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a<<� •..,� Arkansas Department of Environmental Quality <br />Hazardous Waste C ion <br />P.O. Box 8913, Little mock, AR 72219-8913 <br />Telephone: (501) 682-0833 <br />Please prim nr 1ypc. (Form designed for use on elite (12 -pitch) typewriter.) <br />9 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete. <br />GENERATOR INITIAL COPY <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. <br />Manifest <br />2. Page 1 <br />Information in the shaded areas is not <br />Document No. <br />required! by Federal law. <br />WASTE MANIFEST <br />s L t 0 4- <br />3- <br />of - <br />3- Generators Name and Mailing Address <br />A. State Manifest Document Number <br />AR -1495828 <br />B. State Generators ID <br />4. Generators Phone' ) <br />-' <br />5. Transporter 1 Company Name <br />6. US EPA 10 Number <br />C. State Transporters ID H- <br />'Sr3fcI ; LY=: <br />T z - 9 3 8 <br />D. Transponer's Phone t 3tept ...9.110 <br />7. Transporter 2 Company Name <br />8. US EPA 10 Number <br />E. State Transporters ID <br />H- <br />31ai,t.1t zynt,c,,l -rrua4fov-t. <br />V F; 1, 9 e ? J t <br />F. Transporters Phone jb00 Ego 4-^59'? <br />9. Designated Facility Name and Site Address <br />F fit c... I •-. <br />10. US EPA 10 Number <br />G. State Facil" ID <br />H. Fadkiry's Phone <br />12. Containers <br />13 <br />Total <br />14. <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class and ID Number) <br />chummy <br />Unit <br />1. <br />No. Type <br />WWoI <br />Waste No. <br />E <br />. g `. .. •,j <br />2—C' <br />I <br />- <br />R <br />b.. .. .,; .,.:.. .... <br />... <br />A <br />T <br />, <br />x", <br />It <br />J." <br />Q2h <br />J. Atltlihbnill i0bscript fdiMate 2i i p <br />3-'b (. jt <br />K. Emergency Response Information: <br />_ <br />7 t. CY <br />r x T>� saz rtre+rrar. <br />___________________________ <br />if no alternate TSDF, return to generator <br />15. Special Handling Instructions and Additional Information <br />I6. GENERATOR'S CERTIFICATION: I hereby declare <br />that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br />packaged, marked, and labelediplacarded, and are <br />in all respects in proper condition for transport by highway according to applicable intemational and national government <br />regulations and Arkansas state regulations. <br />- <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 clegr@e.l.haVe determined to be economically <br />practicable and that I have selected the practicable <br />method of treatment, storage, ordisposal currently available to me whicp-lod"Imifes the present and future threat to human <br />health and the environment; OR, if I am a small quantity <br />generator, I have made a good faith effort to minimize mXy)ast9 generation and select the best waste management <br />method that is available to me and that I can afford, <br />(I-rintecliTyped Name <br />Signature i / } Month Day Year <br />�Transporter <br />T <br />R <br />17. 1 Acknowledgement of Receipt of Materiels <br />A <br />Pdnted/Typed Name <br />Sigr Month Day Year <br />N <br />p <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />PdntedrTyped Name <br />Signature Month Day Year <br />E <br />R <br />19. Discrepanq Indication Space <br />F <br />A <br />C <br />I <br />L <br />T I <br />20. Facility Owner or Operator. Eradication of receipt of hazardous metal covered by this marvest except as noted in item 19. <br />Y <br />PnntedrTyped Name <br />Signature Monts Day Year <br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete. <br />GENERATOR INITIAL COPY <br />