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i <br /> type,(F ed for use on elite 12-pitch)typewriter.) Form Ob OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1' rID Number 2 P t of 3:E evRes Phone 4,M tTrack g Num er <br /> WASTE MANIFEST CAL 0 0 0 '6 6 21 1 ($UO) 124- <br /> WASTE 017792260 JJ K r <br /> "r 1 <br /> E.clanerdtoes Name end•O ng AddressGreeratm's'3Ne Address I f dghmml VIM maM address) <br /> FIRESTONE 4028746 <br /> 720 E. HAMMER LANE � <br /> i STOCKTON CA 952 <br /> Gimerawlt 209 951-2403 <br /> E.Transporter 1 Goopq Name � `� U.S.EPA 10 Numter <br /> ,S6URY ENVIRONMENTAL SERVICES � w# C A D 0 2 8 2 7 7 0 3 6 } <br /> T Transporter 2 Cwqwq Name U.S.EPA10 Ger <br /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 <br /> 4-Di6pited AjOily Nameand'S4o Address U.S.EPA IO Number <br /> YUMA YES LLC <br /> 2730 E 13TH ST <br /> YUMA 65365 AC.Fi000515924 <br /> s Phom: iQ. 2 <br /> I <br /> # ga. S4 U,S;DOT Description(Including Proper Shipping Name,Hazard Class.ID Number, 10,Containers 11.total 12.Unit 13.Waste Codes <br /> HM and Packing Group(i(any)) NO. Type Quantity WINQI, <br /> 1'NON-RCRA HAZADOUS WASTE,SOLID(NON-CONFORNIING FILTERS) 728 <br /> d D Prt SO P <br /> a <br /> 3 W F <br /> # Z 2. f <br /> W <br /> I <br /> t <br /> t <br /> IE I <br /> i I � <br /> I <br /> r i <br /> 14: Ha OM instNcddrtsandAddi l information <br /> EMERGENCY CONTACT;CHEMTREC 1-SOC-4214-9300 WOES TERINIINAL:CEDES CS w A`✓PF'OPPIATE PERSvt`iAL PRC)'fECTIVE <br /> EQUIPMENT r EMERGENCY COCTC r 800 424 9300 :' TRUCK� P F L # l''153 SFIR-2 r <br /> 15_ GEN TOR' 8 Cte N: to of this t Lusty above by thedmowot packaged. <br /> marked and ad am inti m a for ° to � ga'_ kit dons.0 .. `I am the Primary <br /> I 'fy t me isdf.` to the of eta of t.. <br /> I <br /> Exporter <br /> I M ttu',westo W*ftotion OWMigntWoOod in 40 CFR (e)(4tam 3 * )OfW(41 sm a 50101144amily genwalor)i$trits. <br /> MOM Day Ps P pedY <br /> om <br /> .s is.mmaborial end <br /> [Import to U.S. ®Export from U.S. Part of entrylexik <br /> Tm refit aity): Date U.S: <br /> 17.Transporter Acknowledgment of Receipt of Matedalsi <br /> T 1 - Month Day Year <br /> oleff, 11201a <br /> A- 6 <br /> U2 <br /> maron Day Year . <br /> ) <br /> .Discreytaar <br /> 18a.Discrepancy indication Space 0 Quentit{ [:]Type 0 Residue ❑Asthal Ra ection 0 Full Rejection <br /> Manifest EIINMO Nutriber <br /> IEtr Afthcde Facitity(or Gem rator) U.S.EPA SD Number <br /> U <br /> t4i F Phone: <br /> I w t8c.Signature of Altemata Faciaty(or Generator? Yew <br /> Q <br /> Z <br /> 19.Hazardous Wade Report Managament Method Codes(i.e.,codes for hazardous waste treatment,disposal,and acirdng ) <br /> 0 1 2 S. 14, <br /> b <br /> 20,Deiagmatetl Facft Owner or Operator.Carti6cagon of racetpt of hazardous materials covered by the manifest a in item 18a <br /> tefflTyPed Nam <br /> S M�rtttt Oay <br /> EPA Form 8700.22(Rev.3.05) Previous adWmm are te. FACILITY TO DESTINATION STATE (IF REQUIRED) ; <br />