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Arkansas Department of Environmental Quality <br /> Hazardous Waste liftion <br /> P.O. Box 8913, Littl ock,AR 72219-8913 <br /> w` �` •'" <br /> Telephone: (501) 682-0833 <br /> 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. Mani est 2.Page 1 Information in the shaded areas is not <br /> WASTE MANIFEST 7 2 ® Document No, <br /> required by Federal law. <br /> of <br /> 3.Generator's Name and Mailing Address <br /> INTERLAKE MATERIA! HANDLING INC W11, <br /> '100 <br /> 100 S.SACRAMENTO STREET � �� <br /> LODI CA Sao <br /> 4.Generator's Phone �"3MO � a,��`^aze�� <br /> 5.Transporter 1 Company Name 8. US EPA ID Number tNt �d � a <br /> ENViftClNMiEt+ITAL RECOVERY SERV. 4 0 D 0 9 ? 0 3 9xT � <br /> 7.Transporter 2 Company Name 8. US EPA ID NumbertateTtansptteralD <br /> MAUMEE EXPRESS NI 3 D 9 8 6 6 0 7 3 8 F„ ansisaree s Shona <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G._Stata Faces(Cf <br /> RINECC) <br /> 1007 VULCAN ROAD-HASKELL H.FacllttygPhone <br /> BENTON AR 72015 <br /> A R D 9 8 1 0 5 7 8 7 <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(Including Proper Shipping Name,Hazard Class and ID Number) Total Unit <br /> No. Type Quantity WtlVol y <br /> E a. WASTE FLAMMABLE LIQUIDS,N.O.S.,3,UN1993,PGII(A <br /> DLI G <br /> N <br /> A b. WASTE METHYL ACETATE,3, UN1231, PGS <br /> T DM <br /> R <br /> C. t a €3r <br /> d. <br /> , <br /> J Addj {I 6 n atenaisEastedAbolre Eugene+Ftespon:lafYlfOrt9atKJC! ;i aid <br /> ;[IQt�t fitf41LAIE *� <br /> f Rt?c'2�ticCtTSdR, rE'UCt41C8 'r0E5 �,. s� s �� � <br /> a � s <br /> 15.Special Handling Instructions and Additional Information <br /> BILL TO ENVIRONMENTAL RECOVERY SERVICES*r <br /> USE PROPER SAFETY EQUIPMENT *s ERS W.O.#3815*x'LK <br /> 18. <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 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 /> —Pnnfryped Name Signature Month Day Year <br /> 4,25;, L leGl"e,�-Cs ® (; ® v <br /> T 17.T ansporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Sign re Month Day Year <br /> S <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name Sig urs Month Day Year <br /> R ,�lR/O ® Z t9 lI <br /> 19.Discrepancy Indication Space <br /> L <br /> I <br /> T 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest excep as noted' e . <br /> Y Print y Name /t Signature Month Day Year <br /> EPA Form 87 (Rev.9-88)Previous editioryrs obsolete. <br /> NOTICE:THE ORIGINAL AND NOT LESS THAN TWO(2)COPIES MUST MOVE WITH THE HAZARDOUS S HIPMENT.ONCE DELIVERED,THE TREATMENT/ <br /> 4Tr1RAr.r-InlQDnQAI CArtli ITV AAIIQT ROTIIRNTUIQ r1RIPIR1Al re%0VTr1TUC r-CMC0Are%0 - <br />