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i Form Approved , OMB No. 2050.0039 Please print or type. (Form designed for use on elite (12•pitch) typewriter.) 2 Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 1 . Generator ID Number 0168686 3 6 JJ K O O NN AA UNIFORM H7CAR000073585 US r 800 424-9300WASTE MCAR00007358 �5. Generator's Mailing Address 2895YNAGLEEROAD LEE RD TRACCA 9536 Generators P209 834-1111 U .S. EPA ID6. Transporteny Name CAD028277036 WORENVIRONMENTAL SERVICES U .S. EPAID Number 7 . Transporteny Name CAR000175422 WORE RECOVERY SYSTEM INC . U .S. EPAID Number 8 , Designated Facility Name and Site Address YES MANAGEMENT , INC . 6500 US HIGHWAY 95 YUMA AZ 85365 A Z R 0 0 0 5 2114 5 Facility's Phone: 10, Containers 11 . Total 12, Unit 13, Waste Codes 98 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, No Type quantity Wt.Nol. HM and Packing Group (if any)) IVON-RCRA HAZARDOUS WASTE , SOLID ( OILY SOLID , PAPER FILTERS) '7 �� —_• o DM P III I Will I NEW WIN Lu O 3. — _ _- 4 . 14 . Special Handling Instructions and Additional Information T : CHEMTREC 1-800-424-9300 WOES TERMINAL: CERES CS * PROFILE # JB1 : 162623NRSTRA078N EMERGENCY CONTACT : � �� 002, S OILY SOLID , PAPER FILTERS * * APPROPRIATE PPE EQUIPMENT described above by the proper ing name, am are 15, marked and abeled F accaarded and are nAallOrespacts in properare that the cond tion for transport according nggto appliicablenment are uimmom� l international andy and ynal national governmental egulalions.ilfexport shipment and i am8the Primary d marke p 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 Ilimpoommiam n statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ii I am a small quantify generator) is true. 11 WOMEN lll�ilill111111 Month Day Year nn ue e ator'stufferors Printed/Typed Name L J 16, International Shipments Export from U .S. Port of enlrylexil: ❑ Import to U .S. Date leaving U.S.: Transporter signature (for exports only): I W 17 , Transporter Acknowledgment of Receipt of Materials Month Day Year Signature Transport t1 rintedlType Nam _ 1 © s � �7 O / Month Day Year am Z pe Na a Sinaature _// — 18. Discrepancy Full Rejection 183. Discrepancy Indication Space 0 quantity ElType ❑ Residue El Partial Rejection ❑ Manifest Reference Number: 57 EPA ID Number 18b. Alternate Facility (or Generator) J U LL Facility's Phone: Month Day Year W 18c. Signature of Alternate Faclfity (or Generator) QImam ZI Million (AD19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste te3tment, disp3salIIII MINE=, and recycling systems) liiiiiii MEMONINE 4 O 2. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest natueecept as noted in Ilam 18a Month a Ye PI t y N e EPA Form 87 0 22 (Rev. •05) Previous editions are obsolete, DESIGNATED FANGILI'I 1f TO DE 1 INATION STATE: (IF REQUIRED)