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Pease print or ,(Fofirtdesi designed for use on elite(12 p ) ter.) Form Approured.0M8 No.205HO39 j <br /> I.Generator ID Number 2.Page I of 3.Emergency Response Phone M01E)236963 <br /> king N <br /> J <br /> WASTE MAN <br /> FEST CAL 0 0 0 3 6 6 21 1 1 `, (800)424-9300 J J K <br /> 5 GeneFI es NameSTO € ZOOM r. eira s Siff (0411f than ) <br /> 720 E. HAMMER LANE <br /> SIOCKTOff( CA 95210 <br /> Geremaices 209 951-2403 <br /> C Transporter 1 Compran y Nwe U.S.EPA ID Nuarber <br /> BURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7,Transporter 2 Ca y NarneU.S.EPA ID Number <br /> f , 5'`i <br /> 18,Designated Facility Name and Site Address j f U.S.EPA ID Number 3 <br /> YUMA YES LLC c <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 AZR000515924 { <br /> FaaGty's Phone: (928)344-9828 <br /> ga. gb,U.S,DOT Description(including Propar Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12..Unit <br /> and PacY�n Urouo if any)) 1 13.Waste Codes <br /> HM g' { y). No. Type Quantity Wti hl. <br /> 1 NON-RCRA HAZADOUS WASTE,SOLID(NON-CONFORMING FILTERS) 223 <br /> D M Z,Sb P <br /> z Zul <br /> i <br /> w <br /> 3, g <br /> r <br /> 14. edal Handling instructions and Additional Informs on <br /> EMERGENCY CONTACT.,CHEMTREC 1-800.424-9300*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT "EMERGENCY <br /> CONTACT CHO TRE 80042 9300 R TRUCK# PROFILE#161623NRSFIR627 .-- <br /> �. fZ� <br /> 16. GEE TOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described o6ove by the proper shipping name,and are classified,packaged, <br /> marked and laboledlplacarded,and are In all respects In proper condition for transport according to appotowe'tramadionat end national goommardal regula0cris.It export shipment and I am the Primary <br /> Exporter.I curfily That fflecontents of ft consignment tokre forms of the attached EPA AcknowledgmeM or Coriserit, <br /> I that the waste nabs ent rt�fi R 2P{S)(f l am a targe quandti r} (D} (t n a tor)is <br /> or' s <br /> LMonth �Y YAC <br /> it <br /> C? <br /> hientatiot8` nM stopmevet ❑Import to U.S, y} ❑Export from U.S. Port of enlrylexit t <br /> T <br /> (for-xPons y Date leaving U.S,: <br /> w 17.Tmnsp6rIerAan 04adtlmenfdfReceiptorMatarlals <br /> F t Ptf Signature n Day Year <br /> 0 <br /> QTmispotter z N Signature Moth Day Year <br /> ff-�II <br /> tAa.Discrepancy Ind"raboe Space Quantity ❑Typo lJ Residue lection tJ Ful)Refection <br /> Partial Re <br /> Manifest Reference Number: <br /> 184,Alternate Facility tar Generalor) U.S.EPA 10 Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> I r„Signature of Alternate Facitity or, vector, Day <br /> YewCD4 <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyclIng € <br /> 0 1. 2. 3. 4, <br /> 4'03!�t <br /> 20 FaclfltyOwwlr or Operator.Certification of receipt of hazardous materials cnered by the mairclest except,as noted in Item 1 <br /> re <br /> t <br /> EPA Fo. 8304-22(R* )-A6166s es a ESI NA €LITY.-6 SS'TINAT€ N STATE(i=R IRED) <br /> i <br />