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Please print or type,(1:01111(kis griod for use on elite(12-pitch)tytxtwrifut.) _ _ Forrn Approved,0MB No.2050.0039 <br /> UNIFORM HAZARDOUS]1.Gaecralor!D Nundcr 1.lPage i of 3.Enu:+germ•Rwspimse Phune 4.Manitosi Tracking Number <br /> WASTE MANIFEST C- A{ C 0 G 2 1 0 1 1 e, 1 1-800-424..�i^0(� 012157737 JJ K <br /> 5.�cn oJalJt',flame nr l himi:ig Ad:fress i�li: i(.:!t ri f'+?r{cies Generator's Si!uAd frees(i!d Nunn!th,n nu+Cir✓a addles;) <br /> i':�IIe./ •rat fin F--c-de;:IFrei;iii <br /> 6900 Alcoa Rr_, 1000 Eat Pot1T Rd <br /> Benton AR 72015 French C:annip CA 952?1 <br /> Genotasrw r,PiicAc�: i-13 U 1 ,. 0 1 1 i �_-- <br /> G.1'ranspxtel I GnrrannyNanur U.S EPA iD Nund:ei <br /> Errvirortrne-ntal L-Dpisiacs, Inc. C b.. R D O 0 2 1 r 1 <br /> 1.1ia6Spei1ei 2 C-0mpaly N:,nre U.S.EPA ID Nwot)o, <br /> S.f eskpwtc«i Fadhly 14arimp d 41oAdd:o9s U S FPA ID Number <br /> iitef L'e .!ir;g Service .Inc. <br /> IS0 trrlr.iimeAvm*!Urr <br /> 9Ioo!t-ringlof, CA 0231n <br /> Facw sPhone:90 t) 421-2.012 ;: A D 9 6 2 g a 4 1 N 1 <br /> 9a. 9e,.U.S.DDT Dosagrtoo(iiieudbng Proper Shipputg Name•Haza!d Class,ID Numixf. 10.Containers 11.Total 12.Unit <br /> HM and P >P�acking Group(if any)) No. T Quanfily, IM Nu- 13.wast"Cedes <br /> 1-1aLard1ous v%ste Solid(faint Cleanup Debris) :35 <br /> 1 <br /> Divi Soo F <br /> 2N dm-F:CRAHazardous Vibste bctuid(Paint Ririsate) - 135 <br /> UJI <br /> c� <br /> 02 G!v} �0b <br /> 3 i <br /> 14.Spec-al Handling Insrracleinsand AdditiunallNonralion 'O(;-'l Faint C,lean tip Debris- I'IIT'•17 19 21,(L)Paint Rinsate- 14QP,,172U WO#34337-N <br /> plc S7 2 5 5 <br /> 15. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby declare that the convents of this consignment ara to&y and msurately described above by the ptopc:r ship,Ing now,arcd are dastirMd,packaged. <br /> markc-d and laboiedfplacwded,and are in ail respects in prepor coWit,on for t(anstrurt according to apptcable inlunialional and national govemmental regulations.II export shipment and I ani tie Primary <br /> 1:xfxAcr,I-caddy that the contents of this calsignnenl corfoun to t.'ia terms of the attached Er-AAcknuw edynia It of Con ont. <br /> I certify that lie wasle rrrinun'o -on statement Identified In 40 CF R 262.71(a)(it I em a large quangoneralor <br /> tity )or(b (li I n n small quantity gerwrator)is i uc. <br /> c,anr•rator'sr il(erw's Pditi�y(:e.'.A min. Slpitalur ---- I M3 1 1 9)nlha y Yexr <br /> 111 <br /> 1 - <br /> 16.Intrn1a414k!I SPihnwnt" `l Impan to U.S. C..�Fxirud Irum U, Por of ent !axil: ----.. <br /> R5 Transpxle+signature(for exports only), Dole leaving U.S.: <br /> Or: 17.Translwdar Acknowledgrnant o(Raceipt of blaluralsLLI r <br /> Tral,p;,o!tet f Printeditypud Name, l ilJna!urr Month My Yrar <br /> Month Day Yea <br /> QTunspoder 2 Prin pr, tnno Signature <br /> 105 <br /> iC Discrepancy ff II r <br /> 16a.Discrepancy Indicaticn 1.Space I...! Quantity L.__l T,we L.__�Residuo !..__�Partial Rejection j Fol Replii;n <br /> Manifest Reference Number: .-._. - <br /> U.S.EPA 10 Number <br /> 18b.Alternate Fa(By(or Gorwlstor) <br /> J <br /> U <br /> ti Facility's Phone: Monti Day Year <br /> W 10c Snalurr.ul Atlemare Facility(or Generator) <br /> Q ' <br /> z <br /> tt.Naza dues vlasto Report Managemunt k4e11tod Codes(i.o.,codes(Of hazardous waste,treatment,disposal.and Incycling systems) <br /> 3 4. <br /> 20.Designated'001ty Ow Operator.Cedifi•rGun of recelpi of hazardous materials covered by Me manifest-ca as noted in Iter! Ha -- Month 3 !! ! <br /> T'raetidll aillJsn� — --t--_- ..Shymit r' <br /> EPA Foran 0700-22(Rev 3.05) I'rcviaus editions are obsolete. DESIrNAI E-D FAC UTY TO DESMNATION STAT!_ (IF ) <br />