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K „TSC fyY1 29r} 01" Please print or tvoe. (Form desioned for use on elite 02 -Ditch) tvoewriter.) 7127 POW 2/17/2010 Form ADDroved. OMB No. 2050-0039 EPA Forth 8700-22 ((rev. 3-05) Previous editions are obsolete. ( DGNf19D FACILITY TO DESTINATION STATE (IF REQUIRED) clean harbors has the appropriate permits for all 0708.0620te waste the generator is shipping. UNIFORM AZARDOUS 1. Generator ID Number C A L O 0 016 7 7 3 2 2. Page t of 1 3. Emergency Response Phase (800) 424-9300 4. Mantfest Tracid Number 00 0 24504 MWI WASTE MANIFEST 5. Generators Name and Mailing Address Generators Site Address (it different than mailing address) RWEs F Inc STK 1805 East 23rd St Unit 1 4520 South Hwy 99 Frontage Rd Little Rods. AR 72206 StodrtorNCA 95235 Generators Phone: 45011376-7249 ATTHChris Salter 6. Transporter 1 Company Name U.S. EPA ID Number Clean Harbors EnWronmentai.Services Inc M A D O 3 9 3 2 2 2 5 0 7. Transporter 2 Company Na me U.S. EPA ID Number �y / l tS �✓ O ! l ! r� �-^� 3 8. Designated Facility Name and Site fiogress U.S. EPA 10 Number Clean Harbors 8 LLC 2500 West Lokern Road CA®980675276 four. CA 93206 Facility's Phone: MfiJJ 767&20 ga• 9b. U.S. DOT Description (inducing Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 1 12. Unit 13. Waste Codes No. Type HM and Packing Group (d any)) Quanfity Wt.Nol. o ' E. NON RCRA HAZARDOUS WASTE LIOUIDS. 331 WOXYGE sOLYENT). N/A ® DIM OOOZO z 2. W 0 v 3. 4. 14. Special Handling instnx:ti and Additional lA�(rnation 1 PRO 41752605632 1. CH296696 �(%tl�j�j' Ui�{ 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, arJ are classified, packaged, marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations. it export shipment and I am the Primary ExporW I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a) (d I am a large quantity generator) or (b) (if I am a small quantity generator) is W Generator PnntedfTyped Name// Signa MonDay/1Year Dftr&s 4b 'f4AII�- 1,3th 1 -J I- 16. international Shipme 1:1 Import to U.S. ❑ Export from U.S. Afentry/exiti = Transporter signature (for exports only): Data leaving U.S.: W 17. TranspatarAcknowledgment of ReceOt of Materials IX TranAporter i Printedirrvoed Sigr�tu Month Day Year Ziff,®® QTransporter 2 Printed(Typed Name Signature Month Day Year 1 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. 18b. Altemate Facility (or Generator) U.S. EPA ID Number J ' V W Facilitys Phone: w 1Be. Signature of Alternate facility (or Generator) Month 'Day Year Q 2 N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) C 1. 2. HL32 20. Designated FaciT er or Operator C rtfication of receipt of hazardous materials covered by the manifest m item 18a Month Day Year Printediiyped mq - �� 7 V e O. 3 1/ 0 EPA Forth 8700-22 ((rev. 3-05) Previous editions are obsolete. ( DGNf19D FACILITY TO DESTINATION STATE (IF REQUIRED) clean harbors has the appropriate permits for all 0708.0620te waste the generator is shipping.