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Please print or type.(Form designed lar use on elite(12-pitch)typewrlter. Form Approved,01118 No.2050-0035 <br /> UNIFORM HAZARDOUS '..Generator 0 Number 2 Page 1 of 3,Emergency Response Phone 4,Mael est Tracking Number <br /> WASTE MANIFEST (;A L 0 0(3 3,8 rt-e.931 0 f 4 6 O 4 2 JJ K <br /> 5.Generator's Name and Mailing Address Genemwr's Slle AWfess(1f dlfforem than mailing address) <br /> INVI-NA"L'I'RUCK 4UA'3ti AND a;l:i-AIR)All GaOdta <br /> 2142 W.YO, kEjMf rk AVL j'h' ?Czt iJ(IL` IfSG <br /> MANTFCA OA <br /> Ganerator's Phone: 20 <br /> 6.Tronspoder l Company Name U.S.EPA.D Number <br /> WORLIU O€L Cf 11x1};(} 641 A0*Aj- it R%Aot�; <br /> i; <br /> 7,Transporter 2 Company Nano U.S.EPA ID Number <br /> UdORl OVVIOF R COVERY SYST EAIVI INC. L A f;0 U i)-17 fi rl <br /> 8.Designated FaOity Name and Site Addfass U.S,EPA ID Number <br /> YLINIA Y'E:a LLC <br /> 2730 E 13TIa ST <br /> YUMA A4 6536ir <br /> FaciltysPhone; 028)344-0828 <br /> go, 9b.U.S.DTT Description(Including Proper%pping Name,Hazahl'.Glass.IO Nomber, 1p.Confalners ]S,Total 12.Unit <br /> t3.Waste Codes <br /> KM and Peeking Group(If any)) No. Type Qi*lity wl.�ai. <br /> 1"it'1N-RCr;.A I-A7Al•DOUS WASTE,80LID f OILY PAPLP,-!'1(.]'Fp <br /> U IV] <br /> LU <br /> 2. <br /> 3. <br /> a. <br /> 14.Speciat Hann ing€ngUuctions an A loon-Infoft*n <br /> rNiERt ENC'Y C3044TACT : OHII 'NITRC.Q 1-800-42?l 9000 -1i2023hRs(lvi€'U' OILY a;Q(.Jb. <br /> PAPER FILTERS ''' r`'A1rF'F,C POIATI E RP'F.e,QIUIIsMEN'i <br /> '15, GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby declare that The wntenis of.thts cartslgnment are hrdyenti accurately descdbed:obove by rhe proper shipping name,aro are dassfAed,packaged, <br /> marked and Isheledfplacarded,and aro In all respects fn proper condition for Irarrspnrf aerordirsg to opp%alx'e InfetnatIonol and naWna4 governmental rggulahiorss.It o iport shipment and I aro 1he'Primary <br /> Exporter,I certify that the contents of iNs'consignmant conform ra 114,19rms at a attached EPAA0no,?wdgmenfpf C4lIgltn1. <br /> I certify that the waste mink SzWon statement€dem[Aed in.4+1 OfR211227(a,(r I nm u#ergs"ghanflty generator}OF(bj(;f I am•a smart quanlily gesaaia4ary H Gua, <br /> r <br /> Ganerator'sfOherer's PrinladlfYPed Name Month Day Yser <br /> w <br /> � i6.InlamaUonatShipmani� •• r—� <br /> ❑lrnport Ip U.S. O Exoortfrom U.S. PCri of entry/w <br /> is <br /> — 1'ransportarslgnalura.((oraxpartsanly), t3oialEgvJr1'g'(1.5:; I. <br /> W 17.TransporterAckno+Wedgmonlo#iZecelplofMdlarlals <br /> Tmilsportar 1 Printedriyped Name fi Spnutur y_ hloath Day Year <br /> Q. .yam �'� 1 '' ! / } , �✓�, � ~ - ,..rte f <br /> z Transporter 2 FnhfedfypuuNams $irUnalure:y Month Day eaj <br /> d <br /> 6 1� <br /> 18.tilstreparlcy - <br /> 18a;OlsGaparlGy Ind€,siren Space ❑ Quantify ❑Type ❑Residue ❑Partial R ,flan <br /> eje ❑Full Relecliort <br /> I <br /> #anifest Reference Numbers <br /> 18b.Aitemete Facillly(or Generaloo U.S.EPA ID Number <br /> L) <br /> !•a�#y's Phare: � <br /> 18c:5lgnafure ol'Alfernats Fadily(or Genera(or} Monlh Day Year I <br /> 13;Hazardous Waste Rapor(hlanagaman(Method Codes(€.e•,codes lvr hazerdcuaLU weit+zireapnenl 4lsposal.'arA retycrig systirrtlS}: <br /> p l <br /> 20,Designated FacdllyOrrnar nr Cprrralur;Certif+"cation afraceipl of nazafcteug melerf�Iis co;eretl ay tr3a ntanifest'exceptas'napd!„frern 188 <br /> not d Name S;gnaF 8month Day ear <br /> =PA 1 orm 8760.22(Rev.3 65} rev;ous editions arr9 pbsr11a1@, k? IC It 1,���" „�dC�1G11 Y TO pESTINATION STATE(IF REQUIRED) <br />