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Pleaso print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Generalor 10 Number 2.Page 1 of 3.Emoigcncy Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST - CAL000035904 1 209.239-1361 1006046380 GBF <br /> 5.Cenomtofs 14=0 and MaAngAddrass Gonaraor's 51ta Address(if 00rent than maPng address) <br /> TUFF BOY,INC. <br /> 5151 EALMONDWOOD DRIVE <br /> MANTECA,CA 95337 <br /> Oercra!ars PhanE�r.09-238-1361 - <br /> G.Transporter i Company Nara V.S.EPA ID Number <br /> AMERICAN VALLEY WASTE OIL,INC. CAR000272302 <br /> 7.Tra.nspoder2 Company Nsmo U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEMS INC CAR000175422 <br /> 8,Designated Faaliy Name and Sqo Address U.S.EPA ID NurrJsar <br /> PUMA YES LLC <br /> 2730 E.13TH ST AZROOD175422 <br /> YUMA,AZ 05365 <br /> Fac5ly's Phona.9M&642-8938 <br /> ga 9b.U.S.DOT Description Qrcludog Proper Sh aping Name,Hazard Class,ID Number, 10.Conta!ners 11.Tc!al 12.Unit Q.Waste Coles <br /> HN end Padang Grcup of any)) No. Type Ouantley Wl Ivol. <br /> 0 1. NON-RCRA HAZARDOUS WASTE SOLID,ABSORBENTS&OIL .I DISI 140 P 352 <br /> a4 <br /> z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.5pedal Handerg lnsm:cuons and Addnionzl nlormaFcn <br /> PROFILE#179715NRS ABSORBENTS&OIL ERG#171 <br /> EMERGENCY CONTACT:JOSH <br /> S Z2 <br /> 15. GENERATOR'SiOFFEROR'S CERTIFICATION:Inereby declare that the contents of this consignment are fully and ac •raley descnbod above by the proper shipping name,and aro dawned.packaged, <br /> marked and lebeledlprtarded,and are in 0 respects in proper condition for transport according to applicable internallonal and national govammertal regulations.It oxpod sh:prrenl and am the Pdroy <br /> Exporter,I ciedi(y!.W Ina contents of this oonslgnmenl conform to the terms of mo alt-hed EPAAcknaav!adgment of Consent. <br /> I cerEy that the w sla mW.,nizaWn statement Warlike!in 40 CFR 26227(a)(if I am a large quanuy generator)or(b)(dI am a small quznutygenerstor)Is true. <br /> Goneratoe&jOreroes PrntccUTyped Name S!gw:ur Month Day Year <br /> r^e-/ ✓ ` 1 110 1 z3 I!� <br /> J 16.IrlemallonU Shipments <br /> ❑Import 1.U.S. ❑Export from U.S. Port of enty,ex <br /> K Transporter signature(for exports orJy): - Da!eleaving U.S: <br /> w 17:TransponerAcknox!edgmenl of Rece!pl of fla!erials ' <br /> Tmnsponur 1 PAnte ped Name Signature Alonm Day fear <br /> Ed <br /> o a 1 <br /> 2IA bcr b ,:-� /b z3 11-5 <br /> -- Transport&:2 PantedlTyped Namo 5.gnalum A!cjn!h Day Ycar <br /> } 18.0.'=opercy <br /> 18a.Discrepancy Indcal:on Space <br /> Quantity 1:1 Type ❑Ras!dua ❑Parlia!Re;er.'on ❑FulRaje..1,a1 <br /> Manifest Reference N.mW <br /> 16b.Allemalo Facility(or Genoralor) U.S.EPA 10 Nunbef <br /> J <br /> U <br /> Fadtys Phone: <br /> � <br /> 1ac.SrgnaWre ofAJlemate Factli (or Generatoru y( ) N.cn:h Day Year <br /> z <br /> h19.Hazardous Wasto Report Managemenl Maenad Codes(.o.,cows for hazardous waste Ireabnenl,disposal,and fnding systems) <br /> 4. <br /> 20,Designated Fac9lry G•mer or Operator.CeNarcation of recalp;of hazardous materias covered by Lho marJfost o pl as ncrod fn Ilam 18a <br /> Pdntetl .d Name Slgnat re Month ay Y <br /> G G 2� <br /> EPA Form B700-22(Rev.12-17)Prov'cuse0lons are obsolete. y DE'IGNI 'DFACILITYTOEPA's e-MANIFEST SYSTEM <br />