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ST,,f Arkansas Department of Environmental Quality <br /> Hazardous Waste ion <br /> r� r P.O. Box 8913, Lift l ock, 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 i.Generator's US EPA ID No. Manifest 2.Page 1 Information in the shaded areas is not <br /> ' D <br /> WASTE MANIFEST a Y <br /> ument re uired b Federal law. <br /> 3.Generator's Name and Mailing Address of <br /> A�, en1EQ ,tfi'lerk Nm�er`"P ss ` r r <br /> INTERLAKE MATERIAL HANDLING INC <br /> `110 S.SACRAMENTO STREET <br /> M,.kc <br /> 4.Ge eODI s Phone 2� CA �Qt33"� ' <br /> 0. <br /> 5.Transporter 1 Company Name 6. US EPA ID Number , $tater tans <br /> ENVIRONMENTAL RECOVERY SERV. C, A, 0. Q n nn 9 rJ 7 L <br /> 7.Transporter 2 Company Name 8. US EPA ID Number StafeTrensporter S ID <br /> MAUMEE EXPRESS O.D.#778 N J. D 9 a 6 6 0 7 3 8 0 F=T,ena�o�r�.�hor,e <br /> 9.Designated Facility Name and Site Address10. US EPA ID Number "G State Facility's ID, <br /> RINECO <br /> 1007 VULCAN ROAD-HASKELL H:Factlay s Pfrot76 „ <br /> BENTONAR 72015 D Q S. Q 77 <br /> r <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(Including Proper Shipping Name,Hazard Class and ID Number) Quantity <br /> l W nit <br /> No. Type $ f <br /> E a. WASTE FLAMMA13LE LIQUIDS,N.O.S.,3,UN'4993,PGII(ACETONE) <br /> N D IM <br /> q7 �� �a <br /> b. <br /> A WASTE METHYL ACETATE,3, UN1231,PGII <br /> o <br /> c. <br /> d. �� s <br /> r z � <br /> J Additional Descr tion for Materials Irsted Above <br /> �A � ff 129K Emergency Response Infprelatipn <br /> rW (7 <br /> s ceh <br /> as III AGET SI.lI t3tL11 EC+ . I t p <br /> . � e '¢ S *, �� <br /> ...3. { ,t ,..:. - ,..t ¢s s«-� ? ..^Jlp rr 7 '^4 s,� 'a -;` w,�` •r5 ; y; i�� '; °!'^ �. 2y z`is �` j <br /> If Ti0 3I@f RSL@ T.x`DFS: @I to f#t0 g6!1Et 3t0! �!' > ti s F Y a g3 f I <br /> 15.Special Handling Instructions and Additional information <br /> BILL TO ENVIRONMENTAL RECOVERY SERVICES s* <br /> USE PROPER SAFETY EQUIPMENT ERS W.O. A8'*I-IM- <br /> 1 s. <br /> GEr�, <br /> ATOR'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,star osal 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 plade a good 'th 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 /> P' <br /> yp6d NameIli I Signature Month Day Year I <br /> Q <br /> T 17.Transporter 1 A knowledgement of Receipt of Materials <br /> R <br /> A Printedlfyped Name Signature <br /> N N (] �� Month Day Y®ar <br /> d � <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials p.6010. <br /> R Printed/Typed Name <br /> E i lure Month Day Year <br /> R - <br /> 19.Discrepancy Indication Space <br /> F <br /> I <br /> T 20.Facility Owner or Operator.'Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Y Print y mSigna <br /> � Month Day Year <br /> �. <br /> EPA Form 8700 22(Rev.9-88)Previous edition is obsolete. <br /> NOTICE:THE ORIGINAL AND NOT LESS THAN TWO(2)COPIES MUST MOVE WITH THE HAZARDOUS WASTE SHIPMENT.ONCE DELIVERED,THETREATMENT/ <br /> STORAGE/DISPOSAL FACILITY MUST RETURN THIS®RICINAI CnPvTnT41C f]CM=0ATe%0 <br />