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I <br /> Please print,.or type.(Pd'rm designed for use on elite(12-pitch)typewriter.) <br /> Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS 016 8 6 8 8 0 4 JJ K <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CEMEX READYMIX-4461 <br /> 2365 IRON POINT RD,SUITE 120 ATTN: ENVIRONMEN 30350 S.TRACY DL <br /> FOLSOM CA 95630 <br /> Generator's Phone: 209 993-7454 U.S.EPA ID Number <br /> 6,Transporter 1 Company Name <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 036 <br /> U.S.EPAID Number <br /> 7,Transporter 2 Company Name <br /> WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 1 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA AZ 85365 A Z R 0 0 0 5 2 1 14 6 <br /> Facility's Phone: to )MA-0828 <br /> 10.Containers 13.Waste Codes <br /> 9, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> INON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) <br /> 0 1 DM P <br /> Z2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT :CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#9BI: 162623NRSOEM605 <br /> OILY SOLID, PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT X a <br /> 15. GENE RATOR'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 quantitye m mall ntity generator)is true <br /> �fferor's PrintedlTyped Names 1 n ure Month Day Year <br /> 6 e,( 4=p1�-� t lam .L 26 1 <br /> -j 116.International Shipments <br /> ❑Impart to U.S. trylexit Export from U.S. Port of en <br /> Transporter signature(for exports only): Date leaving U,S.: <br /> ®= 17.Transporter Acknowledgment of Receipt of Materials <br /> w Month Day Year <br /> Transpor,1 PrintedlTyp Nam Signature <br /> 0- J "1 <br /> z Transporter 2 Printed/T a Na a Signature Month Day Year <br /> Al <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: Month Day Year <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> 7, 19.Hazardous;Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> 0 1• 2. <br /> 3. <br /> 1'1 1 o <br /> 20;Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except Wiled in Item 18a <br /> PrintedlTyped NamePC(AvN - Signaturear <br /> zV �" - <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. D SIG Ue gLL LL F MALS rO DESTI131A�-1O S`TAG'E (1F REQUIRED) <br />