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Please print or type.(Form designed for use on elite 12-pitch)typewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Res=, 6130170148 <br /> festTrackingNumber <br /> WASTE MANIFEST C A t 0 0 0 2 9 6 rd;'3 -ff800j 424JJK <br /> 5,Generators Name end Mailing Address Generator's Slte Morose(Idifferent than mailing address) <br /> DC lMNOf,I SERVICL DCIO02 <br /> 235 N MAIN 81 REFI <br /> MANI'f:CA CA 95336 235 N.MAIN S7 <br /> Generators Phone: 209 823-4341 MANTECA CA 95R;:6 <br /> 6.Transporter 1 Company Name USEPA ID Number <br /> WOFtLD CIL ENVIRONMENTAL . . <br /> SERVICES C A D 2 8 2 7 7 036 <br /> 7,TransportCompany Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTF_M INC <br /> 6.Designated FacilityANAName and T, CAR000176422 <br /> Address . <br /> rrS MANAl.1FMFN7.ININCU.SEPA ID Number <br /> 651)[)I1S HIGPIWAY 45 <br /> YIIFr)A AZ 853135 <br /> Facilly's Phone: CJ.8)344.9828 A I R 0 0 0.5 2)_1 4 r <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11,Total 12.Unll 13.Waste Codes <br /> No. Type Quantity WI,NoI. <br /> Ir4orl FW'I?A HA7.ARDC1l1S WA^>TE,S(JLtOS,(PAPER rII.TERS) <br /> � r 352 <br /> LU 24NON-RCRA HAZARD011,S WA <br /> 0Tt:,:iOLID(nRAKE LA'fFIF.SHAVINGS) <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional In(orna6on <br /> i/ _. <br /> FMERGE'NCY G JNTACT:CHEMTREC 1-800-424.9300 YVUES 1 F.RMINAL CEO—;C, SER yN 981 :1-ig 95S:1.71 "PROFiLF!i <br /> 981 1f2B23NRS-DC,'IOO2 PAPER i 11_TERS.902::1710395NRS DC1002 SRAAE LATHE SHAVINGS" "AIRZPRIATF-PPE <br /> E' UIPMENT <br /> 15. GENERATORB/OFFEROR'S CERTIFICATION:I hereby dedare that the contents rt This consignment are fully and accurately desc4bed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/t the rded,conte 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 Pnmary <br /> Exporter". <br /> 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 identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ill am a smalluanti <br /> Generafors/Ofierors <br /> 14I'vo,typed Name gnature <br /> 9 ty generator)IS We. <br /> Si <br /> • ;� (, � ------Month Month Day Year <br /> 16.International Shipments 1Y ` ,/ 1 <br /> El Import to U.S. ❑ ry/e <br /> � Transporter signature(for exports only): Export from U.S. Portof entxit: <br /> w 17.7ranspoderAcknoMedgment of Receipt of Materials Date leaving U.S.: <br /> Transporter,l P4nledflyped Name <br /> O / Signature <br /> a � ' ' J Month Day Year <br /> RTransporter 2 Printed/Typed Name ! <br /> 05 Signature —L <br /> !—1 <br /> Day Year <br /> 18,Discrepancy <br /> 183.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue <br /> ❑PaNal Rejection ❑Full Rejection <br /> 18b,Alternate Facility(or Generator) Manifest Reference Number: <br /> J <br /> v U.S.EPA ID Number <br /> LL Facility's Phone: <br /> w 18c.Signature ofAllemafe Facility(or Generator) <br /> Q <br /> _ Month Day Year <br /> W 1 <br /> 2.9.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and r 11 ecycling systems) <br /> 0 1. <br /> 3. <br /> 4. <br /> 20.Designated Facility Owner or Operalm:CerbficelI no receipt of hazardous materials covered <br /> P4ntedaypeame by the manifest except as noted in Item 18a <br /> d N <br /> Signature <br /> Month Day Year <br /> EPA Form 8700-22(Rev.3.05)Previous editions are obsolete. <br /> GENERATOR'S INITIA1 COPY <br /> NovRECEIVED <br /> b. 2019 <br /> J <br />