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i <br /> Please print or type. (Form designed for use on elite ( 12•pitch) typewriter.) Form Approved , OMB No. 2050.0039 <br /> UNIFQR*AA1 dR000S 1 . Generator ID Number 2, Page 1 of 3, Emergency Response Phoneanifest Tracking Number <br /> WASTE MANIFEST CAR 0 0 0 0 7 3 5 8 5 1 ( 800 ) 424- 9300 7017791401 <br /> JJ K <br /> 5 General�rA Y m� a�d t��ilin9V �� I NAG LE E RD Generators Site Address (if different than mailing address) <br /> 2s95 NORTH NAGLEE ROAD <br /> TPACY CA 95316 <br /> 2 <br /> Generators Phone: 09 8344111 <br /> 6. Transporter t Com any Name U.S. EPA ID Number <br /> ASBURY TWARONNIENTAL SERVICES G A U V 2 8 2 r i t1 c o <br /> 7 Trans rter 2 Com an Name U.S. EPA ID Number <br /> rORLD�/ IIyE RECOVERY SYSTEM ING . CA R 0 0 0 1 7 .5 4 2 ;1 <br /> Designated Facility Name and Site Address U.S. EPA ID Number <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 A i R 0 0 0 '- <br /> Facilil esPhone; ( 928 ) 344- 9828 <br /> ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 , Total 12, Unit 13, Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity Wt./Vol. <br /> 1 NON- RCRA HAZARDOUS WASTE . SOLID ( OILY SOLID PAPER Fii- TEP5� + k r, � <br /> D N1 3 � � P <br /> t¢ <br /> Lu 2. <br /> w <br /> C7 <br /> 3. <br /> 4. <br /> 14 , Special Handling instructions and Additional Information <br /> EMERGENCY CONTACT CHEMTREC 1. 800 424 930 OES TERMINAL CERES CS ^ PROFILE # 9B1 1626t13NRSI RAU 18 <br /> OILY SOLID , PAPER FILTERS ^ ` APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT # ?07 9 � x s. S <br /> 15. GENERATOR'$IOFFEROR'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 labeledr'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, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if l am a small quantitygenerator) is true, <br /> ener�I rsJOfferVs Pdntedfr Name Signature Month Day Year <br /> G <br /> X X <br /> i6. International Shipments El Import to U.S. <br /> Exportfrom U .S. Port of entry/exit: _ <br /> z Transporter signature (for exports only): DaIq leaving U.S.: <br /> W 17. Transporter Acknowledgment of Receipt of Materials <br /> Trans r 1 Printed ped erne Signature Month Day Year <br /> a it k JA _XM <br /> 0'� O ( U <br /> Q Tran Qnt r e e � natu � Ye <br /> P5 A <br /> Ps ! 4 <br /> 18. Discrepancy <br /> 188, Discrepancy Indication Space El Quantity ❑ Type ❑ Res due ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U. S. EPA ID Number <br /> U <br /> ISM FacilitysPhone; <br /> �Q 18c. Signature otAlternate Facility (or Generator) Month Day T - <br /> 19. <br /> . . <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes lie., codes for hazardous waste treatment, disposal, and recycling systems) <br /> LU 1yy(( ( 3. 4 , <br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest exc t as noted in Item 18a <br /> Pr niedfTyped Name Signature Month Day Year <br /> �ctN co �c-�tpr�- ► zwF 5 9 l8 <br /> EPA Form 8700-22 (Rev, 3.05) Previous editions are obsolete. DESii;loir; ir✓ U l JtuILITYTO DESTINATION STATE ( IF REQUIRED ) <br /> I r <br />