Site Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be the site address. which may dilfer from the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification numOer of the de .. signated treatment. storage, or disposal facility identified in item 9 .• 10.
G: Slate Facility's ID Number: Leave blank. • · · .
H;. Facility's Phone Number: Enter a telephone number including area code where ·a'n\:iuthorized agent al the facility can be reached in the event of an
emergency including nights, weekends, and holidays. ·
11: U.S: DOT Descriptions: Enter Qropershipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFR 171-177. If additional soal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet . ..
12.. Conlainers (no. and type): Enter number ol containers !or each waste and the appropriate abbreviation from Table I (below) for the type ol containers.
. TABLE I
OM = Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. cartons. cases. ro/I ells
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. canons. cases I OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. cartons. cases·
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Tola! Ouantily: Enter total quantity ol waste described on each line, relative to the units used in item 14.
1.t. Unit (weighl/volume): Enter lhe :1imropri;itc nbbrcvi;itions from Table II (below) for the unit ol mcnsurc:
Table II I
P = Pounds L =Liters. K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation A.61-79.261 Subpans C ar,d DI
identity the hazardous was!e on each line.
J. Additional Descriplions !or Materials Lis led Above: In the spaces provided. enter the authorizntion number {from !he S.C. DHEC Aulhor1zation Request For
!or each waste stream listP.d in section 11 above. Nole: Belore any hazardouS waste can be accepted !or treatment. storage or disposal in South Carclina. tne
generator must obtain prior authorization from the treatment. storage or disposal facility. J
K. Handling Codes !or Wastes Listed Above: Leave blank.
15. Special Handling Instructions and Additional Information: Generators may use this space to Indicate special transponation, treatment. storage or dispo
information or Bill al Lading Information. For internationat shipments, generators must enter in this space lhe point or departure (city and s:ate) for those
shipments destined for treatment. storage, or disposal outside the jurisdiction of the United States. I
16. Generator Certification: The generator must READ, SIGN (BY. HAND,IN INK), and DATE the certification statement. II a mode other than highway is used. I
word "highway" shou!d be lined out and the appropriate mode (rail. water.or air) insened in the space below. II another'mode in add iii on to the highway mode
used. enter the appropria!e additional mode (e.g.,_and_ rail) in lhe space below.
TRANSPORTER SECTION . .
17'. :rransporter 1 Acknowledgement: Enter the;name ol the person accepting the waste on behall_of t~e_lirst transporter. That person must acknowledl
. acceptance at the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt.
18. Transporler 2 Acknowledgement: Enter. ii applicable. the name of the person accepting the waste on behalf of the second !ransponer. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK) and entering lhe DATE of receipt.
FACILITY SECTION I
19. Discrepancy Indication Spaci?: The authorized representative ol the designated tacility's owner or operator must note in this space any discrepancy betwe
the waste described on the manifes! and the waste actUally received at the facility. Owners and operators of facilities who cannot resoh·e significant
discrepancies within 1 S doys reCoiving tho was le must submit to the Department a letter with a copy ol the manifest describing !he discrePancy and ar.emoIs 10
reconcil~ it The J_reatment, storage. or disposal facility must enler the actual weight of waste in pounds in the spaces provided ii !he am6unt varies any lrom 1~1
specified by t~':1 generator in item 13 or if lhe generator uses a unit ol measure other than pounds.
20. Facility Owner or Operator Cerlilicalion: Print or type the name ol the person accepting the waste on behn!f ol the owner or operator of the l.:icility. ThJt person
must acknowledge acceptanc'e of the waste d~scribed on the manirest by SIGNING (BY HAND IN INKfand entering the DATE of receipt.
1' ASSISTANCE IS NEEDED IN COMPLETION 01' THIS MANIFEST, CONTACT THE TfH".' ".IENT, STORAGE, OR DISPOSAL FACILITY DESIGI/ATEO T.I
REC Er THE WASTE OR.THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKlJ;,., :; FROM 8:00 om TO 5:00 pm.
. : ' ,. . ,
I South Carolina Department of Health
and Environmental Control
(Form desi ned for use on elite 12· itch writer
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
1. Generator's U.S. EPA ID No.
N C D 0 7 6 0
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
10. U.S. EPA ID Number
S C D O 7 0
Form A
2. Page 1
ol
Bureau of Solid & Hazardous Waste M91-
2600 Bull Stree\ Columbia, SC 29201
Phone: (803) 734•5200
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-88
Information in the shaded a<eas is not
required by Federal law, but is by State law.
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity 14. Uni!
No. Type '11\Nr,
a.
d.
Hazardous Wast_e, Solid, nos ORM-E
NA 9189 1 D T
::tf~.~~t~,E:1::::~~ti1:;~~i:i::111ar::'I~~lt!~;~1:::1~11!~~11i:~i11lli1r,=:,;1::
a.l.E..ili.J-I0,2,7,7,4!-lld,0,2!H\.{i(D!!c.LL_J-! I I I I !-I I I I Ii#
b,L+,J-1,,, 1 1-1 1 l __ ,,Jl~f~lllll,~:W,:,1,,,J,,,',sLJ:L.,L,L ... 1.,JII
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71358
2 0 Y
~~~tr·:to1··-e1-91~
:J,r,o,o,61'iv
.. :.='. :. -~--~·· '•'""' ?f.i ~-'-~Ji 'J{ p:
16. GENERATOR•s CERTI_FICATION: I horoby docloro thol lhoconto_nt, olthl, con,ignmonl are fully ond accurotelydescrlbod above by proper 11hipplng name and aro cl_as111lled.
pecked. marked, and labeled. and ore in on ro,pects in proper condition lor Iran sport by highway according to applicable International ond n11tlon11t govornmonl re,gulation1 and
the laws ol the State ot South Carolina.
111 am a large quanlity generator. I certify that I havo a program in place to reduce the volume and toxicity of waste generated to the dog,_ I have determlnod to be economlcally
practicable and that I have selected the practicable method of treatmenl. storage. or dl,posal currently available to mo which minimize, tho present and future uir-1 to human
health and the environment OR. ii I am a small quantitygeneralor. I hove mode a good faith effort to minimize my waste generation and seleCI the best was la management rnetl'lod
thal is avai!atlle 10 me and that I can alford.
Printed/Typed Name Month Day Year
0,?,
Month Day Year
~ :!~'k
Printed/Typed Name Month Day Year
19. Discrepancy Indication Space • I Jibs 'I !lbs
bl Jibs di l'bs
20. Facility Owner or Operator; Certification of receipl ol hazardous materials covered by !his manifest except as noled In Item 19.
Printed/Typed Name Signature Monlh Day Year
PA Form 8700-22 (Rev. 9/86) Previous Editions are Obsol~te [DHEC 1988 (Rev. 10/86)]
(·, J_; -~ .. ! , I • ', ;
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZAROOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typew~iterJ OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: · Federal Regulations require generators and transporters ol hazardous waste and owners or operators ol hazardous waste trea:mel
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)1 and, ii necessary, tht:: continuation sheet U.S. EPA Fo
8700-22A Rev.-9186 (OHEC 1988A) tor both inter-state and intra-state transportation. Transporters who transport hazardous waste into the United States Ir
another count_ry are responsiOle for completing the manifesl Federal and State regulations also require generators and transporters ol hazar_Cous waj:e ar:c
owners or operators ol hazardous waste treatment. stornge. or disposal factht1es to complete the following 1nlormauon ·•.. . I
GENERATOR SECTION ,.
2:
Generator's U.S. EPA ID Number -Manifest Document Number: Enter the generator's US. EPA twelve d1g1t 1dent1f1cat1on number and the unicue live d1g11
number assigned to this manifest by the generator beginning with 00001. llyour company does not have a U.S. EPA Identification NUmber. please con:act S:"c.
OHEC at [phone] about obtaining an fdentific.ition number. · I
Page 1 ol: Enter the total number of pages used to complete this manifest. i.e., the liist page EPA Form 8700-22 Rev. 9/86[DHEC 1988 {REV 10186)] plus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (DHEC 1988A) if any.
