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RECEIVED BY SJCEHD (EF) on 4/3/2020 Please orint or tvoe. (Form desioned for use on elite (12-oitch) tvaewriter.) Form Approved. OMB No. 2050.0039 EPA Form 8700-22 (Rev. 3-05) Pr*ous edillons are obsolete. - DESIGOAtEDWACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS1. Generator ID Number CAD 9 8'1 6 6 2 8 4 4 2. Page 1 of 1 3. Emergency Response Phone (800) 424-9300 4. Manifest Tracking Number 017 4 6 8 6 2 3 JJ K WASTE MANIFEST . 5. Gerteratord8 r%@ V6MTg Address Generator's Site Address (if different than mailing address) 201 E ORCHARD STREET HAMMONTON Ni 08037 4987 WEST LANE 209 952-1222 STOCKTON CA 952:10 Generator's Phone: 6. Transporter 1 Company Name WORLD OIL ENVIRONMENTAL SERVICES U.S. EPA ID Number CAD 0 2 8 2 7 7 0 3 6 7. Transporter 2 Company Name WORLDWIDE RECOVERY SYSTEM INC. U.S. EPA ID Number CAR 0 0 01 7 5 4 2 2 8.1) esiggn�ated Facility Name and Site Address YUMA YES LLC U,S. EPA ID Number 2730 E 13TH ST YUMA AZ 85365 AZR000515924 Facility's Phone: (928)344-9828 go. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. 'JON-RCRA HAZARDOUS, WASTE, SOLID (PAPER FILTERS) X52 00 l DM / P z 2. W 3. 4. 14. Special Handling Instructions and Additional Information EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 WOES TERMINAL: * PROFILE # 961: 161623NRS•PEP359 PAPER FILTERS* *APPROPRIATE PPE EQUIPMENT 15. GENERATOR'SlOFFEROR'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, 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 Exporter, 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) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Gene 7ror's Pnntedfryped Nae Signature �� I it Month /0 11 Day Year ;7 Ile J ir- 16. International Shipm nts ❑ Import to U.S. Export from U.S. Port of entrylexit: z Transporter signature (for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials Trans orter 1 Prinled/Typed Name Signatur --- - -- - Month DayYear a r rr t��` � 2Tab Q nspo Pi to yped a tur Month Day - Year � 1 18. Discrepancy 18a. Discrepancy Indication Space 0 Quantity 0 Typej ❑Residue Partial Rejection 0 Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U W Facility's Phone: w 16c. Signature of Altemate Facility (or Generator) Month Day Year Q 2 55 19. Hazardous Waste Report Management Method.Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4: 20. Designated Facility Owner or Operator: CerUfication of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed a Name Sign ur Month Day Year EPA Form 8700-22 (Rev. 3-05) Pr*ous edillons are obsolete. - DESIGOAtEDWACILITY TO DESTINATION STATE (IF REQUIRED)