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P:O� ox89f3; Ci ack,AR'722i9`8� <br /> � • , a �wx�� <br /> :,, •' " Teepf�oe5Q1 <br /> ;;Please' ror� <br /> prtn type. .(Form de`sfgned(o{use,on elite(f2-piteh)typewriter.) , FbmtApproved OMB Nor 2050-0039 <br /> UNIFORM.HAZARDOUS, [i.e.en, ator US EPAID No ::,.a nnanrfest 2.Page 1 Information in d,e shaded areas is not <br /> V DocumentNo. required by Federal law. <br /> WASTE MANIFEST A 4, 2,:9, 0 3I 5 8 2 of , <br /> 3 Generator's Name and Mal4gAddhm <br /> 9-24 r <br /> 32 <br /> fi+ <br /> s 4.Generator's Phone :. },`:'i l) -3300 <br /> -' S TranspoRer t Company Name 6.; US EPA ID Number <br /> .rn <br /> T.AXs' BERV". `+ft'_0j 1 Q Q 9 '.7 Q 3 9 2 <br /> 7 Transporter 2 CornpaiTy Name p US EPA ID Number <br /> O8:,:.� S. .7 9 9 . x <br /> 9 Designated Facility.Nam@ eras Site Address r 10 US EPA ID Number <br /> a <br /> � _. �I ".R�'r. 7i.7J.ii� " ^� o ���`s ��ti-... / �'�.�.,�• 41�'�r.-'��i <br /> r+ k Y.yt <br /> Y�? <br /> _ �, <br /> f IJZ, tamers. R Unit" <br /> N Y a ti pe `f3uantltyt Wt/Val <br /> / � P <br /> _ r a <br /> P.. <br /> g Y' <br /> w;•z i t � <br /> �' y t fw�,d} ) yp';'`�� n ''�F"t"r.•�4.r$�; � d �+` 4 �� a., at. <br /> - <br /> fx�4�a9 e 'a ;z � .:. .s. r�,r rti r.e �� �3 j�{�'' �•�• a +, <br /> r <br /> 15.Special Handlin Instructions and Addltianal intomrafion „ r <br /> }' A .0 My. S�FRV 1—���421 72'X7 �` z��► �.TLr�� �►TAA1t4��Tli�b R=MnY 8E&was ** <br /> JSE EA T***g 9 tut 3&k9 = <br /> 7.7 <br /> GENERATOR'S CERTIFICATION: hereby declare that the contents of thisconsignmetttare futly'andac cumtefy described above-by proper.shipping name and are classed, <br /> packaged,,marked,and labeledtplacarded,and are in all respects,in proper con:ittortfor trans rt highway..ac cordin to <br /> po byg applicable international and national government <br /> regulations.and Arkaneas state,regulations <br /> If i am a large quantity.gene7ator.I certify that I have a program in place to reduce the volume and tonicity of waste generated to the degree 1 have determined to be economically <br /> practicable and that 1.have selected the practicable method of treatment,storage,oO,disposal'eurrently available to which minimizes the present and future threat to human <br /> e <br /> health and:the tivirontn®nt,OR,III am a,small quantity generator I have ith effortto minimize my waste generation and select the best waste management <br /> method that,fs available tame and that l can aflorda <br /> a <br /> P Name I ! Senar <br /> Month <br /> y Year <br /> 4 Mo Da ar <br /> t• <br /> 4 <br /> ' <br /> T 17. ransporter 1 owledgement of Receiptof Materials• 0007 <br /> A Pnntedrtyped Name , a- Srgnahae Month' Day Year <br /> _S <br /> P <br /> O 18.Transporter.2'Acknowledgement of Receipt of Materials <br /> R Prints ' <br /> 77 <br /> j ..:, Month Day 'Year <br /> 71�,Nams <br /> Signature l *. <br /> Rl' Q 6 f <br /> 19.Discrepancy In fi pace <br /> T '20.Facility Owner or Operator.Certification of receipt of hazardous materials covered by this manifest pt as no;ed in item 19. <br /> Y P'tedlryped Name r(�—/ Signa Month Day Year <br /> sL <br /> EPA Form 0700-22(Rev.9-88)Previous edkion is obsolete. F <br /> .. . SECOND TRANSPORTER C®P i . <br /> rt..gWµ,�} .a7. <br />