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10'40, <br /> o .� rMndflsds ue arLment oT tnvlronmentai Uuallty <br /> Fa : Hazardous Waste P'-SionP.O. Box 8913, Lith.-lock, AR 72219-8913 <br /> Telephone: (501) 682-0833 <br /> Please print or type. (Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS tGenerator's us EPA ID No. Mani est 2.Page 1 Information in the shaded areas is not <br /> C H L D Q 1 2.�. Document No. required by Federal law. <br /> WASTE MANIFEST -�.n- 2 of - - <br /> 3.Generator's Name and Mailin Address A.State Manifest Document Number <br /> BISHO5511 CA RINEGIE STREET AR-1,343435 <br /> MANTECA CA. 95937 9.State Generator's ID <br /> $ 4.Generator's Phone <br /> a 5.Transporter 1 Company Name6. US EPA ID Number C. tate Transporter's ID <br /> ENVIRONMENTAL RECOVERY SERV. C A 0 0 0 0 9 7 0 3 9 2 D.Transporter's Phone <br /> L .7.Transporter 2 Company Name 8. US EPA ID Number E.State Transporters ID <br /> MAUMEE EXPRESS (I.D.#778) N d D 9 8 6 6 0 7 3 8 0 F Transporter's Phone <br /> 9,Designated Facility Name and Site Address 10. US EPA ID Number G.State Facility,IO <br /> RINECO <br /> 1007 VULCAN ROAD-HASKELL H.FecillrffTlgpg <br /> BENTON AR 72D'15 A R D 9 8 1 D 5 7 8 7 0 ��[[7I11 !!�� <br /> 12.Containers 13. 14 <br /> 11.US DOT Descd piion(Including Pr per SNpoirg Name,Hzard Class and ID Number) Total <br /> Unit <br /> No. Type Quantity W Wol waste No. <br /> E a G 343 <br /> N <br /> E / \ D001 <br /> CF G } <br /> R <br /> A <br /> T <br /> 0 <br /> R <br /> c. <br /> d. <br /> J.Aniftayt�scnpaon far Materials Listed Above K.Emergeni Response In rmatbn: <br /> 11A)0111-11519-ACETONE SOLUTION 11A.EPA-CODES:F003 EMERGENCY CALL ENVIROSERV 11- <br /> 5U427-7277 <br /> ------------------------- <br /> if <br /> ---------------------- <br /> if no alternate TSDF, return to generator <br /> 15.Special Handling Instructions and Additional Information <br /> *r BILL TO ENVIRONMENTAL RECOVERY SERVICES'! <br /> USE PROPER SAFETY EQUIPMENT a*ERS W.O.#6686-LK <br /> 16. SFFE , <br /> GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are !y an%a curately 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 /> 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 economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposa('currently available to me which minimizes the present and future threat to human <br /> health and the environment;OR,if I am a small quantity generator,I have made a good faith c mini a my waste generation and select the best waste management <br /> method that is available to me and that I can afford. <br /> Pentedlryped Name Signa Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Raceipt of Materials <br /> R <br /> A Printed/Typed Na a ignaNre p Month Day Year <br /> S / �•i'l !i 1. ['� (.i 7tp <br /> P <br /> 0 18.Tr site cknowledgement of Receipt of M erials <br /> RPri to Name Signature Man Day Year <br /> T <br /> R ?C <br /> 19.Discrepancy Indica' n Space <br /> A �. <br /> c <br /> I <br /> L <br /> T 20.Facility Owner or Operator:Cerci/kation pl receipt of M1azartlous materials covered by this manifest except as noted in Item 19. x.,r <br /> Y -nted/Typetl ams / Signator Month Day Year <br /> EPA Form 8700-22(Rev.9.88)Previous edition Is obsolete. <br /> LNOTICE:THE ORIGINAL AND NOT LESS THAN TWO(2)COPIES MUST MOVE WITH THE HAZARDOUS WASTE SHIPMENT.ONCE DELIVER ED,TheTREATMENT/ <br /> STORAGE/DISPOSAL FACILITY MUST RETURN THIS ORIGINAL COPY TO THE GENERATOR. u <br />