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X,`l i1t­'6q a <br /> Please print or type.(Form designed for use on elite(12-pitch)typewntE_. w _ ? Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Genera r ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C-+ � 1 (800)424-9300 018531259 JJ K <br /> 5.Generator's game and M flip Address Generator's Site Address if different than mailin adr� ` 7�n6 <br /> Gene ato s Phone: `a <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> WO LD OIL ENVIRONMENTAL SERVICES ICAD028277036 <br /> lesTgnate-d <br /> jspo(erg p Nam U.S lD u <br /> Facility Name and Site Address U.S.E A D umber <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA CA 85365 <br /> Facility's Phone: (928)344-9828 IAZR00052114t <br /> 9a, 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(if any)) No. Type Quangly WtNa1, <br /> 0 1NON RCRA HAZARDOUS WASTE,SOLID(OILY SOLID,PAPER FILTERS) D M Q P 52 <br /> z 2. <br /> w <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additlonal Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4249300 WOES TERMINAL *PROFILE#961:OS-PF CERES *ADDITION , <br /> CODES:9B1:, NONE *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT ol I x CC <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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulatlons.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 EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement idenfified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gener t eslOfferoes Printedfryped ame Signal r _ Month Day Year <br /> X X I <br /> .j 16.International Shipmen <br /> Z <br /> 1 1:1 Import to U.S. El Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> UJI <br /> 17.TransporterAcknowledgment of Receipt of Materials <br /> Transporter 1 PrintedfTyped Name \ / Signature - Month Day Year <br /> a O <br /> Z Tr r 2 Printedrryped Name Sig lure Month Day Yedr <br /> a z - -_� C d <br /> 18.Discrepancy <br /> 18a.Discrepf7r ndication Space ❑ QuantiType Residue <br /> ❑ <br /> ty yp ❑ Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 16b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ra+ Facility's Phone: <br /> U 18c.Signature of Allemate Faciety(or Generator) Month Day Year <br /> a <br /> Z <br /> F, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility.0kyner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noteA note ' Item 18a <br /> PdnledlTyped Name Signature Month Day. Year <br /> EPA Form 8700-22(R&.3-05) Prev o s editions are obsolete. DESIGN TED F O DESTINATION STATE(IF REQUIRED) <br />