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,., a to t,<-pn lq rypulyin PA Form 8700-22 (Rev. 3-05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATE ) roan Approveo. UMn rvu. zuovouda UNIFORM HAZARDOUS 1. Generator ID Number 2.Pagolol 3.EmergencyResponse Phone 4. Manifestiracking Number IImWASTE MANIFEST �''' D'a $ 7. 6 v ^- 3 =, =1 (300) 424-9300 017 4 6 8 6 2 3 JJ K ' 5.Ge emloes NagLq and Maili gAddress ,1 j% Generatofs Site Address (If different than mailing address) 101 E ORCHARD S`;"REEI HATMMONTON NT 08037 4987 WEST L;1PlL 209 952-1222 S I OCC ON CIA 9 52:1 Generatoes Phone: B. Transporter 1 Company Name U.S. EPAIO Number WORLD Olt. ENVIRONMENTAL SERVICES CAD 0','_ 3 2 7 7 0 3 6 7. Transporter 2 Com an Name - - U.S. EPAID Number WORLDW ID RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 8. Designated FacilityName and Site Address U.S. EPA ID Number YUMA'YES LLC 2730 E 13TH ST - YUMAAZ 65365 AZR000615924 Facilirys Phone: (923)344-9323 9a. 91b. U.S. DOT Description (Including Proper Shipping N8mo, Hazard Class, 10 Number, 10. Containers 11. Total 12. Unit HM . and Packing Group (If any)) Quantity WLNOI. 13. Waste Codes No. Type NON-RCRA HAZARDOLR WASTE, SOLID (PAPER FILTERS) )52 Q P C) . tA:SpedalHandlinglostiudons'andAddillonalInformation "' - ": - "" -- "' ""'" - "' - - " - EMERGENCY CONTACT :CHEMTREC 1-800-4249300 WOESTERMIN4: .*'PROFILE IV9B1:161623NRS-PEP369 IF PAPER . ' FILTERS* *APPROPRIATE PPE EQUIPMENT /XI. is, GONERgT6g'$IQFFEROR'SCEJtTIFICATIQN. lherebydgclare lhaf(he cgnlenLs o(N(s wnsignm ntere(Ilyantl pi�rptely des5nbed above hylge proper shipping n@me xM die sslped pRckaged,_ " madCed and laLeletllplacaNed, aOd ere In all aspecis to ptgperoondi9an far tri nspdd aaofding to appllca¢le mtemahapal apdAaggnel govemmenla[mguJahoes If eYpoRshfpment aed Ion) Lau PdnlSry. - Exporter l cerlily"UaPthe contents of this , consignment cadpgnto the ferns of the attached EPAAdmpwledgmenl ofCon`.spn4 - �- l.ccrbfgthatthe Wasle minlmizatio0 sJalemen[ Idenfified In 90 CFR 262.27(a)(f Pam a lade quantilygeneralpO or (b) (1f1 am a splall quanUtygenerafor) is Wo. " Gene.'.. s/0 meiprin edilyped Na'oiM6p91 Day -. Ye@P' -a 10, international Shlpmots.... 1'—T _ __:' .._ .. .._._.:�. :. Q Import lo-U.S. " ❑ Export .. .... r_ _. -- h from U.S. Ppfl.arianlJ)iaA -- Z. Transporter stgnpNrq (far exports only): Dale leaving U,S - - (v' w 17. Tmnspw[erAcknowledgm nl oaf-R-ez-` Po Materials - P. ' ".- az¢- Trl Pnn(adITYPed Name 1 Signature..ndlure.. .1e .. tn !DDa?ay •Transpo. .. . - ._ ... .. .". P.d to yped .. . ... .: , ..'MMOppnnlIhA ..."_-i;Y. r.I . yeei. 18. bis evepancy - ' -- 18a. Users ancy Indication Space - � _ ❑ Quantify ❑Type ❑Residua 'Q - - - - Partial Rejection - . ,tion �Fgll Refection Manifest Refem rce Number. •' - _ -"-- - ty( � ) -- 186. Alternate Facility wGeneralor - -- "' - -U.$, EPAIPNumtfei - J v w Facilitys Phone: w 186. Signature of Alternate Facility(or Generator) -"- "" - - - - ' " 'i .'- - Mongi Day ,Year zIV N19. Hagardous Waste Report Management Method Codes (i.e., codes for hazardous Jlaste treatment disposal, and recycling systems) - 20. Designated Facility0,mer or Operator: Certification ofmceiplof hazardous materials covered by the mglf (except es nded in Item l8a Pnnledrfyped Name - SlgiituW .- - Month Day Year (IF REQUIRED)