Laserfiche WebLink
st Arkansas Department of Environmental Quality <br />a: = Hazardous Waste P' 'Sion <br />' P.O. Box 8913, Littk .ock, AR 72219-8913 <br />Telephone: (501) 682-0833 <br />Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />Form Approved. OMB No. 20500039 <br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete. <br />r;FNFRATnR INITIAI rf)PY <br />UNIFORM HAZARDOUS <br />I.Germator's US EPA ID No. <br />Manifest <br />2. Page 1 <br />information in the shaded areas is not <br />y , t y ri ,a 4 <br />D,gcurourn, o.� <br />rsquired by Federal law. <br />WASTE MANIFEST <br />of <br />3. Generators Name and Mailing Address <br />A. State Manifest Document Number <br />AR -1469264 <br />- .. <br />B. State Generators ID <br />4. Generator's Phone t <br />5. Transporter t Company Name 6. US EPA ID Number <br />C. State Transporters ID <br />IL <br />D. Transporters Phone -. ..! -.. <br />]. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID <br />5)N1CI1 i•i:3yLa T140 eL-•tet H i '1 <br />IL <br />H- <br />F. Transporters Phone ,.'llc a4-: 54`. <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />H. Facility's Phone <br />12. Containers <br />13, <br />14. <br />11. US DOT Description (including Proper Shipping Name. Hazard Class and ID Number) <br />Total <br />Quantity <br />Unit <br />1. <br />No. <br />Type <br />WWoI <br />Waste No. <br />G <br />E <br />a. <br />N <br />E <br />R <br />In <br />A <br />T <br />0 <br />Cti <br />c. <br />5 <br />d. <br />t '( - <br />J. Additional belefloicaffisM2tetilis�sJ�'$XN�6J <br />K Response Information: <br />.• <br />Urn - .- . <br />r <br />CiEAhATy <br />1.tL6 t'4t1PL•TRAt;' <br />J <br />s �f/'-JJJ VM1 <br />1Nt'l I.`.i 4J :i �l'3�rtk �.i <br />--------------- <br />if no alternate TSDF, return to generator <br />15. Special Handling Instructions and Additional Information <br />t6. <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 to applicable international and national government <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, if 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 />PdntetlTyped Name <br />Signature <br />Month Day Year <br />T <br />n. Tmnspo"er t Acknowledgement of Receipt of Materials <br />R <br />A <br />Printed/Typed Name <br />Signatufer. <br />Month Day Year <br />N <br />p •, <br />_ ;'' <br />— <br />I <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />T <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials coveretl by this manifest except as noted in ham 19. <br />Y <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />EPA Form 8700-22 (Rev. 9-88) Previous edition is obsolete. <br />r;FNFRATnR INITIAI rf)PY <br />