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Please print or type, (Form designad for use on elite (12-pitch) typewriter.) Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 , Generator 10 thmper � 2. Page 1 or 3. Emergency Response Phone 144 Mnftst Tracking Number <br /> 1289Clf4 013 5 O � � » <br /> WASTE MANIFEST (800) 424-9300 JJ K <br /> 5. Genwtor's Name�(prlaataiPn dress Generator's Site Address (if different than mailing address) <br /> n57 T� <br /> Generatn6ne: _ �� <br /> 6. Transporter 1 company Name U.S. EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES JOAD028277036 <br /> 7. Transporter2 Company Name U.S. EPA ID Number <br /> JIM f <br /> 8. Designated facility Name and She Address V <br /> U.S. EPA ID Number <br /> YES MANAGEMENT, INC , <br /> 6500 US HIGHWAY 95 <br /> YUMA CA 95365 A Z R 0 0 0521146 <br /> FacuitysPhone: (928)344o9828 <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 (d any)) No. Type Quantity "Mi, <br /> c 1NON- RCRA HAZARDOUS WASTE .SOLID (OILY SOLID , PAPER FILTERS ) DM P td 152 <br /> � 2 <br /> 3. <br /> c <br /> 4. I <br /> 14, Special Handling instructions and Additkxhal Information <br /> EMERGENCY CONTACT : CHEMTREC 1-800424-9300 WOES TERMINAL * PROFILE # 9B1 : OS-PF CERES * ADDITIONAL EPA <br /> CODES : 981 : , NONE * APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT v315� <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, sM are classified, packaged, <br /> 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 <br /> Exporter, I cartify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(x) (if i am a large quantity generator) or am a all quantity generator) Is We. <br /> Generators/ ntedlTyp Name SI natu Month Day Year <br /> keg lrC V/ /O e <br /> 16. Interna al Sh me L1 import to U.S. ❑ Export m U. rt of entry/exit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> 134 17. Transporter Acknowledgment of Receipt of Materials <br /> to Signature Month Day Year� <br /> 0 Transp r Printedff�ed� Nemo� <br /> 0 OFC '' 11 iis'',((�//��,' a '' ' <br /> Transporter 2 P ted/Typed Name Signature Month <br /> son0004w <br /> F- <br /> 18. Discrepancy <br /> 18a. Disclepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 1eb. Aitemate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> V <br /> Facility's Phone: <br /> Month Day Year <br /> w 18c. Signature ofAitemate Facility (or Generator) <br /> a <br /> Z <br /> N 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 3. 4. <br /> v , <br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous meterials covered by the manifest except as noted in Item 18a ay <br /> Dey, Year <br /> Printed/Typed Name ignature <br /> �• 6 l 1rr <br /> EPA Form 8700-22 (Rev. 3:05) Previous adiUons are obsolete. DESIGNIATE31 FACILI. TO DESTINATION STATE (IF RECIOIRED ) <br />