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Q,ot,= Arkansas Department of Environmental Quality <br /> Hazardous Waste WWion <br /> P.O. Box 8913, LittMock, AR 72219-8913 <br /> w ' Telephone: (501) 682-0833 <br /> .aJ'Please print or type. (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Page 1 Information in the shaded areas is not <br /> Document No. 1 <br /> required by Federal law. <br /> WASTE MANIFEST C L? � 7 4 -4 � � 07�a.-`,.: � of <br /> 0;7. rator's Name and Mailing Address S tea1.11 11111111111V,�'-' ` <br /> INTEPL,AKE H C?� a t `s �e°t o <br /> 1�S, tCRAMENTO STREET <br /> � � R ' <br /> L001 CA M40 <br /> 4.Generator's Phone : « ,� � �, <br /> 5.Transporter 1 Company Name 6. US EPA ID Number C rteTrgcls�Sbrter a t <br /> EWV NINAENT.*. 1i off 4?tf t. :. fJ 13 c 0 ut 2 "D'TransPtldet'sPhoh� b <br /> F ,4 <br /> p Company o <br /> 7.Transporter 2 Com an Name 8. US EPA ID Number E.StateTrarls orter's tt5 ": <br /> A, t� °.: i'r .' w '..FTtansport®rsPhOne a <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G,.StateFacilityts ID` - , <br /> i r I#I.:� 1 H,ffadlilya one <br /> J W, r �lm <br /> ,_2 r,s r. 11i'. - d.S.A .¢9. a., ,"I 'I t j:� <br /> 12.Containers 13. 14. & } <br /> 11.US DOT Description(including Proper Shipping Name,Hazard Class and ID Number) Total Unit r s � v <br /> No. Type WWoI �NVI, L <br /> E a WASTE FLAi'�t AK �.9�MS,N.O.S, ,,UN9! ,I�� 111 G T £=4 D <br /> r � � <br /> N <br /> R b <br /> A 7X'� FWWI. <br /> A ,E g L,3,1141231, <br /> 4d2d+ P31 <br /> d. <br /> J.Addttbnal Descnption for Materials t�stedAbove }etc Fme > Fippnsgfti abcn >, <br /> X, <br /> �i <br /> lf't10.BItEtTtc"itfs.TSC)'..... <br /> ,.TkstuKrBri6tOr <br /> n. <br /> 1 N S <br /> 15.Special Handling Instructions and Additional Information <br /> t-i k s 'rf t�Af 1. #`#3I.[ G�:'it i• w.. , ;';� 'ra B111 TO ENttRO{'dIVEN$"'.AI.R It. 'ER`t <br /> is. "S I <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 /> PO!ptedrT'yped Name Signature Month Day Year <br /> R17.Transporter f Acknowledgement of Receipt of Materials <br /> A Printedfryped Name p Signature Month Day Year <br /> N <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printedfryped Name Signature Month Day Year <br /> T <br /> E <br /> R <br /> 19.Discrepancy Indication pace <br /> I <br /> T 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Y Printedfryped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.9-88)Previous edition is obsolete. <br /> GENERATOR INITIAL COPY <br />