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Arkansas Department of Environmental Quality <br /> Hazardous Waste �ion <br /> d " P.O. Box 8913, Little ock, AR 72219-8913 <br /> <dtr� ee Telephone: (501)582-0833 <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. Manifest 2.Page 1 Information in the shaded areas is not <br /> WASTE MANIFEST ;' 2 1 91 011 o�cumlent No.. of required by Federal law. <br /> 11 7. A 613.Generator's Name and Mailing Address A state Manef"t"DoCumSomurriw <br /> l4 TERW6 MATERIAL HANDLING INC <br /> L001 t:A. E� ,tate3 araratatr*sq� <br /> tr t <br /> � 4.Generator's Phone <br /> a 5.Transporter 1 Company Name 8. US EPA ID Number _G StatevTransporter's 10 ?, r,.r� <br /> d;1Mfi1R(.N)0t..14'r&RE- 3WRY t7E-:.,v fk t; i fJ k D.Transporter's Phone . .. <br /> 7.Transporter 2 Company Name 8. US EPA ID Number E.StetaTransporter's ID i <br /> AAL YIE..ti..t_gFtRE 1515 i,: F Transporter'sPhone,. <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G:State Facility's 10— <br /> Nr C;c <br /> 01it,.C,c <br /> H-Facility's Phone . <br /> 12.Containers 13. 14. ti k <br /> 11.US DOT Description(Including Proper Shipping Name,Hazard Class and ID Number) Total Unit ` <br /> WASTE <br /> p� !�pgppg,���(r� �»7 r�f�++ff r� };�+ r eft No. �T-yype9� Quantity wtNol steNts i <br /> (' e. ✓'L t F0..t"trd1F'�fr'LE 13QUIDS,N.O.S.,�'��.UNiM-'.PGR fXET�iNE� .4�'d"4 *,.S <br /> E <br /> N p <br /> E . 1 <br /> o f <br /> R <br /> C. <br /> 9 fi <br /> d. <br /> J.Add iggt�al exp n aterials Listed Above K Emergency Response InfomiaUon <br /> " d <br /> if na aiterrtate ��fl,F retry t� enerac _ ��., u,� <br /> y, <br /> 15.Special Handling Instructions and Additional Information <br /> * BILL TO EPAIROWENTAL RECOVERY Soh S*t <br /> U E P OPER T'Y EQUIP T *-tERS .0. W 153`Ltd <br /> 18. '- 1„:: <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 /> Printedlryped Name Signature Month Day Year <br /> .,.. (.. <br /> ell »gyp <br /> f rr r, <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature ' Month Day Year <br /> N , r <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printedfryped Name Signature ? Month Day Year <br /> T <br /> E r <br /> R <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 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 /> PI=NI=R®TnR (MITI®1 MPY <br />