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a srap f . STATE OF ARKANSAS <br />Department of PollWftn Control and Ecology <br />� a® <br />P. O: Box 8913 Litmock, Arkansas 72219-8913 <br />`• ® Telephone 501-562-7444 <br />Please print or type. Form desi ned for use on elite 112- itch ewriter. <br />UNIFORM HAZARDOUS 1. enerators US EPA ID o. <br />WASTE MANIFEST <br />F=3Generator's Name and Mailin Address <br />Pac1iC Coast Producers <br />835 S. Stockton Street <br />LOd> . CA 95241 <br />Form Approved. OMB No. 2050-0039. EXPIRES 9-30-96 <br />4"UjUnl'` i 3 I lot ! I required by Federal law. <br />N 4. Generator's Phone ( 209-33 11 Atm; Jamie <br />< 5. Transporter 1 Company Name 6. US EPA ID Number <br />Tri-State Motor Traisit Co. 9 <br />7. Transporter 2 Company Name 8. US EPA ID Numher <br />n <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate) described above b <br />classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable internattionproal ander national governmname and ent <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 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 the <br />best waste management method that is available to me and that I can afford. <br />Printed/Typed Name Signet JAIME CARCIA Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />9. Designated <br />,�Facility Name and Site Address 10. <br />RI 1\ Ll. <br />US EPA ID Number <br />R <br />A <br />Pi ted/Typed Name <br />S <br />1007 Vulcan Rd.-Haskell <br />P <br />O <br />1 b. Transporter 2 Acknowledgement of Receipt of Materials <br />Benton 72015 <br />7 <br />7 <br />E <br />r <br />Signature <br />' <br />R <br />11. US DOT Description (Including proper i <br />Shipping Name, Hazard Class, and ID Number) <br />-112 <br />12. Corrtamers <br />Total <br />Unit <br />E <br />�.� <br />a. W <br />H �) <br />No. <br />Type <br />Quantity <br />wwol <br />E <br />3 11AM P(H <br />021 <br />01155 <br />G <br />R <br />T <br />b. W R <br />R <br />3 <br />01 <br />00055 <br />G <br />C. <br />NO.S U ) <br />3 UN1993 POM <br />0 <br />0 0 0 5 5 <br />G <br />d. Waste PaRel <br />nrt <br />JO,0,0,5,51 <br />3 UNI 263 PGM R100018) <br />010 11 <br />G <br />n <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate) described above b <br />classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable internattionproal ander national governmname and ent <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 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 the <br />best waste management method that is available to me and that I can afford. <br />Printed/Typed Name Signet JAIME CARCIA Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />102396 <br />R <br />A <br />Pi ted/Typed Name <br />S <br />Month Day Year <br />P <br />O <br />1 b. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />Printed/Typed Name <br />E <br />I <br />Signature <br />R <br />Month Day Year <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />T20 Facility Owner or Operator. Certification of receipt of hazardous materials covered by this mamfe except as noted in Item 19 <br />Y ^Pnnted/Typpd Name 1 _. <br />1 Month Day Ye <br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete. <br />'071C:!. -H ^RIG rNA —. 1 G <br />A yCj <br />WCCpIES MUST ',10W- ?VITH 77- E HA ZARDCC1� lbd �T- " ma=r, <br />.7 <br />