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<br />Hazardous Waste Divi,' -n P.O. Box 8913, Little kAF 72219-8913
<br />Telephone: (501) 682-0833 �))
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<br />roan approved. OMB No. 2050A0.39
<br />UNIFORM HAZARDOUS 1, Generators US EPA ID No.
<br />Maddest
<br />2. Page 1
<br />Inbrtnadon in me shaded yeas is not
<br />WASTE MANIFEST r
<br />D«omen No.
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<br />required by Federal law.
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<br />3. Generators Name and Mailing Address
<br />AX IOAC1lY C."..'!:IS'
<br />A. Sate t4anif9atppgameAt In11¢r
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<br />STO[�LTCLe, a 35201 AT' l AL=T Sf17.0 T-osr.la
<br />W Sete GenemloYs ID
<br />4. Generators Phone ( 009114 8-3256 (209) 58-10i151
<br />5. Transporter 1 Company Name 6. US EPA ID Number
<br />C. State Transporters, ID
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<br />D. Transporleia Phone
<br />7. Transporter 2 Company Name 8. US EPA ID Number
<br />E. State. I o nspoders ID
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<br />F. Transpaners Phone
<br />S. Designated Facility Name and Site Andrew 10. US EPA ID Number
<br />ta1)o- 884.2ffi9'P
<br />G. Stare Facility's ID
<br />1019 A4ffitlC;:i CIPGLP;
<br />H. FacilBys Phone
<br />EL DORADO, AER 71730
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<br />(a 1163-71173
<br />11. US DOT Description (InclWmg Proper Shipping Name, Hazard Class ado, ID Number)
<br />72. Containers
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<br />Total
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<br />Quantity
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<br />(2_.rcethrana, Chlordane), (erg: 1.31). (ppf: 744522)
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<br />K. EmergencyResponse Inbrmatlon:
<br />w• 11C:- 744522( ly5j �)� ) an L'D: ?447 6( I )(C.:1..
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<br />if no alternate TSDF, return to generator
<br />15. Special Handling Instructions and Additional Information _
<br />'r1sar acrrorriats PYF, shcr. haci'=.r:q naza_io':s as eer:xala. :laaa to :.CRA. sx3utt pet 4:1 CTR '_5L.
<br />aas packed a ao,dirag ra 49 :1.R 173.12b\ Tat ?1433- rite: 7850 ->
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<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,
<br />packaged, marked, and labeledliplacarded, and are in all respects in proper condition for transport by highway according to applicable international and national
<br />regulations and Arkansas state regulations. government
<br />If I 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
<br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available -to -me which minimizes the present and future threat to human
<br />health and the emnionmenF OR, if I am a small quantity generator, I have made a good-faWliff rt to minimize my waste generation and select the best waste management
<br />method that is available to me antl that 1 can afford.
<br />"'PdnteWryped Name -
<br />�^ --� Moats Day Year
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<br />17. Transporter 1 Acknowledgement of Receipt of Matertals I
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<br />Name SignaNre
<br />�. -. Month Day Year
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<br />18. Transporter 2 &w wWgement of Receipt of Materials --.
<br />RPmnted?yped
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<br />Name S naNre
<br />11 Month Day year
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<br />19. Discrepancy Indication Space
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<br />M. Facility owner or pt
<br />N Operator. CerOflcatbn ohrecel M hezallous materiels covered by this maddest except as rated in Dem 19,
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<br />Paned/ yped Name
<br />Signature Monts Day Vear
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<br />EPA
<br />Form 8700-22 (Rev 9.88 Pi
<br />revlous 1 ton is obsolete.
<br />TREATMENT/STORAGE/DISPOSAL FACILITY COPY
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