A. State Manilest Document Number: .Leave blank'.
a: Slate Generator Identification Number: Leave blank. . I
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifes: !arms. .
4. Generator's Pholle Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event or , _ ·
emergency including nights, weekends, and holidays. ·'x
5. Transport 1 Company Name: Enter the company name ol the llrst transporter who will transport the waste. • •
6 .. U.S. EPA ID Numb.er: Enter the U.S. EPA twelve digit identification number ol the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
0. Transporter's Phone Number: 0Enter a teleph0ne number including area code where an authorize'd agent ol the lirst transporter can be reached i~ t~e event al
an emergency including nights, weekends, and holidays. -. . I
7:. Transporter 2 Company Name: II applicable, enter the company name cl the second transporter who will transport the waste. U more than 2 trans;:,orters ··
be used. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) continuation sheet and list the transporters in the order they will be transporting the was
8.. U.S. EPA 10 Number:11 applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
E .. State Transporter's 10 Number: Leave blank. · ·
F .. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol th€ second transporter can be reached in ti
event or an emergency including nights, weekends, and holidays. ·
9.
10.
G:
Oesignaled Facilily Name and Site Address: Enter the company nnme and site address of the treatment. storage. or disposal facility designated to receive the
waste listed on this manifest The address must be the site address, which may differ from the mailing address. .
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number or the designated treatment. storage, or disposal facility identified in item 9. I
State Facility's ID Number: Leave blank. •
H;. Facilily's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event ot an
emergency including nights, weekends, and holidays. ·
U.S: DOT Descriptions: Enter proper shipping name, hazard class and 10 Number{UN/NA) for each waste as identified in 49 CFR 171-17i. II additional spal
is needed. use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet.
12.. Containers (no. and type): Enter number ol containers for each waste and the appropriate abbreviation from Table I (below) ror the type of containers.
TABLE I
OM= Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. roll offs I
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF =_Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. cal\ons. cases
TP::: Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic tl<!gS
13 .. Tolal Quantity: Enter total quantity ol waste described on each line. relative to the unils used in item 14. I
t4. Uni! (weight/volume): En1er the .,pprnr,ri.i.lc nbbrcvi.i.lions lrom Table II (below) lor lhe unit ol mensurc:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Melric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
l. Was le Number: Enter hnzardouS wnste nurnbersns sp~cilied in South Carolina Ha·zardous Waste Management Regulation R.61-.-79.261 Subparts.C ar.d DI
identity the hazardous wnste on each line. ·
J. Additional Descriptions lor Malerials Listed Above: In the spaces provided. enter the authorizalion number (lrom the S.C. OHEC Authorization Request For ..
!or each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted for treatment. storage or disposal in South Carclina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes for Wastes Listed Above: Leave blank. · .
15. Special Handling Instructions and Additional Information: Generators may use !his space fo indicate special transportation. treatment. storage or dispo
information or Bill or Lading lnlormation. For international shipments, generators must enter in this space the point of departure (city and s:aie) lor !hose
shipments destined for treatment. slorage. or disposal outside th~ jurisdiction.of the United States. · I
16. Generate, Certilicalion: The generator must READ, SIGN (BY HAND IN INK), and DATE !he certification statement. II a mode other than highway is used, t
Word "highway" should be lined out and the appropriate mode {rail. water .or air) inserted in the.space below. II anothe'r~mode in addition to the highway mod
used, enter the appropriate additional mode (e.g.,.and_ rail) in the space below. ·
TRANSPORTER SECTION
· 17: Transponer 1 Acknowledgement: Enter the name ol !he person a~cepling the waste on behall of the first transporter. That person _must acknowledl
acceptance ol the waste described on the manileist" by signing (BY HANO IN INK) and entering the DATE of receipt. ' ·
18. Transporter 2 Acknowledgcmenl: Enter. ii applicable, the name al !he person accepting the waste on behalf of the second transporter. That person must
acknowledge acceptance al !he waste described on the manifest by SIGNING (BY HANO IN INK) and entering the DATE of receipt.
FACILITY SECTION . . . I
19. Discrepancy Indication Space: The authorized representative or the designated facility's own~r or operator mus I note in this space any discrepancy betwe
the wa~te described on the manifest and the waste actt.ia!ly received at the facility. Owners and operators of facilities who cann_ot resolve signilicara
disc:reoanc:ies within 15 doys receiving !he waslo mus! SLJbmil to the Ooparlmenta lerler with a copyolthe manifest describing the discrepancy and a~emo1sl
reconcil~ it The treatment. storage. or disposal facility must enter the actual weight of waste in pounds in lhe spaces provided if the amount varies any from t
specified by the generator in item 13 or ii the generator uses a uni! ol measure other than pounds. · ·
20. Facilily Owner or Operalor Certilicalion: Print or type the name ol lhe person accepling the waste on beh:iH ol the owner or operator of the l:icility. That person
must acknowledge acceptanc·e ol lhe wasle described on the manilesl by SIGNING {BY HAND IN INK)and entering !he DATE ol receipt.
1, AS:i!STANCE IS NEEDEO IN COMPLETION OF THIS MANIFEST, CONTACT THE Tri.r.• "'.!ENT, STORAGE, OR DISPOSAL FACILITY OESIGrJATEO I
AeCeh . THE WASTE CA THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKU,-, :; FROM 8:00 om TO 5:00 pm. .
I lMi-.'\. i~ \ \ • --.,---=
South Carolina Department of Health
and Environmental Control
UNIFORM HAZARDOUS
WASTE MANIFEST
3. Generator's Name and Mailing Address
Channel Master
ewriler
1. Generator's U.S. EPA ID No.
N C D 0 7 6 0
ManUeat Document No.
0 0 6 0
P. 0. Box 1416, Smithfield, NC 27577
4. Generator's Phone( 919 934-9711
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
6. U.S. EPA 10 Number
S C D O 7 3
8. U.S. EPA ID Number
10. U.S. EPA 10 Number
S C D O 7 0
Form A
2. Page 1
of
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stre-et, Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
roved. 0MB No. 2050-0039 Ex ires 9-30-Ba
Information in the shaded areas is n01
required by Federal law, but is by State law.
11. U.S. DOT Descript!on (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. Total Quantity U. Unit
No. Type 'MNo
a. Hazardous Waste, Solid, nos ORM-E
NA 9189 l D T
a.~-I012171714l-llJ110121\%):;l;;\t}c.LLJ-I J J J J 1-1 J J I I%;,
b. LLJ-1 1-1 ,1J\liii'~i1li:lttd:W:J .,L., -,J:J ill:l
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71359
2 0 Y
;tF·F:.:jiOl'i.-;t~;;~;_
XitE ,a ,a 16 ltt\
16. Ci EN ERA TOR·s CERTIFICATION: I hereby decloro lhal !he conlenta olthla con9lgnmonl are lully and accurately da,crlbod abovo by proP4r 1hlpplng l'lama al'ld are c1aa&11te<I.
packed, marked. and labeled.and are in all respects in proper condition tor transport byhlghwayaccordlng to apptic.blo lntornaUonal and national government re,gulationa and
tho laws of tho State ol South Carolina.
II 1 am a large Quantity genere1or. I certify !hat I heive a pre>Qram in place to reduce the volume and toxlcltyol waste genera led to Iha dogree I have determined lo be economically
prac1icable and that I have solocled tho practicable method ol trealmont, storage, or disposal currently available lo me which minimizes the present and future ltlroat to human
health and !he environment; OR, If I am o smoU quantitygonorotor, I hove mode a good faith ottort lo minimize my weste generetion end se1ecl the beat wute manage men! method
that is available to me and that I can afford.
Printed/Typed Name L, C, c1.:ir
Printed/Typed Name
19. Discrepancy Indication Space
Signature
Signature
Signature Month Day Year
I 1....._...__.__._..._.pbs. C !....._..__......_..__.Pbs.
b I !lbs. d I pbs.
