Laserfiche WebLink
Please pr{nt or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM IIA,ZARDOUS 1.Generator ID Number 2.Page 1 of. 3.Emergency Response Phone 4.Manifest Tracking Number +p <br /> WASTC'MANIFEST CAL00 031 3 i 916-209-7`80 100636IJ90 l�DF_ <br /> 5.Gcoeralors Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ATLAEd"TIC AVIATION <br /> 6652 PIN1=CREST DR SUITE#300 <br /> 6364 S. LINDBERGH RSH ST <br /> Generator's PhoW 6-208-.7680 µLANO, I-X 15024 STOCKTON.CA 95206 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ,�.MERICAN VALLEY WASTE OIL, INC. CAR000272302 <br /> 7.Transporter2 Company Name U.S.FPA ID Number <br /> WORLDWIDE RECOVERY SYSTEMS INC CAR0001754Z2 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YUMA'YEW 2 WASTL-:TRANSFER FACII-HY AZI'R000521146 <br /> 5500 US HIGHWAY 95 <br /> YUMA,AZ! 653W <br /> Facility's Phone 2&344-982 <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(!f any)) No. Type Quantity WL/vol. <br /> 1 rSC) , R17�A HA7Al�l7t?4J�.WNSTF-SC]I.IfI A1R-raORBEK 5,CTII ESM 4. Fr 35 <br /> Dill j--- <br /> Z 2. <br /> LU <br /> (.7 <br /> 3. <br /> 4. <br /> i <br /> 14.Special Handling Instructiors and Additional Information <br /> L'F2ONLE4 ABSORBENTS ERGO 171 <br /> EMERGENCY CONTACT: CaEC?E"M' '' II <br /> Le )0 <br /> 15. GENERATOR'S10FFEROR'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 labeledlplacarded,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 FPA Acknowledgment of Consent. <br /> I certify that Vie waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ii a small quantity generator)is true. <br /> GensratorsfO9 rs PrintedlTyped am Signatur a Month Day Year <br /> 1 16.Inteoliol al`shlpmentlsr' <br /> F ❑Import to U.S. ❑Export from U.S. "Art of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> CC 17,Transporter Acknowledgment of Receipt of Materials <br /> Fw^ Transporter IP a - ped Nam Signa Month Day Yegr <br /> itcri <br /> Transporter 2 PrinfedlTy(ed Name ff Month Day YVar <br /> 18.Discrepancy <br /> 18a.Discrepancy.Indication Space ❑ Quantityyp <br /> ElT a Ll Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> p- 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> C7 <br /> w Facility's Phone: + <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> us19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 2. 3, 4. <br /> 1c <br /> 20.Designated Facility Owner or Operator:Cenification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prinledflyped NameSignature Month Day Year <br /> i / f c <br /> EPA Form 8700-22(Rev.12-1 ) Previous editions are obsolete. j DESIGNATED FACILITYTO GENERATOR <br />