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oi�Ne,T,,f Arkansas Department of Environmental Quality <br /> Hazardous Waste Mision <br /> P.O. Box 8913, LittlMock,AR 72219-8913 <br /> Telephone: (501) 682-0833 <br /> a • <br /> f. 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 /> AxD um nt No. f required by Federal law. <br /> WASTE MANIFEST C 13 0 7 $ 6 4 2 9 0 1 � of <br /> 3.Generator's Name and Mailing Address <br /> INTERLAKE MATERIAL.HANDLING INC <br /> 1029 S.SACRAMENTO}STREET vtatstc T a <br /> LODI CA 95240 <br /> -3500 IIHI, <br /> 4.Generator's Phone W"� �a § t - <br /> S.Transporter 1 Company Name 6. US EPA ID Number <br /> EWRONMENTAi..RECOVERY SERV. C A 0 0 0 0 9 7 0 3 9 2 �rtera �fite <br /> 7.Transporter 2 Company <br /> ��Name 8. US EPA ID Number Eo-State Tt�nspprtar 9 ip ' <br /> 117L'"lU 1ErrC E—XPR1E�SON tl TI 9 5 6 5 0 7 3 8 0 F- <br /> X TranspoKecaPhone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number Cx.$fate!�pHty s tCi x a as`, <br /> RINECG E <br /> 1007 VULCAN ROAD-HASKELL H, aCllitya hone <br /> BENTON AR 72015 <br /> D 98 1 0 5 7 8 7 0 <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(including Unit <br /> Proper Shipping Name,Hazard Class and ID Number) No Type Quantity WtIvol <br /> G a' (� WASTE FLAMMABLE LIQUIDS,N.O.S.,3,UN1993,PGII(ACETONE) D G <br /> E <br /> b. <br /> R <br /> A WASTE METHYL'ACETATE,3, UN1231, PGI! � Go <br /> 207 00-3 <br /> a vj 3/� pqt, <br /> Q© F <br /> d. � <br /> JAdditWnal Descnpborffor Materials LtstadAbrrve K Em8 e I �; . <br /> ei.� t.fa,.,.a?. A<sy<,•�.�.a ,,..,.,,. t � z x., �"5:� � s��a,a���`���� �� � . <br /> AfB�fClC7tIN <br /> � r �� t �r�a� } wx�', S`�4.�}�Mk�`'� ,✓f k', X��k q 'X"��- 3� s�xs� 1� � �� <br /> a .z <br /> 16.Special Handling Instructions and Additional Information <br /> EMERGENCY CALL ENVIROSERV 1-562-427-7277 ** BILL TO ENVIRONMENTAL RECOVERY SERVICES <br /> USE PROPER SAFETY EQUIPMENT ERS W.0.#1367***H " <br /> 16. <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 qood 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 /> P' ypeclName ASignature �� Month Day Year <br /> T 17.Transporter Acknowledgement of Receipt of Materials <br /> R <br /> A Pdnted/Type Name Signature Month Day Year <br /> N <br /> S G! q <br /> P <br /> O 18.TransporterfAcknowledgement of Receipt of Materials <br /> R Pn ted d Name Signa a Month Day Year <br /> T <br /> E 4 D <br /> R <br /> 19.Discrepancy Indic ion Space <br /> L <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 Pri yped Name r Signa M Month Day Year <br /> fill =1 <br /> EPA Form 8700-22(Rev.9-88)Previous edi on is obsolete. <br /> NOTICE:THE ORIGINAL AND NOT LESSTHAN TWO(2)COPIES MUST WOVE WITHTHE HAZARDOUS WASTE SHIPMENT.ONCE DELIVERED,THE TREATMENT/ <br /> STORAGEBDISPORAL FACILITV MUST RETURNTHIA OR111.INAL rnPYTOT41P[;FNFRATnR <br />