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<br />Hazardous Waste Di1'
<br />P.O. Box 8913, Little AR 72219-8913
<br />•° Telephone: (501) 682-0803
<br />Please print or type. (Form designed /or use on elite (12 -pitch) typewriter.)
<br />9
<br />Form Annrnvad nAAR At, pn4n-nneo
<br />EPA Form 8700-22 (Rev. 9-88) Previp,us edition is obsolete.
<br />GENERATOR INITIAL COPY
<br />UNIFORM HAZARDOUS
<br />1.Generalor'sUSEPAIDNo.
<br />Manifest
<br />2
<br />Inbnnaltoninlheshatledareasisnot
<br />Document No.
<br />ruiretl
<br />by Federal law.
<br />eq
<br />WASTE MANIFESTOAF
<br />I rb II ,a
<br />a 'irofPaget
<br />3. Generator's Name and Mailing Address
<br />A. State Manifest Document Number
<br />AR
<br />.=-QUTIT CXXNTT
<br />-1375380
<br />sate, Lr H%i Lest Hi
<br />B. State Generator's 10
<br />TSG!:£'fOlt. C,a •)sa)t ?Y^•'N: al.. tDN fr1.nI5DH
<br />4. Generator's Phone 309 v - 204 4+. $-{O:d
<br />S. Transporter 1 Company Name 6. US EPA ID Number
<br />C. State Transporter's ID
<br />H-
<br />Z 0 10 10 1913 is III ie 16
<br />D. Transporter's Phone
<br />7. Transporter 2 Company Name 8. US EPA ID Number
<br />E. State Transporters ID
<br />H
<br />F. Transporter's Phone
<br />18001684 2591
<br />3with sivatiiii 8xana zt N Z D 9 8 6 9 8 2 1 3 3
<br />9. Designated Facility Name and Site Address 10, US EPA ID Number
<br />G. State FaciliN's ID
<br />Exto n. Ii
<br />D0+ AtMRIVIA,M C-T6K:rE
<br />H. Facility's Phone
<br />ad, r'%81ADA. AR 71.7'9x9
<br />A& 0 0 a 9 7# 8 1 3 2
<br />f8701843-7173
<br />12. Containers
<br />13.
<br />14.
<br />11. US DOT Description (Including Proper Shipping Name, Hazard Class and ID Numbed
<br />Total
<br />OuantilyWWoI
<br />Unil
<br />L
<br />No.
<br />Type
<br />Waste No.
<br />EaT.'hW[+97.ffi
<br />t,TQUTDS. N O.S. 3. IAi1991, t IT. tlilb-tna i .
<br />fe.'r;1 128) . (;•P! 744920)
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<br />fPA
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<br />Tf.�441pf.E S6YY,tD4. l'FttiAISTi:. 15.0.4. 4. 1. (Rr3.D2^.. l't9 1I,
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<br />ft4p.,t ilag testa, Adhowiws) . (erg-, 133), Wt 744921)
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<br />c'Fg8 PPSTTGI.ne'A LIQUID.. 6f..Rii Llli, 'CU%IC. 5. UIN302I . Pci I[,.
<br />In`+c+thtina. '-YtA o1^rlasut). tat¢! 111), in#i 7445429
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<br />NA
<br />d':'tap3'ir,!11CkD r%LdIdD1S1, !>PJ4-D. IFdcpe+al y} (i.im1t93 SDumae1t1) ,
<br />j.,, 1.24) ; yp£: 744£3rs')
<br />J. Additional Description for Materisis Listed Above
<br />K Emergency Response Information:
<br />I, t1Ar 744520{ ) +a 11&I 7448214 -
<br />} ++ 119= 7445.x2( ) °' L1Or 7444284
<br />Id}SX= Lem 3NAOYB.AO
<br />.,
<br />,(0060 839-sdS3
<br />— — — — — — — — — — — — — — — — — — — — — — — — — —
<br />if no alternate TSDF, return to generator
<br />15. Special Handling Instructions and Additional Information
<br />3(N'AFa(.tl]tf)FrC!i`f. fi.. R .' MR5c111 hj t;9'.'-'1t:3!awr 4,IItA.Zt nt.+ smY "'.1'a! 4...,;f
<br />.,Pt'.j f-.) 4`3 '!rli S.'t
<br />NIIa� " si i «anuli e:�. 40 44Yt2ei, A(S-) i-11 ar.-.inni.an. :I mt01402 44 .. s.-.
<br />'IDso I VIA
<br />itu, kc es, CA e5A ':luzia 013 . 139 131 , 12-T
<br />16,
<br />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 labeled/placarded, and are in all respects in proper condition for transport by highway according
<br />to applicable international and national govemment
<br />regulations and Arkansas state regulations.
<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 environment; OR, it I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management
<br />method that is available to me and that I can afford.
<br />Printed/Typed Name
<br />Signature
<br />Month DayYear
<br />T
<br />17. Transporter t Acknowledgement of Receipt of Materials
<br />R
<br />A
<br />PMtadrryped Name
<br />Signature
<br />Month Day Year
<br />N
<br />S
<br />P
<br />O
<br />1 B. Transporter 2 Acknowledgement of Receipt of Materials
<br />R
<br />T
<br />Printedrryped Name
<br />Signature
<br />Month Day Year
<br />E
<br />R
<br />19. Discrepancy Indication Spaces
<br />F
<br />A
<br />C
<br />I
<br />L
<br />T2D.Fecilirythynerpr
<br />Operator: Codification of receipt op-ardous materials covered by this manifest except as noted in Item 19.
<br />y
<br />onnIees Is d Name
<br />Signature
<br />Month Day Year
<br />EPA Form 8700-22 (Rev. 9-88) Previp,us edition is obsolete.
<br />GENERATOR INITIAL COPY
<br />
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