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ArKansas uepartmentof Environmental Quality <br /> Hazardous Waste 17',ision <br /> P.O. Box 8913, Lit&.Aock, AR 72219-8913 .. <br /> 's Telephone: (501) 682-0833 LC,,J, <br /> Please Print or type. (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. 2. age 1 Information in the shaded areas is not <br /> nto required by Federal law. <br /> WASTE MANIFEST m I <br /> 3.Generator's Name and Mailing Address All Manifest Document Number <br /> SISHOP INDUSTRIES AR-1410 515 <br /> 5M7 CARNEGIE STREET U.State Generators ID <br /> k"TECA CA 95337 <br /> c 4.Generators Phone <br /> 5.Transporter 1 Company Name 6, US EPA ID Number ."State Transpartal ID <br /> H- <br /> ENVIRONMEWAL RECOVERY SER1/10ESi INC C tl D O tl 9 T 0 8 g 2 D.Transporter-s Phone <br /> 7,Transporter 2 Company Name 8. US EPA ID Number E.State Transporter's ID <br /> MANEE H- <br /> EXPRErSS P.III 7M N J D 9 E 6 8 tl 7 3 8 n F.Transporter's Phone $gg ff <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G.State Facility's ID <br /> RlNr�E�pC,1w�OL•• /w�r/�,' <br /> 107,MCAN ROAD-HA H.Facility's Phone .. <br /> S MTON SVR 720 1) g a i o 51 7 0. 7. 0. 501778-4 <br /> 12.Centel am 13. 14. <br /> 11.US DOT Desorption(Iraxuding Proper Shipping Name,Hazard Cass and ID Number) " Total Unit I, <br /> No. I Type Quantity- WWOI Waste No. <br /> GE '�41'1 YIEA9 MACETOW,3,LI M OK P* D,V G 343 <br /> N <br /> R <br /> A- - <br /> T <br /> 0 <br /> R _..._..: .. <br /> c. <br /> d. . ._.... .... ., _... . <br /> J.Adyfio al, cdptien for Materials Listed Above .. ._ - K Emergency Response information: <br /> t'r r EMERGENCY CALL EMMOSERV 1- <br /> 11A)p111.113?9-ACCTONE BOLAtTr019 ttAFE�COD!?S:r4D03. <br /> A5152-477"7277 <br /> ------------- -- <br /> -if <br /> ----------- --if noalternate TSDF,return to generator <br /> 15.Special Handling Instructions and Additional)Information <br /> EEL TO <br /> USE PROPER SAFETY EQL NT "ERS W.O.Mr 14247"LM <br /> 6. <br /> GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> packaged,marked,and labeled/placarded,and are in all respects in proper condition for transport by highway according to applicable international and national government <br /> regulations and Arkansas state regulations. <br /> It l 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 economically <br /> practicable and that f have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human <br /> health and the environment;OR,81 am a small quantity generators I have made a.good faith effort to minimize my waste generayon and select the best waste management <br /> method that is available to me and that I pan afford. _1 1, <br /> Pqut@d/ryped Name - SlgneNra Month DaY Year <br /> T 17.Transpoder 1.Acknowledgementnf Receiptof Materials. _ <br /> R <br /> A PentedrTY N J / S nadene Month Day leer <br /> N x <br /> P X <br /> D_ 1.8.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Priated/ryped Name Signature Month Days l Year <br /> E <br /> R <br /> 19.Discrepancy Indication Spam <br /> F <br /> A ^ <br /> C <br /> I <br /> L <br /> I <br /> T W.Facility Owner or Operator.Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> y Pontecirryped Name Signature Monts Day Year <br /> EPA Form 8700-22(Rev.9-88)Previous edition is obsolete. - <br /> GENERATOR INITIAL COPY <br />