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oNi <br />tL <br />Please print or tvt <br />STATE OF ARKANS <br />Department of PollLe Control and Ecology ` <br />R O. Box 8913 'Little Rock, Arkansas 72219-8913 <br />Telephone 501-562-7444 r I L <br />(Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039. Expires 9-30-94 <br />U <br />NIFORM HAZAR®®U$ t. ene toru� I , a R cis normauonm oanacedan�aaistrot <br />WASTE MANIFEST J? 3 • 7 7 1 of 1 fequ"edb'Fed�law. <br />35 s Ahme ar1d il_ Ing Address ♦ ttp fSaidana A, State Manifest Document Number 5 <br />. Stockton G LSweet, EiA.4,u. til s�xtl <br />Lodi r CA 41-0150 a state G®nerstoe ID , <br />4. Generator's Phone (209-3 11 H A S H 3" 6 0 1 7 0 6 7 <br />S. Transporter 1 Company Name 8. US EPA ID Number Q State Tmnaporter's ID , ^`._;,: , PC H <br />TRIAD TRANSPORT 0 K D 9 8 1 5 8 8 7 9 1 D.TransporteesPhone 800-324-1139 <br />7. Transporter 2 Company Nana , 8. "CState EPA ID Number State Transporters IDPC,- _ r - - <br />F. Transporter's Phone <br />9. gd (reqs ly,�(arty aft i �j 1 A. US EPA ID Number G State Farality s ID <br />1007 Vulcan Rd. - H easkell <br />Benton, AR. 72015 H. Facility's Phone 501 8-9Q8Q <br />IAI RI Ili 8 I 5 7 A 7t . <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. <br />Total <br />14. <br />Unit <br />No. I Type <br />Quantity <br />Wt/vol <br />L <br />Waste Na <br />a.Waste Flammable Liquid, N.O.S. (Hexane, lsqxripyl Alcohol) <br />, <br />3 UIN1993 PGJ1 <br />0111 4 <br />D <br />717, 0 <br />G <br />b. <br />C. <br />d. <br />1 i }�Q e rads s� • _ ,t +w <br />..Y'�• lU�- ,� > 1*a �AbOV�ef �C�e'�.�ffi4,p.�t-isrn ,b'�j �'+t �a'�g �;P,;'3�, �.�+g� r a+' � a <br />`r * ' : s L '� CM3 '" •t " 7 ` A <br />K Handfin® Codes for Wastes Listed Above <br />.^!::, ':"' .ti4 ;i:>:.., .. .. <br />EMERGENCY RESPONSE INFORMATION: <br />if go alternate T3DF,,retum to generator <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are <br />classified, packed, marked, and labeled, and are In all respects in proper condition for transport by highway according to applicable international and national <br />government regulations and Arkansas state regulations. <br />If I am a large quantity generator, 1 certify that I have a program in place to reduce the volumn and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and <br />future threat to human 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 <br />the best waste management method that is available to me and that I can afford. <br />VW Printed/Typed Name Signature Month Day Year <br />BEN SNEED 02239: <br />T 17. Transporter 1 Acknowiedgement of Receipt of Materials <br />R <br />A Printed/Typed Name Sig re <br />N Month Day Year <br />s - <br />P ? <br />0 18. Transporter 2 Acknowledgemeni of Receipt of Materials <br />R <br />TPrinted/Typed Name Signature <br />E Month Day Year <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />t. <br />t 20. <br />T FacilityOwner or Operator. Cytification of receipt of hazardous ma rials covered by this manifest excep as noted in 1!1m 19. <br />Y Printed/Typed Name w Signature ® Month Day Year <br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolpTjg' <br />