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Arkansas Department of Environmental Quality <br /> Hazardous to Division <br /> V <br /> t R P.O. Box 89M Little Rock, AR 72219-8913 <br /> I •" Telephone: (501) 682-0833 <br /> Please print or type. (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2051 <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page t Information in the shaded areas is not <br /> Document No. required by Federal taw. <br /> WASTE MANIFEST CAD 0 7 4 6 4 2 91 '07, 0 0 of 1 <br /> 3.Generator's Name and Mailing Address A Stats Manifest Document Number <br /> INTERLAKE MATERIAL0,0 <br /> LING INC j< <br /> 1029 a. SACRAMENTO $ T7a tate Generator <br /> LODI, CA 95240 <br /> N 4.Generator's Phone 209 333-2500 <br /> a 5.Transporter 1 Company Name 6. US EPA ID Number G State Transporter's ID <br /> H• <br /> ENVIRO M%L RECOVERY SERV_ C A 0 0 0 0 9 7 0 3 9 2 D.Transporter's Phone (;SS2) 427-7277 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number E.State Transporter"s ID H- <br /> 1 <br /> TRI STATE MOTOR TRANSIT M 0 I) 0 9 5 0 3 8 9 9 8 F.Transporter'sPhone (800) 224-8768 <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G.State Facility's ID- <br /> RINECO A R II 9 8 1 0 5 7 8 7 1 <br /> 1007 VULCAN ROAD — HA3KELL H.Facility's Phone <br /> BENTON, AR 72015 (501) 778-9089 <br /> ARD 9 8 1 0 5 ? 8 7 0 <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(including Proper Shipping Name,Hazard Class and ID Number) Quantity <br /> UnitI. <br /> No. Type Quanti WWol Waste No <br /> G a' WASTE FLAHK&BLE LIQUIDS, N.O.S., 3, UN1993, PG II <br /> N (ACETONE), (D001, F003) <br /> E O/OCv-'�� O ® D M 33 G � �I <br /> A WASTE METHYL ACETATE, 3, UN1231, PG II (13001) 214 <br /> T <br /> o D MI <br /> Glf�I <br /> R <br /> C, <br /> d. <br /> J Additional DescriptionforMatedalstistedAtove , H }j ' STILL;$( 1'T °,�, <br /> .� <br /> tZ, <br /> e Information: <br /> , Fp03�; h L T& . 1^5427^-727' <br /> IRQB <br /> 2$ <br /> ='tf,no alternate TSD.F�retarcr'to generator <br /> 15.Special Handlin Instructions and Additional Information <br /> EMER6EN Y CALL ENVIROSERV 1-562-427-7277 tt BILL TO ENVIRONMENTAL RECOVERY SERVICES <br /> USE PROPER SAFETY EQUIPMENT**WORK ORDER #12906t*JG <br /> 16. <br /> GENERATOR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are cls <br /> packaged,marked,and labeled/placarded,and are in all respects in proper condition for transport by highway according to applicable international and national gove <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 econc <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 <br /> health and the environment;OR,if I am a small quantity generator,I have made a good effort to minimize my waste generation and select the best waste mana <br /> method that is available to me and that I can afford. <br /> Month <br /> Prid Name Signature <br /> me Day <br /> T 17.Transporter 1 cknowledgement of Receipt of Materials <br /> R <br /> A PrintedfTyped Name S' natu Month Da} <br /> a. Q Z <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> RPrintedlTyped Name Signature Month Dal <br /> E e <br /> R <br /> 19.Discrepancy lndicatin Space <br /> • F <br /> A <br /> t <br /> _L <br /> I <br /> T 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except allod in Item 19. <br /> Yed/Typed Name Signature nti;; <br /> Da. <br /> EPA Form 8700-22(Rev.9-88)Previous edition iso olete. <br /> NOTICE:THE ORIGINAL AND NOT LESS THAN TWO(2)COPIES MUST MOVE WITH THE HAZARDOUS WASTE SHIPMENT.ONCE DELIVERED,THE TREATMENT/ <br />