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Arkansas Department of Environmental Quality <br /> Hazardous Waste DivAhn <br /> ' P.O. Box 8913, Little k,AR 72219-8913 <br /> sa ,e <br /> Telephone: (501) 682-0833 <br /> Please print or.type.. _(Form designed for use on elite(12-pitch)typewriter.) Form Approved.01148 No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest 2.Pag�1 Information in the shaded areas is not <br /> required by Federal law. <br /> WASTE MANIFEST of <br /> 3.Generator's Name and Mailing Address _ „` <br /> INTERLAKE MATERIAL HANDLING INC r bF t r <br /> 1029 S.SACRAMENTO STREET <br /> LQDI CA 95, 40 <br /> 4.Generator's Phone X3-3 <br /> t 5.Transporter 1 Company Name 6. US EPA ID Number { <br /> ENVIRONMENTAL RECOVERY SERV. <br /> 7.Transporter 2 Company Name 8. US EPA ID Number-CA E SfTi �Sff¢rtGi k? c^5r v <br /> S D '% Trsal taYEetr 1?r1ne �? . <br /> 9.Desi nated Facility Name and Site Address 10. US EPA ID Number Oi Stste Family s lt? <br /> RINECO <br /> 1007 VULCAN ROAD-HASKELL H FacilltysPhone <br /> BENTON AR 72tf15 7d 7 <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(including Pro er Shi in Name,Hazard Class and ID Number Toil Unit fa <br /> p ( 9 P PP 9 / No. Type Quantity WtNol , <br /> E a. WASTE METHYL ACETATE,3,llN1231,PGI! DhE G <br /> N <br /> b. <br /> T WASTE FLAMMABLE LIQUIDS, N.O.S.,3,UNIM,PGH(ACETONE) D G <br /> R <br /> C. �� •g <br /> d. 1 <br /> J Addifiornaal./Description for,Materials listed Abova K Emergency Response In#drmation, <br /> 1R Il» ” <br /> �i....r -wwrt liw4.}M.+�4-TQM-. lam. t?' 6- �'- •t b l Z <br /> In <br /> 15.Special Handling Instructions and Additional Information <br /> *� BILL TO ENVIRONMENTAL RECOVERY SERVICES*' <br /> USE PROPER SAFETY EQUIPMENT ERS W.O.#49'72***Hlu* <br /> 16. <br /> GN&TOR'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 t e 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,s ge,or osal 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 h e e a go ith 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' yped Name Signature Month Day Year <br /> T 17.Transport r 1 Acknowledgement of Receipt of Materials �I <br /> R <br /> A Priyped Name Signature Month Day Year <br /> S aV d!d Q Q R <br /> P <br /> O 18.Transporter 2 AcknowledgeVfit of Receipt of Materials <br /> R Printed/Typed Name Signature Month Day Year <br /> T <br /> 19.Discrepancy Indication Space <br /> T 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest exckt as noted i tem 19. <br /> Y yped Nam Signature MMoonnth Day Year <br /> EPA Form 8700-22(Rev.9-88)Previous on is obsolete. fM;: <br /> NOTICE:THE ORIGINAL AND NOT LE THAN TWO(2)COPIES MUST MOVE WITH THE HAZARBeU&WASTE SHIPMENT.ONCE DELIVERED,THE TREATMENT/ <br /> CTADA!`_C/1'fICDACAf CAfliIiTVAAIICTDCTIIDAITYIQ'ADII±IAiAI I+ADY TA TLIC f±CAICDATAD mow <br />