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MISSOURI DEPARTMENT OF NATURAL RESOURCES <br /> IN -RUCT FOR 7I1EcoM- Division of Environmental Otialit <br /> PLE HI ORM ARE ON A - y EMERGENCY RESPONSE <br /> SEPARASEVAE - Waste Management Program: EMERUS GENCY <br /> RESFRO <br /> THIS DO''C�`.• NT MUST BE USED P.O. Box 176 Jefferson City, Missouri 65102 1-IM42q-61w2 <br /> FOR ALL ISSOURI-DESTINED 314-751-3176 CHEM TREC <br /> t.eoe<2q tellSHIPMENTS. HAZARDOUS WASTE MANIFEST" DEPT.OF NATURAL RESOURCES <br /> 314Fda-2436 <br /> Please print or type (Form designed for use on elite(12-pitch)typewriter) - F of Approved.OMB No.2050-0039,Expires 9-30-91 <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page Information in the shaded areas <br /> WASTE MANIFEST CAD 9 B 1 3 7 5 ] 7 ocg{em(J16 of —1— is required by State law. <br /> 3.Generator's Name and Mailing Address U UU A Missouri Manifest Document Number <br /> Newark.Sierra Pgpl�!6oa;d O 113 2 7 4 0 0 0 6 <br /> 80yy0 W. Church .$ ; <br /> 1`SLDCICtOIf LA B.State Generator's ID-other <br /> q.Generators Phone( 209 14616-5251 1 I IUi IIQ 3 36-033192. <br /> 5.Transporter 1 Company Name 6.US EPA to Number C.MO.Transporter'.to <br /> Falcon Energy Associates CAD 9 B 2 2 6 8 5 7 D.Tmnspprter's pnnne 0 63 108 a <br /> 7.Transporter 2 Company Name 8.US EPA ID Number E.MO.Transpoders ID lI 2 H <br /> Ir <br /> The Kiesel Company M 0 T 3 0 0 0 1 1 1 6 0 F.Transporters Phone31 351-5500 Q <br /> 9.Designated Facility Name and Site Address 10.US EPA ID Number G.State Facility's ID d <br /> The Kiesel Co./Kiesel Martie RR 0124 <br /> #1 Branch Street H.Facility's Phone > <br /> St. ,:Louis, MO 63147 M 0 T $. 0 0 0 1 1 1 6 0 (314) 4218 0328, O <br /> 11 US DOT Description(including Proper Shipping Name,Hazard Class,and to NumberJ12.Containers 13. 14. J <br /> Total Unit I.Waste No. <br /> Quantity Wt/Voi. Q <br /> aEPA WASTE CODE Z <br /> LL <br /> Hazardous Waste Liquid, N.O.S.q•s cc <br /> G '{Chromium) OR�— E NA9189 0 1 5 D M 0 0 8 G D 0p 7 O <br /> E b. s - } - EPA WASTE CODELLI <br /> Q <br /> Z <br /> T a I LU <br /> _ EPA WASTE CODE. (7 <br /> R <br /> d. _ — _ <br /> EPA WASTE CODE <br /> J.Additional Descriptions for Materials Listed Above K.Handling Codes for Wastes Listed Above <br /> aRWatte Resin Granular Water Filter bottoms semi—solid O <br /> It <br /> Z <br /> cc <br /> e F- <br /> UJ <br /> 15.Special Handling Instructions and Additional Information Q <br /> . f <br /> 24 Hour Emergency Response # The Kiesel Company 314 421-0328 m <br /> 16.GENERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and'accuratelydescribed above by proper shipping name and are classified..packed.marked, Q <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. <br /> If I am a large quantity generator,1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree.I have detenpined to be economi®Ily predicable <br /> and That 1 have selected the practicable method of treatment,storage,or disposal currently available to whim minimizes the present and future threat td humarobealt�d the environment: Q <br /> OR,if I am a small quantity.generator.I have made a good faith effort to minimize my waste generation an ale the-0est wazle nagemenl method a ailable to me at I can.atlord. R <br /> Print /Typed Nam Si nature - Cc <br /> Ba ) P y 9 Month- Day Year Z <br /> VI C M1L- L- —.�.--a— / U' <br /> TR 17.Transporter 1'Acknowledgement of Receipt of Materials _ ^s -_ Date LJ <br /> A Frontal ped Name Signature I Month Day Vee <br /> N <br /> o Y 3 k >- <br /> P <br /> R18.Transporter Acknowledgement of Receipt of Materials - Data Z <br /> T is ped Name ignetur Month Day Year <br /> o N A L 7� E i✓� p� 1031 <br /> W <br /> 19.Discrepancy Indication Space cc <br /> tU <br /> F CO <br /> A F <br /> I <br /> t: rn <br /> I � <br /> L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest cept as noted in Item 19. y <br /> I 4 L <br /> T Date Q C <br /> yed/TypName Sign§ Month V U h <br /> r �, <br /> EPA Form 8700-22(Rev.9-88) MDNR-HWG 10 1 PREVIOUS EDITIONS ARE OBSOLETE ~ F <br />