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Arkansas Department of Environmental Quality <br /> Hazardous Wasteion <br /> P.O. Box 8913, LiAleck,AR 72219-8913 <br /> Telephone:-(501) 682.0833 <br /> Please print or type, PA„ (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> Document <br /> UNIFORM HAZARDOUS 1.Generator's US EID No. Manifest 2.Page 1 Information in the shaded areas is not <br /> required by Federal law. <br /> WASTE MANIFESTa >� t.! 2 AHI of <br /> 3.Generator's Name and Mailing Address <br /> WTLAKE MATER ,HM �G �� StatM�tpceYtrmber� a <br /> i (�f S. SAANIENTO STREET <br /> DEET <br /> m LODI CA 95240 <br /> 4.Generator's Phone <br /> a 5.Transporter 1 Company Name 6. US EPA ID Number C ,atg Terspf3ttgr efp s <br /> ENVI ON EWi A..,n-El'"OVERY SERY, t F Tiansporter9Phone- <br /> 7.Transporter 2 Company Name 8. US EPA ID Number E.StateTranspbcter sIGT s <br /> R,. <br /> i 8 A AE <br /> es't' <br /> t a �tktl s_.I r.0 + ?.r s.JJ4 r F.Transporter'&Phone <br /> 9.Designated Facility Name and Site Address 10. USEPAID Number G.State Facility's ID o.--`j <br /> sr <br /> ..... hK H.Facility, •.. <br /> 'I'P11 f lfv <br /> t,71,91A- <br /> 12.Containers 13. 14. c <br /> 11.US DOT Description(including proper Shipping Name,Hazard Class and ID Number) Total Unit zf <br /> No. Type Quantity WWoI 1 � � n . <br /> _ ��tasteritb a <br /> E a WASTE E ` I�s� LE UQM...�p EK0.8,,3,l NW93 ,f-,et(fA srlt;:a a, D N <br /> N <br /> R <br /> A WASTE.MET14YLA °i-I t, LIN1731, P01 � <br /> O <br /> P <br /> R O <br /> 6 <br /> d. <br /> x , <br /> J.Additional Description for Materials Listed Above <br /> K Emergency Responselnf�rmatlo a <br /> 1f1tfr¢I#eCCtf@Tf�Fle1UlRBIt$rB�Or � <br /> 15.Special Handling Instructions and Additional Information <br /> p 13ILL TO EtNTk:'iWC:lT •d:NI"AL IRECOVIGRY SERA CI-S� <br /> USE PROPER$AFETY t t.-4lAPMENT E-P'3` .€;t.. 48"4i'ttVr <br /> 16. <br /> GA ATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately descm(bed 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 /> Printedflyped Name { Signature Month Day Year <br /> a, <br /> A <br /> T <br /> R 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Primedlfyped Name Signature <br /> N Month Day Year <br /> r <br /> f 1 <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name <br /> T Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Y Printed/Typed Name �Lure Month Day Year <br /> EPA Form 8700-22(Rev.9-88)Previous edition is obsolete. <br /> l:Cw1C0A-rn0 mwurIlAe nnnv <br />