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I <br /> ease prim or type. Form Approvcd.OMB No.2050-0039 <br /> (Form drrsQned for use on elite(12•piledf)typewriter.) <br /> 1.Gcnaralor ID Idumbef 2.Page 1 of 3.Emcrrlcncy Response Phane 4.rAanifesl Tracking Numbaaar p 7 r �{ <br /> UNIFORM HAZARDOUS 1 (800)424-9300 O 1 7 6 9 U 8 12JJ R <br /> WASTE MANIFEST CAD 9 8 1 9 6 7 6 8 0 <br /> Gonemlofs Site Address(+f diHersnl than nmirgsg address) <br /> 5.G9r a noes N:uno and Mading Addles <br /> STOCKTON DOGGE INC <br /> 3333 AUTO CENTER CIRCLE CA 95212 <br /> STOCKTON <br /> Cannrntofs hone: 209 477-3668 U.S.EF:51D Nvmtwr <br /> S.-frimwoflrr 1 Company Name CAD 0 2$2 7 7 0 3 6 <br /> WORLD OIL ENVIRONMENTAL SERVICES <br /> -• ••�� U.S.EFA ID Number <br /> 7.TPnrr vw 2 Cornfinny Name <br /> WORLDWIDE RECOVERY SYSTEM INC. C A R 0 0 01 7 5 4 2 2 <br /> U-S.EPA ID Number <br /> 8,op-.,ignited Facility Name and Sltn Addfm <br /> PUMA YES LLC <br /> 2730 E 13TH ST 85365 <br /> YUMA AZRO00515924 <br /> F=NYs Phtr-"' 19213 344-9828 <br /> ya 91b10.Containers 11.Total 12.Unit 13.Waste Codes.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No. Type Quantity WtNal. <br /> HM and Packing Group(f any)) <br /> 01- 1•NON-RCRA HAZARDOUS WASTE.SOLID(OILY SOLID,PAPER FILTERS) 352 <br /> o DM P <br /> LU — � • <br /> LU 2• <br /> w - <br /> 3. <br /> 1 -S ,I HanrrM 1,hm dons aWAd&fonal InformaHml <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#9131;162623NRSSTO627 <br /> OILY SOLID,PAPER FILTERS* *,APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATClwSIOFFEROR'S CERTIFICATION: I hereby declaro Udet the center.,or this eon-Anmanl am fully and acwraiely ddscrfned above by the proper shipping name,and are dassltied packagod' <br /> marked and lahnladfphtardod,and are In elf rasped! <br /> peels In propw condition for Msport 3=ming to appllcrrbie,Int ma6=1 and national gwonawntal m9d2trons.If export shipment and I am the Primary <br /> Exporlgr,I ccrtiy that the rbnlanla d this Cons[nrrlenl�nfoNm m the terms Ift <br /> nnl quandA�orate,Or ro]�am a small qunniity gerwmlar)is.Wo. <br /> I Ce tilt'Uur!tfm vrastC minimlmldon stalcrrronl Idanlifiad In d0 CFR 23227{aj( S�jaa. Manlh Day Year <br /> Gtterala+'J s PrintedfTyped Name O k 6 1 1 <br /> ^� <br /> .+ l6.Inlamaeono Sdupmmfts ❑frtipori fo'U:S. ❑Export from U.S. Port of entry/wdl: <br /> Date#.raving U.S.: <br /> hanspMer sk�vrllurc({or oxparts ardy): <br /> xr 17.TransporterAdmcwIp —01 of Receipt of Materials Month Day Year <br /> I <br /> ransporter 1 Pdrrlod(fyped Name Sf�reluro O + r�j <br /> Q!� �h• �- 5kpraWre ldanlh pay Year <br /> nnsporlcr 2 ho1odTTypad 0-1 <br /> 8.Discrepancy <br /> aa.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> U.S.EPA ID Number <br /> Ibb.Mlumalo Fart ity for Gonerawr) <br /> i FVC Nis Phone: ay Year <br /> LM Ilk 5rjnatura of AUemala Facility(or Genanlor) <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes 0.a.,codes for hazardous waste treatment,disposal,and MCA-ling systems) EE7– <br /> LU 1 Z. 3. <br /> 0 <br /> 20.Designated Facility Owner or Operalcr.Certification of fncetpt of hazardous materials covered by the manifest except as noted In Item i8a <br /> Month Day Yenr <br /> Sa}nalure <br /> Prinicy'Ype<1�lnrnc <br /> E(IF REQUIRED) <br /> EPAP-ifm 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STAT <br /> .J <br />