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` URI DEPARTMENT OF NATURAL RESOUR� <br /> IN STR UCS 4N5 FOR THE COM- Division of Environmental Quality PLETIO F THIS FORM ARE ON A y EMaaGarvtr a6sP0xsa <br /> SEPA TE SHEET. Waste Management Program U.S.COAST GUARD <br /> THIS DOCUMENT MUST BE USED P.O. BOX 176 Jefferson City, Missouri 65102 1eWM2*Noe <br /> FOR ALL MISSOURI-DESTINED 314-751-3176 1-900.424-9300 <br /> BHIPMENTS. HAZARDOUS WASTE MANIFEST DEPT.OF 3iT6]<f]66°oRC1-G <br /> Please print or type (Form designed for use on elite(12-plical typewriter) Form Approved.OMB No.2050-0039,Expires 9-30-91 <br /> UNIFORM HAZARDOUS Generator's US EPA ID No Manifest 2 Page —� Information in the shaded areas <br /> Document No. <br /> WASTE MANIFEST A D 9 8 1 3 7 m is required by State law <br /> 3.Generators Name and Mailing Address A.Missouri Manifest Document Number <br /> Nevark Sierra Paperboard 0 1 113 1 217 1 4 0 0 8 <br /> (209\l 466-5251 800 W. Church St. B.State Generator's ID-other <br /> Generators Phone( Stockton, CA 95203 <br /> 5.Transporter 1 Company Name 6.US EPA ID Number C.MO.Trensporte'S ID CA 2463 <br /> FALCON ENERGY ASSOCIATES D.Transporters Phone 209-463-7108 F- <br /> 7.Transporter 2 Company Name 8.US EPA to Number E.MO.Transporter's ID CA 25301H 1202 Q <br /> THE KIESEL COMPANY IM,OiTi3iOiOiOilt1IlI6jOF.Transporters Phone 314-351-5500n <br /> 9.Designated Facility Name and Site Address 10.US EPA ID Number G.Stale Facility's ID <br /> THE KIESEL COMPANY RRO124 O <br /> #1 Brunch St. H.facility's Phone <br /> St. Louis Mo. 63147 - 314-351-5500 <br /> 11.US DOT Description(Including Proper Shipping Name.Hazard Class,and ID Number) 12.Containers 13 14 Q <br /> Total Unit I.Waste No. Z <br /> Quantity WVVoI LL <br /> NON RCRA HAZARDOUS WASTE, Solid EPA WASTE CODE Z <br /> CA 2 0 <br /> S av 23 <br /> (Grease) l) p D M P <br /> G MO T)098 <br /> E D EPA WASTE CODE � <br /> N Q <br /> E !n <br /> R N <br /> A EPA WASTE CODE <br /> T <br /> O <br /> R <br /> d - -- EPA WASTE CODE <br /> J.Additional Descriptions for Materials Listed Above K.Handling Codes for Wastes Listed Above <br /> a. Floorsweep contaminated with grease Q <br /> D. _ Q <br /> C. z <br /> d. w <br /> 15.Special Handling Instructions and Additional Information a <br /> W <br /> S <br /> 24 HOUR EMERGENCY RESPONSE # 1-314-421-0328 (THE KIESEL COMPANY) . CID <br /> > <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 Classified,packed,marked M <br /> and labeled,and are in all respects in proper condition for Transport by highway according to applicable international and national government regulations and applicable state regulations. Q <br /> If l 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 practicable Q <br /> and that have selected the practicable method of treatment,storage,or disposal currently available to which minimizes the present and future threat to human health and the environment, <br /> OR,if I am a small quantity generator,I have made a goad faith effort to minimize my waste generation and t the best waste m agement method available to me that I can afford. W <br /> Year Z V <br /> Day ea <br /> Printed/Typed Name Signature Month W <br /> 0 <br /> W <br /> T 19IN <br /> .Transporter 1 Acknowledgement of Receipt of Materials , Dale f <br /> A Prin(a{!(Typed�me \\ Signature /� Monro Day Year Q <br /> cl o� <br /> P <br /> D 18.Transporter 2 Acknowledgement of Receipt of Materials Date Q <br /> Month DYear m <br /> T ontay Primed/Typed Name Signal re t Z <br /> E �/ / <br /> R W <br /> to <br /> 19.Discrepancy Indication Spgce W <br /> m <br /> F I— <br /> A N <br /> C M <br /> L 20.Facility Owner or Operator:Certification of recei of haxartlous materials c vend DDy/t�his ma�ni/fes/s1 except as noted in Item a <br /> I Ef/�4x d'J� I'7 �T�>!Ii Dete O <br /> TMonth <br /> Day Y ar U <br /> Y Pri yped Name Signa ^ N <br /> EPA Form 8700-22(Rey.9-88) MDNR-HWG 10 PREVIOUS EDITIONS ARE OBSOLETE <br /> t1 <br />