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nmental Quality <br />1aP.® Brox 8913; Li ock,AR 72219-89,13 <br />Telephone: (5 1) 682-0833 <br />Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />UNIFORM HAZARDOUS 1. enerator's ME EPA ID No. <br />WASTE MANIFEST r.. a .i .ol .m .a .,7 .o .4 .r .z <br />PLASTIC PAINTING-STOCKTON <br />'107 VAL DERVIN PRWY <br />STOCKTON CA 95206 <br />4. Generator's Phone 209 982-0422 <br />a 5. Transporter 1 Company Name 6. US EPA ID Number <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />10. US EPA ID Number <br />RINECO <br />1007 VULCAN ROAD <br />Form Approved. OMB No. 2050-0039 <br />2. Page 1 Information in the shaded areas is not <br />required by Federal law. <br />of 1 <br />Phone ( 800) 627- <br />12. Containers 13. 14. '. <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class and ID Number) Total Unit I• <br />No. Type Quantity wt/vol Waste No. <br />G a. <br />E WASTE Paint related material D001, , <br />N 3, UN1263, PG III <br />E <br />R IHINERAL SPIRITS) <br />A WASTE Paint related material F003,F005, <br />0 3, UN1263, PG II D001,D035 <br />R D M G <br />I C. <br />s T <br />a.44-1249 °" ' C. NEVA HENSLEY 801-776-0095 <br />b.44-7028 0004-03840 d. <br />---------------------------- <br />if <br />------------------- <br />if no alternate TSDF, return to generator IL <br />1 IT <br />15. Special Handling Instructions and Additional Information <br />EVERY SPILL RELEASE OR INCIDENT INVOLVING ASHLAND CHEMICAL <br />MUST BE REPORTED TO 1 -800 -ASHLAND, DAY OR NIGHT. <br />16. <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 />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 disposal 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 effort to minimize my waste generation and select the best waste management <br />method that is available to me and that I can afford. <br />Printed/Typed Name P'�A .fin r SignL u�fL� Month Day Year <br />LLr, L) u i t V Lt / \ / -i7, w..[n n U z sem, �r elr .e► L/ / A A _ A <br />1 17. Transporter 1 Acknowledgement of Receipt of Materials " <br />R <br />A Pri ed/Ty ed Name nature Month <br />N QqS <br />P <br />O 18. Transporter 2 Acknowledgement of Receipt of Materials <br />R Printedrryped Name Month <br />T %Sign�%r <br />jj 19. Discrepancy Indication Space- <br />ij F <br />r A <br />C <br />I <br />L <br />I <br />I T 20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this mAMtjs1 except as noted in Item 19. <br />Y Pr ted/Typed Name Signa <br />�. <br />EPA Form 8700-22 (Re . 9-88) Previous edition Is obsolete. 77 <br />NOTICE: THE ORIGINAL AND NOT LESS THAN TWO (2) COPIES MUST MOVE WITH THE HAZARDOUS WASTE SHIPMENT. ONCE DELIVERED, <br />STORAGE/DISPOSAL FACILITY MUST RETURN THIS ORIGINAL COPY TO THE GENERATOR <br />