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r Apr 16 05 04:12p Angela Metz <br />Arkansas Departm--a of Environmental UUanry <br />Hazardous Waste Sion <br />P.D. Box 8913, Little Rock, AR 72219-8913 <br />Telephone: (501) 682-0833 <br />3 - <br />2094685672 p.3 <br />Form Approved. OMB No. 2050-0039 <br />Plcnu <br />pim w rypc. (Form designed for use on este (tZ-pdcnl rypcewmerl MMeest <br />2. Pape 1 Inlermatlm re IM shaded areis rot <br />t. Oenanmra <br />UNIFORM HAZARDOUS US EPA to No. D«.anent by <br />required by FWOM law. <br />WASTE MANIFEST <br />d <br />a Stam 1lemNelt Obcumem resettle <br />I G naltern Plana aKl stating AM,m <br />AR- 4 9 5 8 <br />em 'Tat ply <br />e. Sint. Generaern Ip <br />1810 a aA1 imm <br />sTCe"W, G 95201 AT=-;m5m alrnam <br />♦. GananalWS Rhwe(309)468-30 6(209 668-3066 <br />US EPA ID Number <br />C. Same Ttanspodeh ID H. <br />5 Tonspmtes / CamWtry Name 6. <br />D. TransP°nere I <br />O O 06' ! a 0 g 6 <br />lYt26 >t�rC us EFA ID Nterser <br />_ <br />E since Tmneponern m w <br />7. Tran,", 2 Cttnparry Name a <br />R T--p-Wt Phwts _ <br />SLR .3 1/ t D! 6 6! 8 4 '1.3 3 <br />6 casi9reed Fxaay Name and She Ahrens t0. US EPA Ip Number <br />G. Gldw Faclaty'n 10 <br />PJesm, MCC. <br />309 AlEMTCM CIIsf3E <br />K FecahPrs Fran <br />M I1QSAp0, AR 71730 t o 6 9 '7 s <br />(910) 663-7173 <br />@. Qlrsein016 <br />13. <br />Talal <br />14. <br />tlr„t <br />1. <br />it, US DOT Oea ption Inquiry Prayer Shopiv Name. HEID Namhed <br />Om°� <br />WrA'd <br />Wash Ne. <br />Na. <br />T e <br />G <br />aflJe661�Li�tm. i.C.S., 3, 431899(laPlb-pae4), <br />N <br /><aags 1281. drE: 7445201 <br />!P <br />is <br />E <br />R <br />t lOI.ID6, SIC, t.C.3., 4.1. m13m, 2C II. <br />TpbaEisfe <br />lass, wieriw.lr (eas: 133), Wp 746,521) <br />IA <br />0 <br />� <br />• <br />�� <br />P <br />a <br />R <br />c. <br />iJtCl'r� Shij� <br />dPAIwi' ICER'® IW'pIWL, 3, VOL163, W II, 0101-8 011624), <br />(ea`g: 128), (pfn 744526) <br />$ <br />r <br />i Ci O <br />r <br />n' <br />J. Adbypi I + �alnmmlisl9d ¢.t �- ) ee 11H: 746621( % X <br />K cmer9etcy RsapNrno InbmuUvrc <br />) e• 110r 74.526( 3XNiB cF <br />3 >a <br />1 , <br />isoolsss-soa! <br />------------------------- <br />if no alternate TSDF, return to generator <br />15. Spedet Ha itg Mstm,,d.. and Addkontd Inhere -b r <br />weeta, app»tiaCe p1L when 1 mxwll3 +4 7]alALdKV rteLiels- Lata ie � care It per 40 CM 261. t @) (1) <br />eiultssiatn. aH packed aapasdinq tin 69 CM 173.12b. aaD114s3- Site,: 7850 5 RA esidq.Eu 3t. <br />StaaYtm CIL 95206 ( Me Guilin 128 , 133 , 131 <br />ra. GENERATOR'S CERTIFICATION: I hereby declare that the o oafs or this consgnmenl are hilly and accurately desmrted above by Proper shipping rants and are classified. <br />packaged, markni, and mbale liplamrded, and are in ae raspecM in Proper e0ni hion for ImnsyOn by highway according 10 egg] icable International and rarormi 9oearnmem <br />regulations and Ankanlsas state regumtifim. <br />Ih 1 am a large gaantry ganeretor. I eerily that I have a progrann in pence to reduce the vohone and mdeiry generated m the degree t ademmrirled 10 be economita)y <br />'d1 More Iftreat W hrunan <br />pracpcabl and that I have selected de W nimble, medtod of treatment. garage, or d' u ntly to ale mem a present and <br />best marragemttrd <br />healM and ate envinpnment; OR, a 1 am a smaa quarlMy generator. I have mad good faith Sinn I mhtitiew my ere0on end select the waste <br />method that is a raila0m m me and that 1 mn afford. _ <br />Wan Name Si99aWre , AAVM Ory Ynr <br />r ti <br />T <br />geam el Ree fat eeas <br />17. Trweponer t AertpeaadrrW d <br />R <br />A <br />PnnleNryped Name <br />Si, Wne asenm emy Year <br />5 <br />T o lc1 <br />P <br />p <br />le. Tmnponer 2 Advwwbdgemmr °I Recam d Mamdak <br />T <br />PdnmWryped Name <br />Siywtvre afwn pay Yd/ <br />E <br />R <br />t9. o'serewno/ Itdtalion Space <br />F <br />A <br />C <br />1 <br />L <br />1 <br />m. Fac3ry Pew w Opemmn CemrKatlan of ratxpt at temmoun melennk covered M his manileu evepl as neer) m item 19. <br />T <br />Y <br />PnnnWrypM Flints signLlure Mina, 1bY Y. <br />EPA <br />EPA Form 0700-22 (Rev. 9-86) Yremous eonion is vats_: __- <br />