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Please print or type.(Form des[ ad for use on elite.12-pltrdl typswritaf.) Farm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2:Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WA$fr �lANifEB"f d A L 0 0"0,1'9 9 9 1 (800)424.9300 _ 85n 885 JJ K <br /> 5.Gems awls N8 slid M Address Ganeratar s Site Address(If different than malling address) <br /> WX P IUM� VAS AGGREGATE-CEMEX <br /> 23861110M POINT RD.SUITE 120 ATTN: ENVIRONMEN <br /> FOLSOM CA 95M 30M S TRACT BLVD <br /> Generator's Phone: 209835-1464 TRACY CA 85371 <br /> e.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Trans 2 Company Name U.S.EPA ID Number <br /> RECOVERY SYSTEM INC. C A R 0 0 017§-j!-2.- <br /> a- <br /> 4 2.28-Daslgnaledradilty Name and == U'S.EPA ID Number <br /> YES KwM60dw,INC <br /> 195W US HIGHWY 95 <br /> Y(!Rk A2 86365 AZR000521146 <br /> FocIfi s Phone: 92A 9878 <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)) No. Type Quantity Wt.Nol. <br /> 1 NON•RCRA HAZARDOUS WASTE,SOLID OILY SOLID, PAPER FILTERS) 362 j <br /> 3. <br /> .4. <br /> 14.We[Handling Ins(ruclions and Additional Information <br /> EMERGENCY CONTACT:CHEMTKC 14DO.424-9300 WOES TERMINAL:CERES CS *PROFILE N 9131:16=3NRSR 1111001, <br /> t]i�Y_`(►!1"J.s' r R ILT6 <br /> PPE, . .."fidcN- , 75--;i e . 77Y --' F <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 /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gene lee lofferor's PrintedlFy{ped Name Sig_ Month Day Year <br /> -1 16.intainaffod-in Shlpmen <br /> F ElImport to U.S. FA Export from U.S. entrylexit: <br /> z Transporter signature(fa exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> � TransporterI PrintedrTyped Nama l 5iy7nalur� Mohthr Year <br /> 17 <br /> d - t '. <br /> Z Trapsportar2 Pl1n(edffyped Name Sigriawre Monlh Day Year <br /> 18.Discrepancy J <br /> 18a.Dlscrepartey Indication Space ❑ Quantityype <br /> ❑T El Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Facilitys Phone: <br /> Igo,Signature DI Alternate Facility(nf Gunarn(ar) Mentir Day Year <br /> -2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1- 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Monthay Ye <br /> �( <br /> fi1111( 1 r �� I �I i�< < D <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete, + DESIGNATED FACILITY TO GENERATOR. <br />