Laserfiche WebLink
.ar •.., <br />Arkansas Department of Environmental Quality <br />t - ° <br />Hazardous Waste r'-ision <br />P.O. Box 8913, Litt. ock, AR 72219-8913 <br />2. Page <br />Telephone: (501) 682-0833 <br />Please print or Ivne. <br />(Form desioned for use on elite (12 -aitch) Ivoewntec) <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EPA Form 8700-22 (Rev. 9.88) Previous edition is obsolete.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 <br />rr,nnenfor's US EPA ID No. <br />Manifest <br />2. Page <br />Information in the shaded areas is not <br />' g 4- <br />- Document.No„ <br />required by Federal law. <br />WASTE MANIFEST <br />of <br />3. Generaiui rte:-. ,:err m 11, 1 A 1 Jr, <br />A. State Manifest Document Number <br />AR -1375222 <br />- <br />B. State Generators ID <br />4. Generators Phone(I <br />5. Transporter t Company Name US EPA ID Number <br />C. Slate Transparter's ID <br />H- <br />O. Transporters Phone <br />a'Ei:+i r <br />1. Transporter 2 Company Name 8. US EPA ID Number <br />E. Stale Transporter's ID ' <br />H- <br />F Transporter's Phone s. a Vii)ISO' .'3`J! <br />:ra�osif+..'Px3i .• +; i .t'. $,rl a y -.:^ . -:- -�_ <br />.r <br />s�.a. i h. ... <br />9. Designated Facility Name and Site Address 10. US EPA to Number <br />G. State Facility's ID <br />- <br />H. Facility's Phone <br />12. Containers <br />13. <br />14. <br />US DOT Description (Including Proper Shipping Name. Hazard Class and ID Number) <br />Toul11. <br />'y <br />Unit <br />t. <br />Na. <br />No, <br />Type <br />WWoI <br />Waste No. <br />E <br />N <br />E <br />^ <br />lo. ran 7 <br />0 <br />R <br />d .. _ , ,aa?"t ... t r rife.-: f. ql ...y, <br />J. Addition I DescriRlion,tor.f�lhanals Listed Above <br />K. Emergency Response Information: <br />x �. „- -.. •.•t } r• tilt. 7445^.6y <br />NFri1SaR' Tru �}rk"47'Yfa/#C <br />— — — — — — — — — — — — — — — — — — — — — — — — — <br />if no alternate TSDF, return to generator <br />15. Special Handling Instructions and Additional Information <br />1s 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, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated <br />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 <br />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 <br />waste generation and select the best waste management <br />method that is available to me and that I can afford. <br />Pnnted(ryped Name <br />Signature <br />Month Day Year <br />T <br />R <br />17. Transporter I Acknowl¢tlgemeN of fleceipl of Materials <br />A <br />Pmead typed Name <br />Signature <br />Month Day Year <br />N <br />/ <br />S <br />18Transporter2Acknowledgemediof Receiptof Matertais e' ' <br />TPrintedlryped <br />Name <br />SigrfaWre '�,` <br />Month Day Year <br />,- <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 covered by this manifest except as noted in Item 19. <br />y <br />Priurid/ryped Name <br />Signature <br />Month Day Year <br />EPA Form 8700-22 (Rev. 9.88) Previous edition is obsolete. <br />GENERATOR INITIAL COPY <br />