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.i 4 • Please print or pe. Form designed for use on elite 12- itch typewriter.) Form Approved.OMB No.2050-0039 P type.( 9 � 2-pitch)tYP ) PP UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 0 19 9 9 800 424-9300 11017696696JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) RMC PACIFIC MATERIALS AGGREGATE-CEMEX 2365 IRON POINT RD,SUITE 120 ATTN:ENVIRONMEN FOLSOM CA 9.15630 30350 S TRACT(BLVD Generator's Phone: 209 835-1454 TRACY CA 95�'A77 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 0175422 8.Designated Facility Name and Site Address U.S.EPA ID Number YUMA YES LLC 2730 E 13TH ST YU MA AZ 85365 A Z R 0 0 0 515 9 2 4 Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt VOI. 1-NON-RCRA HAZARDOUS WASTE.SOLID(OILY SOLID,PAPER FILTERS) 352 2-- QM SW P 2. W C9 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 WOES TERMINAL:CE:RES CS *PROFILE#9T1:162623NRSOEM605 OILY SOLID, PAPER FILTERS * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT t/ J 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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity genera r)or(b)(if I am a small qu ntity generator)is true. enera or's/0 r`s Printed/Type Signa a Month Day Year ' G0 ? Ed'I1 -J 16.International Shipments ❑Import to U.S. Export from U.S. Port f try/exit: Z Transporter signature(for exp s only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materi TransC�11� ntedlTy d Nam Signature Month Day Year 0. �6 a Tran2ffgWZ4W4d1Typ9d N me M Day Ye qll 1 . 18a,Discrepa y Indication Space ❑ Quantity ❑Type ❑Residue Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year CDB z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a P nt ed Namet naturMonth Day ear iAM EPA Form 700.22(Rev.3.05) Pre-viobe editions are obsolete. D 'IGNATED FAC T STINATION STATE(IF REQUIRED)