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M*RI DEPARTMENT OF NATURAL.RESOURCES <br /> I TR .SVS <br /> FOR THE COM- Division of Environmental Quality EMEROEACY RFSPONsE <br /> P <br /> MIS FORM ARE ON A <br /> SEPARATE BEET. Waste Management Programua cogsrnue90 <br /> P.O. Box 176 Jefferson City,Missouri 65102 ,GlI84IK <br /> THIS DOCUMENT MUST BE USED gIEM R 4-93 <br /> FOR ALL MISSOURI-DESTINED 314-751-3176 - +-eooe2a-AU <br /> SHIPMENTS. HAZARDOUS WASTE MANIFEST DEPT. 3AT -2436RCES <br /> Please print or type (Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039,Expires 9-30-91 <br /> UNIFORM HAZARDOUS Generators US EPA ID Na Mind ormation in the shaded areas <br /> Document No, <br /> WASTE MANIFEST CAD 9 8 1 1317 ,5 ,1 5 7 0 1010 0 ,5 of i is required by State law <br /> 3.Generator's Name and Mailing Address NEWARK SIERRA PAPERBOARD CORP. A.Missouri Manifest Document Number <br /> 800 W. Church St. 0 '11 13 12 17 0 10 10 15 <br /> > Stockton . ca. 95203 , 1, #._ - 13.Stale Genlatorer <br /> s lD-oth <br /> 6.Generators Phone( 209-46%-5251 ` A <br /> 5.Transporter 1 Company Name 6,US EPA ID Number C.MO.Transporter's ID CA 2463 <br /> FALCON ENERGY ASSOCIATES CAD 9 8 2 5 2 6 8 5 7 D.Transporters Phone209-463-7108 r <br /> 7.Transporter 2 Company Name 8.US EPA ID Number E.MO.Tmmsporter's ID CA2530I140 H1202 <br /> THE KIESEL COMPANY IMOT 3 0 0 0 1 1 1 6 0 F.TmosportersPhone 314-351-5500 a <br /> 9.Designated Facility Name and Site Address 10,US EPA ID Number G.State Facility's ID <br /> THE KIESEL COMPANY RRO123 <br /> #1- Branch St. H.Facility's Phone. d <br /> St. Louis, Mo. MOT 3 0 0 0 1 1 1 ,6 ,0 314-421-0238 ' U <br /> 11,Us DOT Description(Including Proper Shipping Name,Hai Class,and 10 Number) 12.Containers 13. 14. J <br /> Total Unit I.Waste No, Q <br /> Quantity Wt/vol, Z <br /> I WASTE UUMBUSTIBLE LIQUID, N.O.S. , PERROLEUM EPA WASTE rood LL <br /> LUBRICANT), COMBUSTIBLE LIQUID,,-.MI1993. CA 331 <br /> 0 D M 0 0 5 G U 0 0 1 0 <br /> E b ! EPA WASTE CODE Q <br /> N <br /> cr <br /> IL <br /> R t al W <br /> A -... ..,._ - .. ...EPA.WASTE CODE <br /> O f <br /> R # <br /> EPA WASTE CODE <br /> d <br /> r <br /> ' 8 <br /> J,Additional Descriptions for Matenals Listed Above K.Handling Codes for Wastes Listed Above <br /> a. WASTE GREIM. T 0 $ <br /> UL <br /> e = <br /> C. <br /> r <br /> d W <br /> 15.Special Handling Instructions and Additional Information � <br /> 24 Hour emergency response #k 1-314-421 ~ <br /> LU <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. 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 /> 11 I am a large quantity generator,)certify that I have a program in place to reduce the volume and toxicity of.waste generated to the degree I have determined to he economically practicable 0 <br /> and that I have selected the practicable method of treatment,storage,or disposal currently available to me wbh minimizes the present and future threat to human.health and the environment; Q <br /> OR,if I am a small quantity general q I have made d good faith effort 1¢minimize my w s1e generation and set a best waste anagemeat method vaI to me j I can afford. W <br /> Pn ypetl Nalpe / Signature ' Month Day Year Z <br /> vtC kP � ` OBJ I <br /> Date W <br /> R17,Transporter 1 Acknowledgement of Receipt of Materials <br /> A Prinletl/TypeO Name Signature onih Day Year H <br /> Y <br /> ry m <br /> P V 1© Date W <br /> D 1R.Transporter 2 AcknowlWgement of Receipt of Materials Z <br /> R Sig ure Month Day Year Q <br /> E <br /> R PItl�fypecl O NANameL� D' b J W <br /> ¢ <br /> 19.Discrepancy Indication Space W <br /> Irl <br /> F (~/1 <br /> A <br /> ' C ': <br /> L 20.Facility Owner or Operator Certification of receipt of hazardous materials covered by this manif except as noted in Ilearl 4 LL <br /> Date O W <br /> DayYear <br /> V M nth n � O F <br /> /Typed Name - It Sl (y y V3 <br /> 0 GpL//i V{ S S <br /> EPA tonno 6700-22 mev.9499) MDNR-HWG 10 PREVIOUS EDITIONS ARE OBSOLETE <br /> a. <br />