20. Facility Owner or Operator, Cer1irica!lon of receipt of hazardous materials covered by this manifest excepl as noted In Item 19. ·
Printtd/Typed Name Signature Monfll Day YNI
PA Form 6700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
STATE OF SOUTH CAROLINA 1NSTRUCT1o'Ns FOR UNIFORM HAZARcious WASTE MANIFEST I
IMPORTANT: rtPE jon a 12-pitch (elite) typewriter) OR USE FIRM·POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatme1·
storage. or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86 (OHEC 1988 (REV 10/86)] and, if necessary, thE! continuation sheet U.S. EPA For
8700-22A Aev:9/86 (DHEC 1988A) tor both inter-stale and intra-state transportation. Transporters who transport hazardous waste into the United States Ire
another country are responsiD!e !or completing the manifesl Federal and State regulations also require generators and transporters ol hazardous was:e ar:c
owners or operators ol hazardous waste treatment, storage, or disposal facilities to complete the following information. ·1 GENERATOR SECTION ,.
2:
Generator's U.S. EPA ID Number-Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the uniGue live digit
number assigned to this manifest by the generator beginning with 00001.11 your company does not have a U.S .. EPA ldentirication Number, please contact S.C.
OHEC at {803) 734-5200 about obtaining an Identification number. · · ·. ' -· ' · · · I
Page 1 of: Ente~thetotal number of pages used to complete this manirest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 (DHEC 1988 (REV 10/86)] i::lus t
number ol continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any. . ·
A. Stale Manifest Oocumenl Numbei: . Leave blank.
B: Stale Generator Identification Number: Leave blank. I
Generator's Name and Mailing Address: Enter the nam·e and mailing address of the generator who will manage the returned mandes! forms.
Generator's Phoiie Number: Enter a telephone number with area code where an authofized agent of the generator can be reached in the event of ,
3.
4.
emergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digil identification number of the first transporter identified in item 5.
C. Slate Transporter's ID Number: Leave blank.
O. Transporter's Phone Number: 0Enter a teleph~ne number including area ~ode where an authorized agent of the lirst transporter can be reached in the event or
an emergency including nights, weekends, and holidays. · · I
1:. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. II more than.2 transporters
B ..
E
F ..
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) continuation sheet and list the transporters in the order they Win be transpor.ing the was
U.S. EPA 10 Number:11 applicable. enter the U.S. EPA twelve digit 10 number of the second transporter identified in item 7.
SI.ale Transporter's ID Number: Leave blank. I
Transporter's Phone Number: Enter a telephone number including area code .where an authorized agent ol the second transpor1er can be reached int
event ol an emergency including nights, weekends, and holidays.
9.. Designated Facility Name and Site Address: Enter !he company name and site address of the treatment, storage. or disposal facility designated 10 receive the
waste listed on this manifest The address must be the site address, which may diller lrom the mailing address.
U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment. storage, or disposal facility identified in item 9. I
Stale Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event of an
emergency including nights, weekends, and holidays. ·
U.s: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) roreach waste as identified in 49 CFR 171-177. II addilional spa.
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (OHEC 1988A) Continuation Sheet. .
12.. Containers (no. and type): Enter number al containers for each waste and the appropriate abbreviation from Table I (below) for the type of container$.
, ,:
TABLE I
OM = Metal drums. barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes, cartons. cases. roll otls
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes, cartons. cases
OF= Fiberboard or plastic drums. barrels. kegs OT= Dump truck CF= Fiber or plastic boxes. ca~ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity ol waste described on each line, relative to the units used in item 14.
1-1. Unil (weight/volume): Enter the :,ppropri.olc nbbrcvintions from To1ble II (below) for the unit of rnc:,surc:
Table II
I
I
I.
J.
P 1: Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
Wasle Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and 01
identify the hazardous waste on each tine.
Additional Descriptions for Materials Usled Above: In the spaces provided. Cnter the aulhouwtion number(from the S.C. DHEC Aulhor1zat1on Request For
!or each wasle stream listr.d in section 11 above. Nole: Belore any hazardous waste can be accepted for treatment storage or disposal in Sou!t'l Carclina. ttie
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes lor Wastes Listed Above: Leave blank. ,
15. Special Handling Instruction~ and Additional Information: Generators may use this space to indicate special transportation, treatment. storage or dispo
information or Bill al Lading lnformntion. For internationnt shipments, generators must enter in this spnce the point ol departure (city and s:ate) for ·those
shipments destined lor treatment, storage, or disposal outside lh~ jurisdiction or the United States. · I
16. Generator Cer1ilication: The generator must READ, SIGN (BY HAND IN INK), and DATE lhecertilication statement ti a mode other than highway is used. t
word ''highway" should be lined Out and the appropriate mode (rail, water.or air) inserted in the space below. II another mi=:de in addition to the highway mode
used. enter the appropriate additional mode (e.g.,.and,rai!) in the space below.
ffiANSPORTER SECTION
17: Transporter l Acknowledgement: Enter the name or the person accepting the waste on behatr al the first transporter. That person mus: acknowledl
acceptance of the waste described on the manHest by signing (BY HAND IN INK) and entering the DATE of receipt.
18. Transporter 2 Acknowledgement: Enter. H applicable, the name of the person accepting the wasle on behalf al the second transporter. That person must
acknowledge acceptance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE al receipt.
FACILITY SECTION . . I
, 9. Discrepancy Indication Space: The authorized representative al the designated facility's owner or operator must note in this space any discrepancy bet we
the waste described on the manifest and the waste actt.ially received .at the lacility. Owners and operators ol facilities who cannot resolve significant
discrepancies within 15 days receiving tho woste mus I submit lo the Oep_ar1ment a 18tter with a copy or the manifest describing the discrepanc-,· and a~emp:s to
reconcil~ il The lreatmon~ &lorage, or dispoanl locility must ontcr lhe m;tuat weight ol woslc in pounds in lhe spaces provided ii the amount varies any from t!":I
specified by the generator In Item 13 or ii the generator uses a unit of measure olher than pounds.
20. Facility Owner or Operator Cerlilicalion: Print or type the nnme of the person accepting !he waste on behall of the owner or operator of the lacility. Th.it person
must acimow!edge acceptanc'e of the waste described on the manirest by SIGNING (BY HAND IN INK)°and entering the DATE o! receipt.
Ill' .ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST. CONTACT THE TP.1'.'. ',!(;NT, STORAGE, OR DISPOSAL FACILITY OESIGtJATEO Tl
P.ECEI. THE VIASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKLJ;\, :; FROM 8:00 am TO 5:00 pm.
I. South Carolina Department of Health
and Environmental Control
Bureau of Solid & Haz.ardous Waste Mgt
2600 Bull Street Columbia. SC 29201
Phone: [phone]
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 E..oires 9.30.sa
UNIFORM HAZARDOUS 1. Genera\or'sU.S.EPAIDNo. Manifeet Document No. 2. Page 1
of WASTE MANIFEST N c D o
3. Generator's Name and Mailing Address
Channel Master
P. O. Box 1416, Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Sile Address
GSX Services of SC, ·rnc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
S C D O 7 3 7
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
0 0 6 1
SCD07037
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number} 12. Containers
No. Type
L Hazardous Waste, Solid, nos ORM-E
NA 9189
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71360
1 D T
Information in the shaded a<eas is not
required by Federal law, but is by State law.
13. Total Quantity U. Unit :·:l1.Wa:itii1Number:;:!\:
'Mf{rj, :.:Jt/D';\.//\ ??tf-JW
2 0 Y
ri\•\:-· ;'6cti(9",~
\11E101Q161~f
16. GENERA TOR'S CERTIFICATION: thereby declare that the con1ents of this consignment are lully and accuratetydeacrlboc:I above by proper ,hipping nama and ara c:lasa,lied.
packed. markod. and 1ahalcd, and are In all respect, In propercondlllon !or transport byhlghwayaccording to applicable lnlarnallonat and national government r991.1latton1 and
U'le law, ol the State ol South Carolina.
