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\ Form Appro"d.OMS No.2050-W39 <br /> Please pnnimtype. <br /> 1.Gerarela lD NYmNIFEST w 2.PWI of 3.Emageryy RB%P0ma PXdpa d.3W TruMrl9 Xumba <br /> UNWAM HAZARDOUS cAL0004cslr< 1 (8001124"9300 0203 1967 JJK <br /> 5.Darin Nemo am MaaNAmmM GaWmNPa SM/ddlaa(HdiBeanl Nal meihN BddfMB) <br /> TIKI LAGUN MARINA RESORT�MCDONALD RD <br /> 12988 W.MCDONALO ROAD ,CA 95206 <br /> STOCKTON <br /> Genamfe Pla.: 209 48429ff''v <br /> fi.TmngaNr 1 CorryaryNm U.S.EMID <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 0 2 2 8 8 2 7 1 0 3 6 <br /> TNAWa 2CompaF/Nam Cu.s. AR00 0 AlR <br /> WORLDWIDE RECOVERY SYSTEM INC. C001 1 5 4 2 2 <br /> 0 <br /> B.Dad9reaN iatlRy Nanad9YAddras U.S.FJMID NumXW <br /> YES MANAGEMENT.INC. t' <br /> 6500 U5 HIGHWAY 95YUMA AZ 85365 00 21146 <br /> 6500 <br /> FalaHmne: 9283449828 <br /> 96.0.5.DOTDeaO�6on(6mIWYg PraWr Sbppgq Neme,H®tl[lan,10 NMMa, la NoteNaa 11.T9b1 11 WR 13,Abde Codes <br /> HM W'4 PakYMQWro01am)) No. TM Qaary YAM. <br /> o iNON-RCRA HAZARDOUS WASTE.SOLIDS(OILY ABSORBENTS) f D Ni 100 P 52 <br /> a 2. <br /> bWD <br /> 3. <br /> d. <br /> i <br /> td.Epedal Xaa a am Aeamora mlamauan <br /> EMERGENCY CONTACT:CHEMTREC 1,600424-9300 WOES TERMINAL:CERES Ca NA.ERG#9E1.171 `PPL F! <br /> 162623NRS-TIK003 OILY ABSORBENTS " :00PR'iLFPPE EQUIPMENT JL�OI^ IY 3 <br /> 15. GENERATOR'SIOFFEROR'SDERTIFICATOX: IMaby dedere Nat cmbnh dtldaamd9nien1 WalWN and-ecamarydaaWlam abate by tlW paper Wppkgwn,atl ea tleesXetl.papkegm, <br /> .a Al WmleMbdlgamdegem am mdl ma'am In FA,er.6.w Ma ao,AdAg MapplbNe imemauonaemmnaalyoaannanrs apdauon.Xa.od wprrmtam l anma N.q d <br /> ExpWXr, .mYnut Ne mmm dNN cm,, ntmniwm W.eine dmeaMmed EFAAaMem"d It dC t, <br /> I.my Nd N.winmNbNmRa m&Ar*Md Md 6 493MM27(a)NI am a Ia9ewedW gamer.)or(b)(KI anesme9wantlrygarieamr)b M. <br /> GenaV�011emla PdnadRyped Nan neNn Maty Dry Ynr <br /> 1661-41 1 1e <br /> F 16.Inamatlonal$6lpmenb ❑Impwto U.S. ❑FapMham U.S. PMdamylaMt <br /> ? Tra pMer a l9naWm(IoraNrdN OXM: Deb WAN U.S.: <br /> re 17.TrenapakrMAwMed➢niaAd Pemipld AYbMb <br /> rT.,,Amr1 Pdnm Y*Nama `` 6lgnare T IAA* NY Yea <br /> a wLI E�^d^fl uLIwl <br /> z ran 2Fm mad Nan Q9nalure uadn Day veer <br /> 62 L0 IV <br /> ♦I te.gauepncy <br /> 118a.WarepalW lMwtlon Span ❑ III ❑Type Ll Fd. ❑PWaal R*i*n El Ful Reledlan <br /> Mnd.t Ras..Numnr <br /> ta6.AmmMe FaWliry(a Ge.abr) U.S.EMID NIFMa <br /> U <br /> LL FMpYe PM Mento NY Year <br /> w lac SI9reMadPNemde Fadlry(W(arerab) <br /> 6 <br /> S <br /> V' 19.Nnar&ua Wain ReprlMna]emeM McVud Ced¢a(I.e.,[Wa9bluaarGau'aeeb heehl.dyanl,em nrydrq ayabma) <br /> 1 2. 3. d. <br /> o ' Ll z <br /> 20.DasgneW FWily Winer W Operelar CeNAcallan dremipid F+nNam mabrielsmnied by Na manihsl evmgn Med F <br /> 1 Rin Xama SI9naMre Monty Day Year <br /> 3 aS <br /> EPA Form 872(Xev. 471 Prevlous editions are ob late. SIGNATED FACILITY TOEPA'SaMANIFEST SYSTEM <br />