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i` <br />OF ARKANSAS �. �. <br />• Department of Pollution C trot and Ecology <br />P O. Box 8913 Little Ro kansas .72219-8913 ; } <br />phone 501-562-7444 (� <br />ease print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />Form Approved. OMB No. 2o5o-0039. Expires 9-30-94 <br />UNIFORM HAZARDOUS--- eneratceS o - <br />WASTE MANIFEST fit 9 Is' DocwmencNo ® reyuleedbyFederallaw re <br />3. Generator's Name and Mailing Addres- <br />Pacific Coast Producm <br />835 S. -Stockton St. <br />5. Transporter 1 Company <br />7. Trenaporter 2 Company Name <br />Aum Jamie U=a <br />Lodi CA 41-0159 <br />9. DesignatedFacility Name and Site Address 0 <br />US FPA ID NI <br />Rineco <br />1007 Vulcan Rd. -Haskell <br />Benton,72015 10R <br />11. US DOT Description (including proper Shipping Name, Hazard CI <br />ass, and ID Number) <br />a. <br />Waste Flammable Liquid. N.O.S. (Methyl Isobutyl KeEa/Xylene) <br />3 UN1993 PGII <br />b. <br />Non Matetial (Oil) <br />G <br />e <br />Descriptlons for Materials Elated Above <br />970 <br />. 93022-0972 e � � . <br />t ";� s� s� ter. <br />If oo alternate TSDF, return to generator r �`i <br />15. Special kindling Inetrections and Additional information <br />Na <br />Type <br />TOM <br />Quantity <br />Ufiii <br />WWoI <br />No: ;,.. <br />L4 1915 <br />DN a <br />Above <br />%scncnarvtt"' cERitFICATION: 1 heredy 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 volumn and toxiclty of waste generated to the degree I have determined to be <br />future threat to human <br />economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and <br />the best waste managementhealth <br />method that Is available to meand the environment; OR, it ls and that Iam a Clcan afforti generator, I have made a good faith effort to minimize my waste generation and select <br />Printed/Typed Name <br />Sig tore <br />TA TMF r_A D r• T A ` % Month Day Year <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />rnnted/TYped Name <br />nate Month Day Year <br />• <br />1s. Transporter Acknowledgement of Receipt of Materials <br />PriMed/Typed Name ' <br />Signa re <br />I Month Day Year <br />19. Discrepancy Indication Space <br />a U <br />1 <br />l ?0. Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />Rinted/Typed Name <br />Signature Month Day Year <br />=orm 8700-22 (Rev. 9-88) Previous edition is obsolete. t� <br />