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MISSOURI DEP RTMENT OF NATURAL RESOURC <br /> INSTRUCTIONS FOR THE COM- Division Of Environmental Quality EMERGENCY RESPONSE <br /> GUARD <br /> PLETIO FORM ARE ON A Waste Management Program U.land 1.-SRW <br /> SEPAFF'ff�TE SHEET. g 1 aW 444 8002 <br /> P.O.Box 176 Jefferson City,Missouri 65102 cREM TREc <br /> THIS DOCUMENT MUST BE USED 314-751-3176 t.e00124.sam <br /> FOR ALL MISSOURI-DESTINED DEPT OFNATURAL RESOURCES <br /> SHIPMENTS HAZARDOUS WASTE MANIFEST 314.634.242E <br /> Form Approved.OMB No.2050-0039.Expires 9-30-91 <br /> Please print or type (Form designed for use on elite(12-pitch)typewriter <br /> UNIFORM HAZARDOUS 1Generator sUSEPA IDNo ManifestNo <br /> 2Page �_ Information in the shaded areas <br /> WASTE MANIFEST CAD 9 8 1 3 7 5 1 5 7 0 0 0 0 <br /> of —� required by State law <br /> 3.Generator's Name and Mailing Address <br /> NEWARK SIERRA PAPERBOARD A.Missouri Manifest Document Number <br /> 800 W. Church St. Oil 3 2 7 4 <br /> B:State GenerataYs ID-other <br /> Stockton, Ca. 95203 <br /> 4.Generator s Phone(209-466-5251 <br /> 5.Transporter 1 Company Name 6.Us EPA ID Number C.MO.Trensporter's ID 2463 � <br /> A 9 $ 2 5 2 6 $ 5 7 D.Transponoli Phone 209_463-7108 2 <br /> FALCON ENERGY ASSOCIATES CA 2530 H 1202 a <br /> 7.Transporter 2 Company Name <br /> 8.US EPA ID Number E.MO.TransporteYs 10 <br /> THE KIESEL COMPANY <br /> MOT 3 0 i 0 1 1 1 6 0 F.TranspoidiPhone 314-351-5500 <br /> 9.Designated Facility Name and site Address 10.Us EPA ID Number G.State Facility's ID } <br /> RRO124 a <br /> THE KIESEL COMPANY H.Facility's Phone O <br /> #1 Branch St. <br /> St. Louis Mo. 63147 M 0 T 3 0 0 0 1 1 1 6 0 -314-351-5500 a <br /> 12.Containers 13. 14. <br /> 11.US OOT Description(Including Proper Shipping Name,Hazard Cfass,and to Number) Total Unit I.Waste No. Z <br /> Quantity WI/Vol. Iy <br /> EPA WASTE CODE (r <br /> ( PETROLEUM CA 223 O <br /> LUBRICANT ) , ORM-E, NA9198 0 <br /> G EPA WASTE CODE � <br /> E PbReri, __ ,,. n c nr�,*rnTT�mSST�SS411-F O <br /> N p ' U) <br /> E rcr N <br /> R EPA WASTE COOE �L <br /> A <br /> T C <br /> O <br /> R <br /> EPA WASTE CODE <br /> d. <br /> K.Handling Codes for Wastes Listed Above <br /> J.Additional Descriptions for Materials Listed Above - 'P 4 � <br /> a.Waste grease with floorswee W a <br /> a <br /> C <br /> twat aid- z< <br /> a <br /> C. Ulu <br /> W LI <br /> d. p u <br /> 15.Special Handling Instructions and Additional informmmn W L <br /> IL <br /> F- - <br /> EM2RUfENCY RESPONSE 24 HOUR # 1-314-421-0328. m ' <br /> 16 GENERATORS CERTIFICATION I hereby dedonclam that the dihon for transport highway adecodthis in consignment <br /> applicable ily nternationallly described and h ional governmentby tregulationper o and applicable stalename and are lregolei hacked.marked. 0 <br /> and labeled.and atria an respecls'm proper p 9 Y g to the I have Q I <br /> afnld am a large <br /> nave quantity <br /> selede0 lneepmnicabee(fy that I have a meted of treat ent.is storam in age,piece <br /> d sposal Currently educe the volume <br /> to ad toxicity <br /> which aminimiizesste athe present aeelutum threat to(human health and the llenvi environment: <br /> Q <br /> OR,it am a smell quantity generator,I have made a good faith effort to minimize my waste generation and t the best waste management method available to me That can Month Day Year W I <br /> }� L3 `a Q Signature r ,` <br /> Printed/Typed Name ll <br /> (JQ✓I C �- Date k=- <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Month Day year O <br /> R Signature <br /> N Printed/Typed Name ` U <br /> S Dale m <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials Month Day Year f <br /> R Signa re Z <br /> T or ]Typed NNaameems /J /' W <br /> R /C-G Cid r'` W <br /> M <br /> 19.Discrepancy Indication SPICE F- <br /> F rn <br /> 7 <br /> A � <br /> L 20.Facility Owner or Operator.Certification of receipt of hazardous materials covered by this maniles cept as noted in Item 19. IL <br /> Dale IL <br /> 1 nth Day ear N <br /> T Sig. / <br /> ,, Prin eped.Name, <br /> r <br /> EPA Form 8700-22(Rev.9-88) MDNR-HWG 10 PREVIOUS EDITIONS ARE OBSOLETE <br />