111 am a large quantity generator, I certity that r have a program In place to reduce the volume and toxlcltyol wastegeneraled lotha degree I have determinoc:I to be economlcauy
practicable and that I have ,elecled the practicable method ol trealmenl storage, or dlspoaal currently available to me which minimizes the present and lutura thrut to human
health and the environment; OR, ifl am a smnll quantity generator, I have made o good IBilh oflort to minimize my waste generation and selecl the bell wuta management methOd
that is available to me and thol I can allord.
Printed/Typed Name. 4
0
, L
l'-• e.r-.
Signature Month Day Year
0?.2
Month Year
-,
Printed/Typed Name Signature Month Day Year
19. Discrepancy Indication Space !lbs. C I !lbs. •IL...L. ........ _.__.,
b)L...L.J....L-'--'-pt,,, d I !lbs.
20. Facility Owner or Operator; Certificalion or receipt or hazardous materials covered by lhis manifesl except as noted in Item 19.
Printed/Typed Name Signature Month Day Year
PA Form 6700-22 (Rev. 9/86) Previous Editions are Obsolete (DHEC 1988 (Rev. 10/86))
j.' ,4 ./ I .._,, .. t ,L
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN· PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9186 {DHEC 1988 (REV 10/86)1 and, ii necessary, the continuation sheet U.S. EPA For
8700-22A Aev:9I86 (DHEC 1988A) lof both inter-state and intra-state transportation. Transporters who transport hazardous waste Into the United States lro
another country are responsible !or completing the manifest Federal and State regulations also require generators and transporters of hazardous waste ano
owners or operators of hazardous waste treatment. storage, or disposal racilities to complete the lo!lowing information. . • · I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manilesl Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unicue five'dig1t
number assigned to this manifest by the generator beginning with 00001. If your company does not h3vea U.S:'EPA Identification Nu'mber. please contact S.C.
OHEC at [phone] about obtaining an Identification number. · · I
2: Page 1 ol: Enter the total number ol pages used to complete this manirest, i.e., the liist page EPA Form 8700-22 Rev. 9/86 [DHEC 1988 (REV 10/86)1 Plus It
number ol continuation sheets EPA Form 8700-22 Rev. 9186A (DHEC 1988A) if any.
A. State Manifest Document Number: .Leave blank.
s:
3.
4.
Slate Generator Identification Number: Leave blank. I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator. who will manage the returned manifest !arms.
Generator's Phorie Number: Enter a telephone number with a·rea c0de where an authorized agent of the generator can be reached in the event at
emergency including nights. weekends. an9 holidays.
Transport 1 Company Name: Enter the company name of the first transporter who will transport the waste.
6. U.S. EPA ID Number: Enter the U:S. EPA twelve digit identification number ol the lirst transporter identified in item 5.
s. I C. Slate Transporter's ID Number: Leave blank.
D. Transporter's Phone Number: 'enter a telephOne number including area code where an authorized ag.ent ol lhe first transporter can be reached in the event of
an emergency including nights, weekends, and holidays. t
7:. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. JI more than 2 transporters
8 ..
E ..
F ..
9.
10.
G:
be used, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC ,1988A) continuation sheet and list the transporters in the order they will be transoorting the was
U.S. EPA 10 Number:1I applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
State Transporter's 10 Number: Leave blank.
Transporter's Phone Number: Enter a telephone number including area code where an authorized agent ol thE! ~econd transporter can be reacl",ed in ti
event ol an emergency including nights, weekends, and holidays. · .
Designated Facility Name and Sile Addi-ess: Enter the company nnme nnd site address of the treatment, storage. or disposal lacility designated to receive the
wasle listed on this manifest The address must be the site address, which may ditfer from the mailing address.
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the designated treatment, storage, or disposal facility identified in item 9. I
Slate Facility's ID Number: Leaye blank. ·
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent ol the lacility can be reached in the event al an
emergency including nights, weekends. and holidays. u.s: DOT Descriptions: Enter proper shipping name, hazard class and ID Number (UN/NA) for each waste as identified in 49 CFA 171-1 i7. II additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 1988A) Continuation Sheet. . -
12.. Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) for the type of containers.
TABLE I .
OM = Metal drums. barrels, kegs TT = Cargo tanks (lank trucks) CM = Metal boxes. cartons. cases. roll otls I
OW= Wooden drums. barrels, kegs TC= Tank cars CW= Wooden boxes. cartons. cases
OF= Fiberboard or plastic drums, barrels, kegs DT = Dump truck CF= Fiber or plastic boxes. cartons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth. paper or plastic bags
13. Total Quantity: Enter total quantity of waste described on each line, relative to the unils used in item 14. I
14. Unit (weighl/volume): Enter 1he :1ppropri:1te nbbrevi:1tions from Table II (below) for the unit ol mensurc:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meiers Y = Cubic Yards G = Gallons (liquid only)
1. Was le Number: Enter hazardous waste numbers as specdied in South Carolinn Hazardous Waste Mnnngement Regulation A.61 • 79.261 Subparts C ar.d DI
identity the hazardous waste on each line.
J. Additional Descriptions for Malerials Listed Above: In the spaces provided. enter the authorization number (lrorn the S.C. OHEC Authonzn11on Request For
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted !or treatmenl storage or disposal in South Carctina. the
generator must obtain prior authorization from the treatment, storage or disposal facility. I
K. Handling Codes !or Wastes Listed Above: Leave blank.
TS. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation. treatment. storage or dispo
inlormation or Bill or Lading Information. For international shipments, generators must enter in this SP?Ce the point of departure (city and s:a:e) for those
shipments destined for treatment, storage, or disposal outside the jurisdiction of the United States. · I
16. Generalor Certilicalion: The generator must READ, SIGN (BY HAND IN INK), and DATE the certification statement. II a mode other than highway is used. r
word ''highway" should be lined out and the appropriate mode {rail, water .or air) inserted in th~ spa Ce below. II another mode in add.ition to the highway mode
used, enter the appropriate additional mode (e.g ... and. rail) in the space below.
TRANSPORTER SECTION .
17: Transporter 1 Acknowledgem~nt: Enter the ~ame of .the. person acc~pting the waste o~ behalf or the first tr~nsporter. That person must acknowledl
acceptance of the waste described on the manilest by srgning (BY HAND IN INK) and entering the DATE of receipt. ·
18. Transporter 2 Acknowledgement: Enter, ii applicable, the name of the person accepting the waste on behalf al the second transporter. That person must
acknowledge accepli'.lnce of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering the DATE ol receipt.
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized rcpresenta!ive of the designated lacility's owner or operator must note in this space any discrepancy bet we
the waste described on the manilest nnd the waste actually received al the racility. Owners nnd operators ol facilities who cannot resolve significant
discreponcies within 15 duys receiving lho was to must submit to the Department a lallor with a copy of the manifest describing the discrepancy and ar.emots to
reconcil~ it The trealmenl storage, or dispos.il lacility must enter the actual weight ol waste in pounds in the spaces provided ii the amount var.1es any from t1
specilted by the generator in item 13 or if lhe generator uses a unit al.measure other than pounds.
20. Facility Owner or Operator Cerlilicalion: Prinl or type the name ot lhe person accepting the waste on behnJI ot the owner or operator ot the f.Jcili1y. ThJt person
must acl(iiowledge acceptance of tho waste described on the manifest by SIGNING (DY HAND IN INK)° and entering the DATE of receipt.,
r, ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE rr,r,· · ·.IENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED 1
REC Er THE VIASTE OR THE S.C. OHEC MANIFEST SECTION AT [phone] WEEKu;:, :; FROM 8:00 am TO 5:00 pm.
