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Please print or type.(Form designed for use on elite(12-0tch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number - 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 3 5 0 0 3 1 1 016711323 JJ K <br /> 5. en ra or's Name and Mailing Address Generator's Site Address(d different than mailing address) <br /> 7 LWY WC, <br /> TRACY CA mn4 <br /> -' Generator's Phone: <br /> 209. 229 - 7440 d <br /> 6Rb�{C�'901RO'N ENTAL SERVICES INC C EPAAIR0Number 0 9 7 1 0 1 7 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEM WC C A R 0 0 0 9 7 5 4 2 2 <br /> 8.f Y 61L'1 ed tag troland Site Address U.S.EPA ID Number <br /> 2730 E 137H ST <br /> YUMA AZ 85225-101 <br /> Facility's Phone: 9M A Z R O',0 0 5 1 5 0 2 4 <br /> ga, 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)) <br /> No. TWO Quantity WlNol. <br /> 1 NMRCRA HAZARDOUS VMSTE,SOLID(OILY DEBRIS, 223 <br /> 0 ABSORBENT) <br /> �j W • <br /> w 2' <br /> 14.Special Handling Instructions and Additional Information9�'VE5-151423-My I zInIG ERC0171 <br /> 15. GENERATOR'SIOFFEROR'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 regulations.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 EPA Acknowledgment of Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.274a)(if tam a large quantity generator)or(b)(ii I am a small quantity generator)is true. <br /> Gene erorpp's��Printe y e Signa f Month Day Year' <br /> r 11fJ\ � � e r i <br /> L' 16.International Shipmepts <br /> t= ❑Import to U.S. ❑Export from U.S. Port of en /exit; <br /> Z Transporter signature(for exports only): Date leaving U.S.- <br /> w 17.Trarisporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed[Typed Name Signature Month Day Year. <br /> En - ft 4S <br /> Z Transpdrter2 Printed/Typed Name Signa Month Day Year <br /> 2d <br /> 1/7 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quanti <br /> ty ❑Type ❑Residue El Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> Zi <br /> U .. <br /> LL- Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a s <br /> Z <br /> y19.Hazardous Wastp Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. �� 2. <br /> T <br /> . 4. <br /> 20.Designated Facility Owner or Opera r.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature � / Month Day <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br /> 12723.1714 <br />