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,NE ST4T Arkansas Department of Environmental Quality <br /> Hazardous Waste 4&ion <br /> P.O. Box 8913, LittlgTock, AR 72219-8913 <br /> k Jam.�d9 6i'° <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 1.Generator Ia US EPA ID No. Manifest 2.Page 1 Information in the shaded areas is not <br /> Document No. required by Federal law. <br /> WASTE MANIFEST i 7"l, T ' 0 `I of <br /> T-3G.n'.,.tor's Name and Mailing Address A,State Manifest DocurnenC N/u�m er <br /> IMT, <br /> ,;ad.�%XE "1T-'Xn4.TA.L Vs�:�'IDTING INC: <br /> ,. 1 6.. <br /> 1 4" <br /> Oa I ?". se'01 8 StateGenaretorslD <br /> 4.Generator's Phone <br /> _ <br /> a 5.Transporter 1 Company Name 6. US EPA ID Number O.State ransparter's ID t t.-f.P i ,1- <br /> �';e' .,,- ..tr'!i:aV t fa.L ..F 0"VEi1! .`•"d .s.}.s. H <br /> A. ?F €, f '9 :'3 9r., D.Transporter's Phone <br /> I -Lk <br /> 7.Transporter 2 Company Name 8. US EPA ID Number E.State Transporter's IDT <br /> , <br /> h..l f!'," H <br /> ED � � j sa F Transponer's Phone ��t.:,r� 1 4 4 - <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G-State Facility's ID <br /> t a r <br /> .A Ndai a <br /> y .J <br /> .. <br /> .r ..,_. • .us<.� <br /> q�.'t t, •3}, Vit, r H.Facility's Phone <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(Including Proper Shipping Name,Hazard Class and ID Number) Total Unit Ywr I ! <br /> No. Type Quantity wt/vol <br /> G a. EA3 4rP' j'&`eATV sRIOU N Q 3.;. 3, ,i..t? :3a I41 <br /> kr <br /> A 46 �x <br /> g (" <br /> A <br /> C d ,d?d,0 i j <br /> T f ... <br /> C* <br /> d. <br /> Addiaonat DescNpfion f�r I Aatadals F i&tad Above r + K.ErnegengRepsponse information.r <br /> ak•�r 5` <br /> 009u <br /> R <br /> Y <br /> y. . <br /> W � <br /> ,..-. <br /> „ <br /> _ � a� IRa t <br /> X <br /> t €iIfierrYateTSDF, recur r t ge�iatrs <br /> 15.Special Handlm Instructions and Add di net Information s IP.' <br /> rj e' <br /> .. trod,a ti".edien �,;�`vre€d.w� Gt�E .i ".0 s n s .`i'; z 3�.: L . T ...kms #1"�', .... ,s�ni fig, •c.a.'. x i,.' �.� <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 Signature Month Day Year <br /> r <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> N <br /> S <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printedfryped Name Signature Month Day Year <br /> T <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> I <br /> L <br /> I <br /> Tk2077lity Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Y Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.9-88)Previous edition is obsolete. <br /> /'�CNIC®ATA® 11111TAA1 n/1®V <br />