I South Carolina Department of Health
· and Environmental Control
Bureau ol Solid & Hazardous Waste Mgt
2600 Bull Stree~ Columbia, SC 29201
Phone: [phone]
Emergency & Holiday~ [phone]
LEASE PRINT or TYPE (Form desi ewriler Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
F
UNIFORM HAZARDOUS
WASTE MANIFEST
1. Generator's U.S. EPA 10 No.
N C D O 7
Msnlfe•t
Document No. 1400062
3. Generator's Name and Mailing Address
Channel Master
P .. 0. Box 1416,
4. Generator's Phone 919
Smithfield,
934-9711
5. Transporter 1 Company Name
Willms Truckin Co
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
;GSX Services of SC, Inc.
Route, l Box 255
Pinewood SC 29125
NC 27577
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA 10 Number
10. U.S. EPA ID Number
S C D O 7 0 3 7
11. U.S. DOT Description (including Proper Shipping Name, Hazard Cfass, and ID Number}
a
d.
Hazardous Waste, Solid, nos ORM-E
NA 9189
0;fm~,:~~A~~1;~;~i!~1!~~t~~,!!1~:i!t!f1;;;,:_
a ILili.J-I0 I 2 17 I 7 14 1-11 I l 1 0 I 2 ! cd:<frifai c. LLJ-1 L. ..JIL-1----'--L--'
b. Li_J-I 1-1 Jlf:;J1i,i.r1ii!~:w:1 . . __ 1--:1 ....
15. Special Handling Instructions and Additional Information
GSX Work Order No.: 71361
2. Page 1
of
l D T
Information in the shaded areas is not
required by Federal law, bul is by State law.
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i'~\~':F.~1:·o~;'·t·,:~g;~i-~~
t.'!1£ ,a ,a 16 ,·g
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tl:
16. GENERA TOR0S CERTIFICATION; I hereby declare that the contents Ol lhls conalgnmonl o.re lully and accurately described above by pro~r ,hipping name and••• cla1a1ll.-d,
packed, marked, and la.be led, and are in all respects in propercondiUon tor transport by highway according to applicable lnlornaUonal and naUonal government rogu1at10n1 and
1.he laws ol the State ol South Carolina. ·
111 am a largo Quantity genere1or, I certify \ha! I have a program in place to reducot'1ovotumo and toidclty ol waste generelod 10 Iha d&Vrff I have determined 10 be economlcally
prect1cab!e and that I have selocted the pracllcable method ol treatment. storage, or disposal currently availeble lo me which minimizes the present and future trlreal to human
health and the environment; OR. II I am a smoll qua.ntitygonorator. I hove mado a good lalth etlort to minimize my waste generation end salecl the beat waata management rnethOd
the! is available to mo and Iha.I I con attord.
Printed/Typed Name tf?
f<-.S er-L, Signature Month Year
(
18. Transporter 2 Acknowledgement of Receipt of Materials
Printed/Typed Name Signature Month Day
19. Discrepancy Indication Space
a I !I"'-C I Ii"'-
b I !I"'-d I libs. ·~ 'i-:-=--::--c::-::----::----=-=---~ 20. Facility Owner or Operator; Certification of receipt or hazardous materlals covered by !his manifest except as noted in llem 19. I Printed/Typed Neme Signature
EPA Form a700.22 (Rev, 9/86) Previous EdlUona nre Obsoloto (OHEC 1988 (Rev. 10/86)]
Monttl Day Year
,-;. ' ' t . ' ~ , . •-: i'-.~·.,. ti r t ' ii • . I :.
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZARDOUS WASTE MANIFEST ' .
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARO ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Federal Regulations require generators and transporters of hazardous waste and owners or operators ol hazardous waste treatmel
storage, or disposal licilities to use the U.S. EPA Form 8700-22 Rev. 9/86 {DHEC 1988 (REV 10/86)1 and, ii necessary, thEI continuation sheet U.S. EPA For
8700-22A Aev:9/86 {DHEC 1988A) loi both inter-state and intra-state lransportatlon. Transporters who transport hazardous waste Into the United Slates Ira
another country are responsible for completing the manifest Federal and State regulations also require generators and transporters al hazardous waste ano
owners or operators of hazardous waste treatment. stor~ge, or disposal racilities to complete the !allowing information. .· . . . I
GENERATOR SECTION
1. Generator's U.S. EPA ID Number-Manilest Document Number: Enter the generator's U.S. EPA twelve digit identification number and !he unique five digit
numbe'r assigned to this manifest by the generator beginning with 00001. If your company does not have a U:S._EPA Identification Number, please contai:t Sic.
OHEC at [phone] about obtaining an Identification number. · · I
2: P~ge 1 of: Enter the total number of pages used to complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)! plus:
number of continuation sheets EPA Form 8700-22 Rev. 9/86A (OHEC 1988A) if any.
A. State Manifest Document Number: .Leave blank.
a:
3.
4.
Slate Generator Identification Number: Leave blank. . I
Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest rorms.
Generator's Phone Number: Enter a telephone number with area code where an authorized agent al the generator can be reached in the event of
eniergency including nights, weekends, and holidays.
5. Transport 1 Company Name: Enter the company niime or the first lransporter who will transport the waste.
6. U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5. I C. Slate Transpor1er's ID Number: Leave blank.
0. Transpor1er's Phone Number: 0Enter a teleph0ne number including area code where an authorized agent ol lhe lirsl transpor1er can be reached in the event ol
an emergency including nights, weekends, and hotidays.. · . f
1:. Transporter 2 Company Name: II applicable, enter the company name of the second transporter who will transport the waste. If more than 2 transporters
8 ..
E.
F ..
9.
10.
G:
be used. use a U.S. EPA Form 8700·22A Rev. 9/86 (OHEC -1988A) continuation sheet and list the transporters in the order they will be transoon.ing the was
U.S. EPA ID Number:1I applicable. enter the U.S. EPA twelve digit ID number ol the second transporter identified in item 7.
State Transporter's ID Number: Leave blank.
Transpor1er's Phone Number: Enter a telephone number including area code Where an authorized agent of thE! ~econd transpor1er cari be reached in ti
event ol an emergency including nights, weekends, and holidays. ·
Designated Facility Name and Site Address: Enter the company name and site address cl the treatment, storage, or disposal facility designatea to receive tl",e
waste listed on this manifest The address must be the site address, which may diller !rem the mailing address.
U.S. EPA 10 Number: Enter the U.S. EPA twelve digit identification number ol the designated treatment, storage. or disposal facility identified in item 9. I
State Facility's ID Number: Leave blank.
H;. Facility's Phone Number: Enter a telephone number including area code where an authorized agent at t_he facility can be reached in the event ol an
emergency including nights, weekends, and holidays. ·
U.S: DOT Oescriplions: Enter proper shipping name. hazard class and ID Number (UN/NA) for each waste as identified in 49 CFA 171-177.11 additional spal
is needed, use a U.S. EPA Form 8700-22A Rev. 9/86 (DHEC 19S8A) Continuation Sheet. . .
1 r.
12.. Containers (no. and type): Enter number of containers for each waste and the appropriate abbreviation from Table I (below) for the type of containers.
TABLE I
OM= Metal drums, barrels, kegs TT= Cargo tanks (tank trucks) CM= Metal boxes. canons. cases. roll oHs I
OW= Wooden drums, barrels, kegs TC= Tank cars CW= Wooden boxes. car1ons. cases
OF= Fiberboard or plastic drums. barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. can.ans. cases
TP = Tanks por1able CY= Cylinders BA= Burlap. cloth. paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line. iela!ive to the units used in item 14. I
14. Unit (weighl/volume): Enter 1he npproprintc nbbrevintions from Table II (below) for the unit ol mensurc:
Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid only)
I. Was le Number: En!er hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regu!ation A.61 • 79.261 Subparts C ar:d DI
identify the hazardous wnste on each fine.
