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Please print or W.(Form d ned for use on elite(12-pitch)4paovritet'.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1I.Gen=10"ONumber 2.page 1 of 3.Emergency Response Floe 4.IAanthtst TmcWnNber <br /> WASTE MANIFEST CALOOOQ.,r'7083 1 1.888-785.7225 101126§218 F L E <br /> 5.Generators Nam and k1aging Adftss . Gimeratorsite Aftem(d drfterent than madrfg s <br /> Panslla Trucking <br /> 5000 E. Fremont St ' <br /> Stockton, CA 85205 <br /> Gener�rastpoortstteePtrton�e:2094W3-6010 ' ' . ''•,�^ <br /> AOYdrtCeC1 y \ U.S.EPA ID Number <br /> ertllcal TransPo7t Inc. (SV) CAR000070540 <br /> 7VTe&W2de KeZefy System, 1l1C r U.S.EPA 10 Number CAR000175422 <br /> Fa <br /> rra ed obty Name Address U.S.U.S.EPA IO Number <br /> Yuma YES, LLC <br /> 2730 E. 13th St AMMI515924 <br /> Yuma, AZ 11,5385 <br /> Fac nys Phone: 928-344-GM <br /> ga. 9b.U.S.DOT Description(incuh g Proper Shipp�ng Name,Hazard Cass,ID Number. 10.conta++ers 11.Total 12.U61 13.Waste Codes <br /> HM and Padang Group(d any)) No, Type Duarttty MAW. <br /> t on- Hazardous Waste,Solid, DM P 352 <br /> 0 _ <br /> I i <br /> z on- azar ous Waste Filters) 352 <br /> 0M P <br /> 3. �J <br /> 4 <br /> 14.Spedal Harw'ing InsblXOM arta AddftW Iafc(maton Pro 153651 DDclument# D184434 <br /> 1) 176760 PAY- <br /> 2) 174198 PAY W0 16 66 5 <br /> 15 GENERATORIMFFEROR'S CERTIMATtON: I hereby declare that the anterds of M caaigrunenl are 44 and eoaratety desaibed above by One proper shipping narne,and are dassilied.packaged. <br /> marked and IabetekL'placarded.and are in all respects in proper conffrrak for transport asmrdmg to applkaWe Wernational and nabiai governmental reptdatyorts If export#Vnea and I am the primary <br /> Exporter,I oerBy that to contents of fats consgwterd conform to ft terra of the atashed EFAAdvkowledgncnt of Consent <br /> I certty that the waste minimization statement identified In 40 CFR 28227(a)(i 1 am a large guankty gakerabr)or(b)(if I am a small tor)is true, —9077 <br /> Year <br /> Generatoes(Offeroes PdnWffyped Name ,C) j U fV D - f <br /> 13< 15 Ila I <br /> J ifi.tnttxnational Shipments ❑Import to U.S. ❑Export rrom U.S. Port of entryfexit: <br /> Transporter s dee for experts Data leaving US- <br /> IX 17.TranspowAdkn gnke dor Receipt of htaleriais <br /> Trans t Pnn flame xgkature ea <br /> (U <br /> 0 �L l <br /> CL <br /> 'eA <br /> Transporter prinledlTyped N ( A� � � Tmy yew <br /> , <br /> I It <br /> 18,Discrepancy N <br /> I Ba.Discrepancy tkw5caton Space ❑Q tly ❑Type ❑Residue ❑P.-w Ro cb. ❑Fu0 Resection <br /> Manifest Reference Number. <br /> 18b.Altemate F"(or Generator) U.S.EFA 10 Number <br /> J_ <br /> V <br /> Faceitys Phone: <br /> 1 Bc.Signature of ftmate Facdkty(cc Generator) M" Day Year <br /> y19.Haurdous Report Management Vwttod Codes(i.e.,codes for hazardous*We treatment.disposal.and recyd'aq systems) <br /> 0 1. 2. 3. 4. <br /> 20,Designated Fatuity Owrker or Operator.Certification of receipt of hazardous materiats covered by eke manifest except as notod in Item tBa <br /> ntedrTyped Name Signature Moftth Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous edi()ons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />