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MIS*l DEPARTMENT OF NATURAL RESOURCES <br /> INSTRUCTIONS FOR THE COM- Division of Environmental Quality aYUOaIgTREslgRss <br /> PLETION OF THIS FORM ARE ON A <br /> SEPARATE SHEET. Waste Management Program u.a WAST GUARD <br /> ,.soDase OU <br /> THIS DOCUMENT MUST BE USED P O. Box 176 Jefferson City,Missouri 65102 . <br /> FOR ALL MISSOURI-DESTINED CIrW T11EC <br /> 314-757-3776 ,-sm+xwm <br /> SHIPMENTS HAZARDOUS WASTE MANIFEST DEM OF NAtUMLREfOURCES <br /> ]u aaa43a <br /> Plgax prim or tree IForm designed for ux on else It2pnchl typewmen 1 Form Approved.OMB No.2050-0039.Ea Dlros 43o9t <br /> UNIFORM HAZARDOUS t.Generators US EPA ID No Manifest 2 Page Information In the shaded areas <br /> WASTE MANIFEST CA 8 0 8 9 6 8 1 0 6 8 a 611 of is required by State law. <br /> 3 Generator s Name and Mailing Address A MisWud Mw ao oom5tent NmOer <br /> u <br /> Eldorado Chemical Company, Inc. Oil 1 24 9 0 0 0 1 <br /> P.O. Box 5158, Stockton, California 95205 S.stet*Generators to-ol <br /> . Generators Phone I 8543 CAD089681068 <br /> I5 Transporter I Company Name 6 US EPA 10 Number C.MO.Trwporral ID The Kiesel H1202 <br /> i � <br /> m ea I D Tr•nepone aPhon. 314 351 5500 Q <br /> 7 Transporter 2 Company Name 8 US EPA ID Number E NO TradsperlKa ID Qa <br /> F.Transporteh Phone, <br /> 9 Dereg d Facility Name and Site Address . .�.,.. <br /> 10 US EPA ID Number G.SMI*Fa day's 10 <br /> J c <br /> The Kiesel Company t " RR-124 a <br /> - H.Faichry's Phone <br /> # 1 Branch Street 7 U <br /> St Louis Missouri 63116 �� 3 0 0 0 1 1 1 0 314 421 0328 <br /> at <br /> 11 US DOT Description(Including Proper SrupPng Name.Matins Chats.and ID Numderl 12 ConOmM 13. 14.ra Ir/T o .L <br /> LrV - Total Unit 1.W"q No. <br /> ^ ., aahbty W1yva U. <br /> a EPA WASTE CODE Q <br /> GI Hazardous Waste, Liquid,N.O.S. ,ORM-E 91899EMR-31 0 0 1 y 5 E j 6 Non-RCRA x <br /> E D EPA WASTE CODE <br /> N O <br /> E N <br /> IAI H <br /> T c EPA WASTE CODE <br /> O <br /> R <br /> d EPA WASTE CODE <br /> of Addi5orwi Descriptions for Materials Listed Atwve K.Handling Codes for Wastes Listed Above <br /> O <br /> W <br /> b. = p <br /> C. re at <br /> d. Q <br /> o = <br /> 15.Special Handling Instructions and Addilional Information W <br /> = IM <br /> F W <br /> Id <br /> F <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are hilly and accurately described some ply Groper shipping name and are classified, packed. named. O m <br /> am labeled,and are m all respects in proper condition for transport ply rnghway according to applicable international and national 9O,,ah enl regulations am applicable state regulations F. f <br /> 1t I sa large quantity generator. I ceNly Wt I have a program in Pace to reduce the ,dume and tounty of waste generated to the degree I nave determined to be economically practicabb 6 W <br /> m <br /> aM plat I nave selected the practicable method of treatmentstorageor disposal currently avLI tole I no h mmlmaes the prexnl and future threat to human health and the enr^onmenL W s <br /> OR,d I am a small quantity gmarl I here made a good faith effort to mlmmae my weste generation Imt the east waste management method intuitable to me trial I can afford <br /> Month Day rear W <br /> PnnteORyped Name SignaN ^ W IM <br /> L w/ l x ! S8 = o <br /> T 17 Transpor,ef 1 Aca owledgemenl m Rech P, f els _ Dale I— W <br /> A PnmedrTyped Name re Month Day year F F <br /> NS Y O <br /> g F <br /> Po <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> m W <br /> RSignature <br /> Month Day year F <br /> T PnntediTyped Name <br /> E _ <br /> R W US <br /> 19.Discrepancy Indication Space W <br /> fD <br /> F Fly F <br /> A <br /> C a Z <br /> L 20.Facility Owner a Operate'.Certification of receipt of haramous material,corned by his manifest except as noted In Item 19. d �' <br /> I Data O <br /> Type0 Name Signature Month On' Year J <br /> T SAM F: LDcA,- �_- / 7 � LL <br /> EPA Form 5700-221Rer 9-881 MDNR-HWG 10 PREVIOUS EDITIONS ARE OBSOLETE <br />