J. Addilional Descriptions !or Malerials Li sled Above: In the spaces provided, enter the authorization number_ (lrom the S.C. DHEC Au1hor1z;:i11on Request For
lor each waste stream listed in section 11 above. Nole: Before any hazardous waste can be accepted fortreatmeni storage or disposal In South Carclina. the
generator must obtain prior ·authorization from the treatment, storage or disposal facility. J
K. Handling Codes for Wastes Lisled Above: Leave blank. ·
15. Special Handling Instruction, and Additional lnlormalion: Generators may use this space to indicate special transportation. treatment. storage or dis po
information or Bill or Lading tnrormation. For international shipmcn!s, generators must enter in this space the point al departure (city and s:ate) ror those
s~ipments destined for !reatment, storage. or disposal outside th~ jurisdiction ol the United States. · I
16. Generator Certification: The generator must READ, SIGN (BY HAND IN INK), and DATE the cer1ilication statement. II a mode other than highway is used. 1
Word "highway" should be lined out and the appropriate mode(rail. water.or air) insE!rted in the space below. II another mode in addition 10 the highway mode
used. enter the appropriate additional mode (e.g.,,and_rail) in the space below.
TRANSPORTER SECTION
17: Transpor1er 1 Acknowledgement: Enter the name of the person accepting the waste on behall of the first transporter. That person must acknowledl
acceptance of the waste described on the manifest by signing (BY HANO IN INK) and entering the DATE of receipt.
18. Transpor1er 2 Acknowledgement: Enter. if applicable. the name ol the person accepting the waste on behalf of lhe second transporter. That person mus:
acknowledge acceplance of the waste described on the manifest by SIGNING (BY HAND IN INK) and entering lhe DATE of receipt. ,
FACILITY SECTION I
19. Discrepancy Indication Space: The authorized representative or the designaled facility's owner or operator must note in this space any discrepancy bet we
the waste described on the manifest and the waste actUally received at the facility. Owners and operators of facilities who cannot resolve signdican:
discrepancies within 15 days rocoiving tho woato mus I submil to !he Oopar1menI o loiter with a copy ol lho monilosl describing the discrePanc·1 and ar:em61s to
reconci!~ it The treatmenl storage, or disposal facility must enter the actual weight of waste in pounds in the spaces provided if the amount varie. s any rrom 1~1
specified by the generator in item 13 or if the generator uses a unit ol measure other than pounds.
20. Facility Ownei-or Operalor Cerlilicalion: Print or type the name of the person accepting the waste on behalf or the owner or operJIOr of !he l.::icillly. Th.JI person
mus! acknowledge acceptance ol the waste described on !he manifest by SIGNING (BY HAND IN INK)°and entering the DATE ol receipt.
Ill" AS~!STANCE JS NEEDED IN COMPLETION OF TH1S MANIFEST, CONTACT THE rr.r.• "'.!ENT, STORAGE. OR DISPOSAL FACILITY DESIGN.A.TEO Tl
P.ECEJ•, -THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKI.,;\,:; FROM 8:00 am TO 5:00 pm.
I ' ' -":!
. .,_
South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Bull Stree\ Columbia, SC 29201
Phone: [phone]
Emergency & Holidays: [phone] I PLEASE PRINT or TYPE (Form desi ned for use on elite 12 · writer
UNIFORM HAZARDOUS 1. Generat •
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1
of lnlormalion in the shaded Meas is not
required by Federal law, but is by State law.
I
I
I
I
I
I
I
I
I
WASTE MANIFEST N c D
3. Generator's Name and Mailing Address
Channel Master
P. 0. Box 1416,· Smithfield, NC 27577
4. Generator's Phone [phone]
5. Transporter 1 Company Name
Willms Truckin Co Inc.
7. Transporter 2 Company Name
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route, 1 Box 255
Pinewood, SC 29125
6. U.S. EPA ID Number
SCD0737
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
d.
.!j::; .. ~~0,:i/: .. ::::~i}:J\i;il]!@;: \![ :'.:,,·:; '.:-·.:, ... ·,;:,,-i•'.'> ,':':::'.~:;:::l: ti'illt
a.lE.M.]-!0,2,7,7,4l-lld,0,2!i:1Altfid1ij°·LLJ-1 J J J J 1-1 J I J l!f!
b, Lu-I J J J .. J 1-1 J .. ' ..... '. 1ll:~1il'lf!1~~=L J •• J:L .. ,., ........ I.!~
15. Special Handling Instructions and Additional lnlormation
GSX Work Order No.: 71362 .
16. GENERATOR"$ CERTIFICATION: J hereby declare that the contents olthis consignment are fully and accurately described above by proper shipping name and are clasailled,
packed. marked. and ,a-beled, and are in all rospects in propor condition for transport by highway according 10 applicable international and national government regulations and
tl1e laws of the State ol South Carolina.
111 am a large Quantity g0eneralor, I C8r1ify that I have a program in place to reduce the volume and toidcltyofwastegeneraled to the degree I have determined to bo oconomlcally
practicable and that I have selected the practicable method of treatment, storage, or dlsposat currently available to me which minimizes the present and luture throat to human
health and the environment OR, If I am a small quantitygonorator, I have modo ogood laith effort 10 minimize my westegeneration and select the beat waste management method
Iha! is avai!ablo to mo and tho! I con afford.
I Printed/Typed Name /1} L
h-1------...:'f~c,~+:-' z..r-~....:· ::.·~~~--1.---,M"""..!..::::.~~~~~~~=,.,---~~~l!:J.~
Year
T I if-iig;,=:::.,.::;:,::...':'-;::::::.::.=:.e:r=:c.:.::.::,.;::.::::c..=c=::,,1"---,,c::f-f-----'----+-1c,--'i<~--r-c-1+------~-==:--:::----,::-::-f
0 R~'-=+============::.:..----,-,,-----!'--------------------..,.,--,--:---,::---1 I ~i-4 __ P_r_in ___ ed_N_•_m_e-'---------------...l"'S-ig_n_a_tu_r_e ________________________ ,1,....,..,1..,_,1,...1....1,_
Month Day Year
19. Discrepancy Indication Space
F
I! • I pbs. CI pbs.
bl pbs. d I jibs. ,,_ ______________ _
~ 20. Facility Owner or Operator; Certification ol receipt ol hazardous materials covered by lhis manilesl excepl as noted in Item 19. I Printed/Typed Name Signature
EPA Form 8700·22 (Rev 9/86) Previous Ed1t1ons are Obsolete [DHEC 1988 (Rev. 10/86)]
Monti! Day Year
STATE OF SOUTH CAROLINA INSTRUCTIONS FOR UNIFORM HAZAR_OOUS WASTE MANIFEST I
IMPORTANT: TYPE [on a 12-pitch (elite) typewriter] OR USE FIRM POINT PEN -PRESS DOWN HARD ALL COPIES MUST BE LEGIBLE!
GENERAL INFORMATION: Feder'al Regulations require generators and transporters of hazardous waste and owners or operators ol ha_zardous waste tream■I.
storage, or disposal ficilities to use the U.S. EPA Form 8700-22 Rev. 9/86.[DHEC 1988 (REV 10/86)] and, if necessary, the continuation sheet U.S. EPA Flin
8700-22A Rev: 9186 (DHEC 1988A) foi both inter-state and intra-state transportation. Transporters who transport haiardous waste into the United S_tates from
another country are responsible !or completing the manifest Federal and State regulations also require generators and transporterS of hazardous wa$te and
owners or operator~ al haza.rdous waste treatment. storage. or disposal facilities to complete the following information. I
. GENERATOR SECTION
1. Generator's U.S. EPA ID Number• Manifest Document Number: Enter the generator's U.S. EPA twelve digit identification number and the unique five digit
number assigned to this manifest by the generator beginning with 00001. If your company does not have a U.S. EPA ldentirication Number, please contactl.
DHEC at {803) 734-5200 about obtaining an identification number. ·
2: Page 1 of: Enter the total number of pages.used to complete this manifest, i.e., the fiist page EPA Form 8700-22 Rev. 9/86 [OHEC 1988 (REV 10/86)) plu e
number of continuation sheets EPA Form 8700~22 Rev. 9/86A (DHEC 1988A) if any.
