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HrKansas uepartment of tnvironmentai uuanty <br /> Hazardous Waste D' ' ion <br /> P.O. Box 8913, LittliffiWick, AR 72219-8913 <br /> Telephone: (501)682-0833 <br /> Please print or type. (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0033 <br /> l <br /> UNIFORM HAZARDOUS. t.Generator's US EPA ID No. Manifest 2.Page 1 Information in the shaded areas is not <br /> WASTE MANIFEST E t Document No. required by Federal law. <br /> m k of <br /> 3.Generator's Name and Mailing Address x� <br /> INTERLAKE TiAkt7 #�! i a I,x <br /> . SACRAMENTO STREETLOU CA 9,M40t <br /> N 2 S <br /> � 4.Generator's Phone <br /> a 5.Transporter 1 Company Name 6. US EPA ID Number <br /> t V'16GW fid"rPd RECCaWRY SERV. <br /> 7.Transporter 2 Company Name 8. US EPA ID Number <br /> C`,,IAI IMEE,EXIPRESS k a i) ° t t ;3 R F T€arlsporter aPPaxae <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G;State Facility's IR <br /> v aw {a rl s s-'s <br /> ef H Faality s Phone,, <br /> suis\ i!l r s r� .I � .7 , e <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(Including Proper Shipping Name,Hazard Class and ID Number) QTan6l Unit # rt <br /> No. Type ty wtivoi <br /> G a. ',jVAQTr7 FLAMMABLE LnUI a9 N.O.S.,"4,Y�F iM,PGH KETO�E�-3 <br /> E M <br /> /# Fa S 2ry � <br /> � . "i-vow &,,isr a" <br /> R b. - torr <br /> A WASTE ACETATE,3, I.N ;131,PC-41 <br /> T car <br /> O , <br /> r: <br /> C. i <br /> „fat c� <br /> r <br /> 1 t <br /> d. <br /> J.AlpD ri t' n atenals Listed Above rgency,Response Information <br /> 31t f'e � <br /> rstt 0 ' <br /> f S bib Y," i ,X ,et, <br /> if no,'alternate TSD, ,.Feturrf°to ene'rat6r,, <br /> 15.Special Handling Instructions and Additional Information <br /> " SILL TO E- LAN ENTAL RECOVERY SERVICCES� <br /> USE PRtOPER SWETY EQ T "ERS W.O, I5 1'h LIQ: <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 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 /> 7inted[Typed Name Signature Month Day Year <br /> TR 17.Transporter 1 Acknowledgement of Receipt of Materials 7 <br /> A PnntedtTyped Name Signature 1 r'f Month Day Year <br /> N <br /> S fe-. / r <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R PrintedlTyped Name Signature 2 Month Day Year <br /> T r <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <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 Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.9-88)Previous edition is obsolete. <br /> GENERATOR INITIAL COPY <br />