Laserfiche WebLink
Form Approved,OMB No.2050-0039 <br /> Please print or type, <br /> 1.Generator 1D Number 2.Page 1 of 3.Emergency Response Phone T.Manifest Tracking Num r <br /> fWASTE <br /> RM HAZARDOUS 1 209-239-1381 GBF <br /> MANIFEST CAL0000355004 <br /> enerators Name and Mailing AddressTUFF BOY, INC. <br /> 515'1_E ALMONDWOOD DRIVE <br /> MAN{ECA,CA 9533%nerale s PhonaD 1 61 U.S.EPA ID Number <br /> 6.Transporter 1 Company Name CAR000272302 <br /> AMERICAN VALLEY WASTE OIL, INC. <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Comuany Name CAR000175422 <br /> WORLDWIDE RECOVERY SYSTEMS INC <br /> U.S.EPA ID Number <br /> B.Designated Facility Namo and Site Address <br /> YUMA YES 2 WASTE TRANSFER FACILITY AZR000521148 <br /> 6500 US HIGHWAY 95 <br /> YUMA,AZ 85385 <br /> Facility s Phone02a-344-9828 <br /> 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> ga. 9b.U.S.OOT Description(including Proper Slipping Name,Hazard Class,ID Number. Quantity WWol. <br /> HM and Packlag Group(it any)) No. Type <br /> 352 <br /> 1 NON-RCRA HAZARDOUS WASTE SOLID,ABSORBENTS 8 OIL 1 DM 215 P <br /> 0 <br /> z 2. <br /> LU <br /> O <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> PROFILE#179715NRS ABSORBENT,OIL ERG*171 <br /> EMERGENCY CONTACT:JOSH , 1� y 1 •-�-7 <br /> 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,and are classified,packaged, <br /> marked and labeled/placarded,and are In all respects in proper condition for transport according to applicable international and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,l certify that the contents of this consignment conform to the terms of the attached EPAAckna,Nedgment of Consent <br /> I certify that rho waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)lift am a small quantity gene or)Is true. � Day Year <br /> Gerlerd Pnnte j typed Name _ 177 J2Z- <br /> mational Shipments ❑Import to U.S. ❑Export from U.S. Port entrylexiC <br /> F Dale leaving U.S.: <br /> ? Transporter signature(for exports only): <br /> W <br /> 17.Transporter Acknowledgment of Receipt ofMalerials M th Day Year <br /> Transpo do drr ped Nam Signature <br /> O <br /> a gnature onlh Day ear <br /> Z ns tedfTyped NaKe <br /> r � i <br /> 18.Discrepancy <br /> 18a.Discre'paricy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> 18b.Allemale Facility(or Generator) <br /> J <br /> v <br /> ra Facility's Phone: Month Day Year <br /> LO 16c.Signature ofAltemate Facility(or Generator) <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> LLJC3 1' 2• 3, <br /> 20.Designated facility Owner of operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Monl Day Year <br /> Print edfl yped Name Signature <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. ESIGNATED L.ITY TO EPA's e�MAN EST�� a i FIT <br />