A. State Manifest Document Number: .. Leave blank. I B: Slate Generalor Identification Number: leave blank.
3. Generator's Name and Mailing Address: Enter the name and mailing address of the generator who will manage the returned manifest !arms.
4. Generator's Phorie Number: Enter a telephone number with area code where an authorized agent of the generator can be reached in the event ol an
emergency including nights. weekends. and holidays.
5. Transport 1 Company Name: Enter the company name of the lirst transporter who will transport the waste. I 6. U.S. EPA ID Number: Enter the U.S. EPA twelve digit identification number of the first transporter identified in item 5.
C. Slate Transporter's 10 Number: Leave blank:
D. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent of the first transporter can be reached in the event of
an el!'.~-~g~ncy inc_lhl.~.'.'19 nigh~.~e~~~!1~~tand-_hq~Qays. --· . . . . .... lJ!_:ft. . !,.' ·~r•/•·,.1.:~·UL!,... . . I
Transporter 2 Company Name: If applicable, enter the company name ol the second transporter who will transport the-Waste:·I1 rTioie"th3ri 2 tran·s·porte-r, 11 ·
be used, use a U.S_. EPA Form 8700-22A Rev. 9/66 (DHEC 1968A) continuation sheet and list the transporters in the order they will be transporting the waste.
8.. U.S. EPA ID Number:lf applicable, enter the U.S. EPA twelve digit ID number of the second transporter identified in item 7.
Stale Transpor1er's ID Number: leave blank. I E'.
F .. Transporter's Phone Number: Enter a telephone number including area code where an authorized agent or the second transporter can be reached ir, e
event of an emergency including nights, weekends. and holidays.
9.
10:
G:.
Designated Facility Name and Sile Address: Enter the company name and site address of the treatment, storage, or disposal facility designated to receive the
waste listed on this manifest The address must be the site address. which may differ lrom the mailing address. I
U.S: EPA ID Number: Enter the U.S. EPA lwelve digit identification number of the designated treatment. storage. or disposal facility identi!ied in item 9
State Facility's ID Number: Leave blank.
H;. Facility's _Phone Number: Enter a telephone number including area code where an authorized agent of the facility can be reached in the event al an
emergency including nights, weekends, and holidays. I
11'. U.S: DOT Descriptions: Enter Rroper shipping name, hazard class and ID Number(UN/NA) for each waste as identifie? in 49 CFR 171 -177. If additional s9e
is needed, use a U.S. EPA Form 8700-22A Rev. 9/66 (DHEC 1968A) Continuation Sheet. . ·
12.. Containers {no. and type): Enter number al containers for eac;h waste and the appropriate abbreviation from Table I (below) for the type ot containers.
TABLE I I
OM = Metal drums. barrels. kegs TT = Cargo tanks (tank trucks) CM = Metal boxes. cartons. cases. roll offs
. OW= Wooden drums. barrels. kegs TC= Tank cars CW= Wooden boxes. car1ons. cases
OF= Fiberboard or plastic drums, barrels, kegs OT= Dump truck CF= Fiber or plastic boxes. car1ons. cases
TP = Tanks portable CY= Cylinders BA= Burlap, cloth, paper or plastic bags
13 .. Total Quantity: Enter total quantity of waste described on each line, relative to the units used in item 14.
T4. Unit (weight/volume): Enter the appropriate abbreviations from Table II (below) for the unit of measure: I
. Table II
P = Pounds L = Liters K = Kilograms T = Tons M = Metric Tons N = Cubic Meters Y = Cubic Yards G = Gallons (liquid Of')
I. Waste Number: Enter hazardous waste numbers as specified in South Carolina Hazardous Waste Management Regulation R.61-79.261 Subparts C and
identity the hazardous waste on each line. .
J. Additional Descriptions for Materials listed Above: In the spaces provided. enter the authorization number (from the S.C. DHEC Authorization Request Form)
for each waste stream listed in section 11 above. Note: Before any hazardous waste can be accepted !or treatment. storage or disposal in South Carclinaje
generator must obtain prior authorization lrom the treatment, storage or disposal facility.
K. Handling Codes for Wastes listed Above: Leave blank. ·
TS .. Special Handling Instructions and Additional Information: Generators may use this space to indicate special transportation. treatment. storage or disposal
information or Bill ol Lading lnlormation. For international shipments. generators must enter in lhis space the point al departure (city and state) !or those
shipments destined lor treatment, storage. or disposal outside the jurisdiction of the United States. I
16. Generator Certification: The generator must READ, SIGN (BY HANO IN INK), and DATE the certification statement. II a mode other than highway is used e
word "highway" should be lined out and the appropriate mode (rail, water. or air) inserted in the space below. If another mode in addition to the highway mo e Is
used, enter the appropriate a_dditional mode {e.g ... and_ rail) in the space below.
TRANSPORTER SECTION I
17: Transporter 1 Acknowledgement: Enter the name of the person accepting the waste on behalf of the first transporter. That person must acknowle e
acceptance al the waste described on the manirest by signing (BY HANO IN INK) and entering the DATE of receipt.
T 6. Transporter 2 Acknowledgement: Enter, if applicable, the name of the person accepting the waste on behalf al the second transpor1er. That person must
acknowledge acceptance al the waste described on the_manifest by SIGNING (BY HAND IN INK) and entering the DATE of receipt I
FACILITY SECTION ·
19. Discrepancy Indication Space: The authorized representative al the designated facility's ow_ner or operator must note in this space any discrepancy betw n
the waste described on the ·maiiilest and the waste acttially received at the facility. Owners and operators of facilities who cannot_ resolve significant
discrepancies within 15 days receiving the waste mu·st submit to the Department a letter with a copy of the manifest describing the discrepancy and attemo,,
reconcile it The treatmenl storage, or disposal tacility must enter the actual weight al waste in pounds in the spaces provided if the amount varies any from t
specified by the generator in item 13 or ii the generator uses a unit of measure other than pounds.
20. Facility Owne"r or Operator CertlUcation: Print or type the name ol the person accepting the waste on behalf of the owner or operator ol the lacilily. That person
must aci<nowledge acceptance of the waste described on the manifest by SIGNING (BY HANO IN INK)and entering the DATE of receipt. t
IF ASSISTANCE IS NEEDED IN COMPLETION OF THIS MANIFEST, CONTACT THE TREATMENT, STORAGE, OR DISPOSAL FACILITY DESIGNATED
RECEIVE THE WASTE OR THE S.C. DHEC MANIFEST SECTION AT [phone] WEEKDAYS FROM 8:00 am TO 5:00 pm.
I ..>UUUI \.,c;UUlllld Ut:J)dl Ullt:lll VI nt:dlUI
and Environmental Control
Bureau ot Solid & Hazardous Waste Mgt
2600 Bull Stree\ Cotumb;a. SC 29201
Phone: [phone] ~ I PLEASE PRINT or TYPE (Form desi ned for use on elite 12~ itch
UNIFORM HAZARDOUS 1. Generator'sU.S.EPAIDNo.
Emergency & Holidays: [phone]
Form A roved. 0MB No. 2050-0039 Ex ires 9-30-88
2. Page 1 Information In the shaded Meas Is not
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WASTE MANIFEST c D o 9 7 6 o 4 7 1 4 ol 1 required by Federallaw, but Is by State law.
3. Generator's Name and Malling Address
Channel Master
P. O. Box 1416,
4. Generator's Phone 91 9
5. Transporter 1 Company Name
Willms Truckin
7. Transponer 2 Company Name
Smithfield,
934-9711
Co. Inc.
9. Oesignaled Facility Name and Site Address
GSX Services of SC, Inc.
NC 27577
:l{l:~=i~\1:l!ltt~t1~t~~
,;,:~,~%~1~~~~illt~Z.ti~~~~;
6. U.S. EPA 10 Number T
SCD073709297oF
8, U.S. EPA ID Number
10. U.S. EPA 10 Number
;~~~:o!d B~~ ;~i2s s C D O 7 0 3 7 5 9 8 5 .1i(ilniil~lll1\1fg~t•~i1~,i~J&l\l
11. U.S. DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers 13. TotaiOuantity 14.Uni1 :(_(.i~~~{%
I No. Type 'M/Vd 11{!¥6?'&\:}kitftl
G a. Hazardous Waste, Solid, NOS ORM-E :\i'i"FfoFifiJ~
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~ 1-b-. _N'.'.:A:...:9:;l'...'.8'..:9:__ _____________________ wu..2lcC:C~Ml-L.JL.J...:2:L':0~_!Y_tJ!•:·····•i;·L=F=.~= •. ~~-'.=,~;:-•,=·1§::.: .... ~~·.·
A \~I I I J I··) ·:-;,,. t :a ' 61---------------------------------------1-L.L..l-_l_J._.L...J.._J~L...l--.....l~}t:tJJJ=·':·::·:'=:' :'!~;I)
R C. [lf'a""'"i""'""j'v:.'t~i
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GSX Work Order No.: 7 i '-f5°'-/
16. GENERA. TOR'S CERTIFICATION: I her a by decl•r• that the contents ol lhla consignment are lully and accurelely de1cribed above by proP4r ahlpplng name and are claHin.-d,
pacl.ed. marked, and laheled,and are in all respects in proper condition for transport by highway according to applicable inlarnaUonat and natlonal government re,gulatlona aod
Ula l&ws of Iha SUila ol South Carolina.
111 am a large quanlity gariaralor, I certify !hat I have a pr09ram In piece lo reduce the volume end 1oxlcltyof waalegeneraled to lha deg,_ I he.,..datermlnod lo be economlcally
pr11c1icable end that I have selected the practicable method ol treatment, storage, or dlapoaal currently available to me which mlnimlt•• Iha praaanl and future threat kl human
health and the environment; OR, If I am a a mall quantity generator, t have mede a good faith effort to minimize my waste generation and aalect tha beat waata ma.nagamanl method
that la available to me and that I can afford.
Printed/Typed Name Signature ol. ~ Month
~ 17. T ranspQrter 1 Aumowledgement of Receipt of Materials
A Printed/Typed Naeie ~ W. --Jea..v'Y\ <2(__
~ 18. Transporter 2 Acknowledgement of Receipt ol Materials
I ~ Printed/Typed Name
....+-R --------'------~ ...............
Signature Month Day Year
19. Discrepancy Indication Space .~ L 11---------------
• I l'bo. CI l'bo.
b I I'"'-d I llbl.
~ ~20_. _F_a_c;_tity.:....:Ow_ne.:.r_o:..r..:0:..:pe:..:c.r•:;to:;r.:.., Certi=.:.·1..:;ca=tio:;n:..o:..l_rec=•::ip_t o.,_t_haza __ :...r:..dou=•-ma..:.-t•:...rla=l•..:cover=c.ed:..:;by:!.Cth'-11::· .:.ma.::;;n:;He,::;.t •.:.x..:ce=pt..:aa=•.:.ot.:.ed.:...:l":.."..:•..:m:..1..:9.;.. --------------~
I._.__P_nn_· _led_/_T_yped __ -_____________ ...J._Sig_na_tur_• ___________________ ...JI...JI...JL...L...L...1.-1
EPA Form 8700-22 (Rev. 9/86) Previous Editions are Obsolete fOHEC 1988 (Rev. 10/86))
Mon1h Day YOII
I South Carolina Department of Health
and Environmental Control
Bureau of Solid & Hazardous Waste Mgt
2600 Boll Street, Columbia, SC 29201
Phone: [phone]
I Emergency & Holidays: (803)734-5-124
;.P.:LL:;:;.IS::;E:.:,.P:;R,:;INT;:,.;°':-,:TY,:,;,PE;.,~(F:,;o::r,,m,.d:,es:",:!ln,:ed,;:,;f;,or~u:;se,:.::o;.:n.,ol::,:lt,:o,1.l:.;2'-•:;;lt;::c:,.hL.:.u:;;;;:;:;::.,_...; _____ -,-,-,,,_--.':'""~F.;o::,:rm,;;.;;Al:Froved.;;.;;:::::,·;::0;,:M;::B;.;N,;;o;;.,::;20:;;50:::;:-0039;;;;::,.:Ex:.;1;,:ros:;.:9.:·30:::;:·88:;
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UNIFORM·HAZARDOUS 1. Genoralor'sU.S.EPAIDNo. 2. Pagel Information In the shaded arees 11 not
WA TE MANIFEST C D O 9 7 6 O 4 7 l 4 of l roqulredbyFedor1ll1w,butlsbySlllol1w.
3. Generator's Name and Malllng Address
Channel Master
P. 0. Box 1416,
4. Generator's Phone 919
Smithfield,
934-9711
5. Transporter 1 Company Name
Willms Truckin Co.
7. Transporter 2 Company Name
Inc.
9. Designated Facility Name and Site Address
GSX Services of SC, Inc.
Route 1, Box 255
Pinewood SC 29125
NC 27577
.~il':~:t;i:1~1~·1tt~l:i:ltt{~t1,~:li
-ti;{=l;f 11~:tii~l;'.li;1;~\itrri1i~01Ri;[r]'.:::%
6. U.S. EPA ID Number
SCD073709297oT
8. U.S. EPA ID Number
10. U.S. EPA ID Number
S C D O 7 0 3 7 5 9 8
11. U.S. DOT Description (mcluding Proper Shipping ~me. Hazard Class, and ID Number) 12. Containers
No. Type
d.
~~~a1r:i=t1ll1~;: .,w.,~~= iii'' ·•· ... , ..... "'. •
a. l..h..HJ-i Qi 2, ?1 71 41-i li ~
b. Lt_j-i
•~••=••M<-",•;•••• i~W:_,. •J.,L 1::.: : ... : .. :ri,1
15. Special Handling Instructions and Additional lnlormation
GSX Work Ord.er No. : 7 / 'f ,S-5'
1 6. GENERATOR'S CERTIFICATION: t her a by declare tttal the contents ol this cons!Qnment are fully and accurately described above by proP4r shipping name and ar• classille-d,
pack.ad. mark.&d, and la°beled,and ere in all reapecl& in proper condition lortranaport by highway according lo appUcable lnlarnaUonal and natlonal government ra,gulallons and
ttie taws of Iha State ol South Carollna. '
If I am a large quantity generator, I certify that I have a program In place to reduce the wlume and to:lliclty of waate generated to tha degrN I haYII datan'l'lined to be economblly
practicable and that I hava selected the practicable method of treatment. storage, or dlapoaal currantty avallable to me which mlnlml:r.u the preaent and future thrNt to human
health and tha environment: OR, If I am a small quantity ganeraror. I have mad a a good faith effort to mlnlml:r.e my waate generation and .. ,ect the boat waste management method
that Is available to ma and that I can arrord.
Printed/Typed Name
I ~ 17. Transporter 1 AcKnowledgement ol Receipt of Materials
~ ctrinted/Typed Name ,# // ~ff Month Year
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0 i f-"C...P .. ri:.n,.ced:.::..:/T:.:y:.pc.;ed:..~:.;;;•;;;m:.:ec...:.:.:::.c;.:..;_:_;..:.c:.:.::;icc:.:...::::;.:..=---...,.-------------------,.,L----------,----,
R I
Month Day
19. Discrepancy Indication Space .• ~
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b I Jibs. d I
I + ~20=.-=F=-,-c"i11'"·1y-O,.w_ne_r_o_r_O"pe-r-•tor.-,"'ee-rti-.fi-,ca-tio_n_ol receipt of hazardous materials covered by this manifest except as noted in hem 19. Yt-----'-----'---------'------....------'------'------------------Prinled/Typed Name Signature Month C.y
EPA Form 8700-22 IRev. 9/861 Previous Editions nre Obsolete fDHEC 1988 lRev. 10/8611
Year
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Year