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% <br />`p rtment°of Pollution Control and Ecology: <br />III Box 8913 Uttleffifk, Arkansas 72219-8913 T <br />Telephone 501-562-M4 <br />ease pAnt or type. (Form designed for useonelite (12 -pitch) typewriter.) Form Approved OMB No 2050-0039 Expires 9,V-94 <br />EEQaZ==iZ# <br />gn <br />FlIqUifed by Federal law, --4 <br />83S S. Stockton S"a Lodi (A5 �"'9524 i59 <br />2W3"11 w.z. <br />4. Generatoes Phone <br />7. Transporter 2 Company Name 8. <br />9. ItIlWacility Name and Site Address 10. <br />WcmRd. -Elik" <br />B6vton, AR. 72015 ARD9 <br />11. US DOT Description (including Proper Shipping Name, Hazard Clas%, and ID Number) <br />WLTr7T <br />.14 r , 7r, <br />!7 —1 rj9r.r <br />- A <br />llw� 11UNI <br />MEN, <br />am <br />;7- <br />010 <br />d. <br />2�- X <br />01011 <br />W�1■ <br />15. Special Handling Instructions and Additional Information <br />JUL 3 1 <br />18. 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, I certify that I have a program in place to reduce the 41umn 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 7h 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 />A <br />Printed/Typed Name Signature Month Year <br />Day Day Y <br />V — <br />Bob Hieb <br />TR 17. Transporter 1 Acknowledgement of Receipt of Materials <br />A Printed/Typed Name <br />N Sig Month Day Year <br />S j <br />.2 <br />P kz 14 12-191 <br />0 19.fran4orier'2 Acknowledgement ;TRecagofMaterials <br />' <br />R <br />T Printed/Typed Name Signature Month Day Year <br />E I <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 20. Facility Owner or Operator. 4nification of receipt of hazard: X materials covered by this manifest except as noted in It?p 19. <br />T 11 — It <br />y4o Printed/Typed Name /P.I . Signature <br />jo ---- <br />A. 0o7nt_h Day Year <br />EPA <br />d <br />e7424_ <br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete. 4! <br />NOTICE: THE ORIGINAL AND NOT LESS THAN TWO (2) COPIES MUST MOVE WITH THE HIAZARDOU . S - WASTE SHIPMENT. ONCE DELIVERED, THE TREAT- <br />MENT/STOPAGE/DISPOSAL FACILITY MUST RETURN THIS ORIGINAL COPY TO THE GENERATOR. <br />