|
tN[ STAT.^
<br />UNIFORM HAZARDOUS1
<br />Generator's US EPA ID No.
<br />STATE OF ARKANSAS
<br />2 Page 1
<br />Department of Polll I Cr -rl and Ecology
<br />p 9Y
<br />P.O. Box 8913 Little Hock, A. _nsas 72219-8913
<br />Telephone 501-682-0744
<br />Plea>e print or I% pe,
<br />(Form designed for use on elite (12 -pitch) tVPewnter)
<br />P71111 anrovid noon Aln 0050 n
<br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete.
<br />NOTICE: THE ORIGINAL AND NOT LESS THAN TWO (2) COPIES MUST MOVE WITH THE HAZ
<br />STDRAGEDISPOSAL FACILITY MUST RETURN THIS ORIGINAL COPY TO THE GENERATOR.
<br />UNIFORM HAZARDOUS1
<br />Generator's US EPA ID No.
<br />Manifest
<br />2 Page 1
<br />Information in the shaded areas is not V
<br />WASTE MANIFEST
<br />r, imN 0 a a 5? Z
<br />Document No.
<br />9 5 6.
<br />of
<br />required by Federal law.
<br />-3
<br />3.'tb tp�,'s,�,)gmr}.r tvdi)irlp,Addr(JhQlJ LN DEPARTMENT OF PUBLIC
<br />11 U8U110V YEAUS�T
<br />A. State Manifest Document Number
<br />-WORKS
<br />HFAi1ZVE.LIUTON - , ;: ", ,..
<br />AR- 0
<br />STOCKTON, CA 95201 ' f ; ` •)
<br />B. State Generator's ID
<br />4. Generator's Phone ( 209 )468-3066
<br />5. Transporter 1 Company Name 1 6. US EPA ID Number
<br />C, State Transporter's ID H
<br />D. Transporter's Phone
<br />7. Transporter 2 Company Narwe 8. US EPA ID♦Number
<br />E. State Transporter's ID H•.- o 4
<br />M_ ,.y n / , 1 S���
<br />7
<br />F. Transporter's Phone � 4O ,\ 7 �7 f�
<br />9. Designated Facility Name and Site Address 10. US EPA ID Number
<br />G. State Facility's ID
<br />ENSCO–Waste Treatment
<br />309 American Cirele
<br />H. Facility's Phone
<br />EI Dorado, AR 71730 ARD 0 6 9 7 4 8 119.21
<br />(871) 863-7173
<br />12. Containers
<br />13.
<br />14.
<br />11 . US DOT Description (Including Proper Shipping Name, Hazard Class and ID Number)
<br />Total
<br />Quantity
<br />Unit
<br />I.
<br />No.
<br />I Type
<br />WLV,I
<br />Waste No.
<br />G
<br />a. Flammable liquids, n.o.s.,
<br />N
<br />3, UN 1993, II
<br />E
<br />(Petroleum Distillates Alcohol)
<br />/
<br />D.F.0
<br />/ 7
<br />P
<br />non RCRA
<br />A
<br />b Flammable solid, organic, n.o.s.,
<br />T
<br />4.1, UN1325, II
<br />R
<br />(Petroleum Distillates, Alcohol)
<br />0(224
<br />C FO2
<br />9 70
<br />P
<br />non RCRA
<br />RQ, Pesticides, liquid, flammable, toxic, n.o.s.,
<br />3, UN3021, II
<br />(Petrollau■ Distillates. Chlordane)
<br />00
<br />D t
<br />O/ O/0
<br />P
<br />non RCRA
<br />° RQ, Pesticides solid, toxic, n. o. s.,
<br />6.1, UN2588, II
<br />(Chlordane, DDT) (Marine Pollutant)
<br />00/
<br />C
<br />00Zl9
<br />P
<br />non RCRA
<br />e
<br />daditiog�1al r�i�°� "'i�+���i for ri d A ovX ERG# 128
<br />. / o
<br />K. Emergency Response Information.
<br />lib.) WMDS# 744521 ( SL )c GY ) ERG# 133
<br />24–Hour Emergency Tel#
<br />11c.) WMDS# 744522 ( ) ERG# +"
<br />Infotrac (800> 535-5a��
<br />an Hayden
<br />iZt. _WMH44523–t—t7t�'P'— ----"
<br />ternate SD
<br />I no a , return to generator
<br />x7kL4�A
<br />1'1 '°'1 P ns1 i°R atdir!XtMPTti°PER 40 CFR 261.4(b) (1) EXCLUSION
<br />SITE: Lovelace MRF
<br />Wear proper protective equipment when handling hazardous
<br />2323 E Lovelace Rd
<br />materials
<br />Manteca, CA
<br />1s
<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
<br />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
<br />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 />PrinterJ;T Name
<br />Sign at
<br />Month ay
<br />E /�
<br />%
<br />3
<br />T
<br />R
<br />17 Transporter 1 Acknowledgement of Receipt of Materials
<br />A
<br />PdiTyped Name
<br />Signal
<br />Month Day Year
<br />N
<br />S
<br />41
<br />`
<br />P
<br />O
<br />18, Transporter 2 Acknowledgement of Rec t of Materials
<br />R
<br />T
<br />Printed. T yped Name
<br />Signature
<br />Month Day Year
<br />E
<br />R
<br />�
<br />1 J"(`A—. C,
<br />1
<br />19. Discrepancy Indication Space
<br />F
<br />A
<br />C
<br />L
<br />T
<br />20. Facih[y Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19.
<br />Y7tedTyped
<br />Name ure
<br />Me Ih Day Y
<br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete.
<br />NOTICE: THE ORIGINAL AND NOT LESS THAN TWO (2) COPIES MUST MOVE WITH THE HAZ
<br />STDRAGEDISPOSAL FACILITY MUST RETURN THIS ORIGINAL COPY TO THE GENERATOR.
<br />
|