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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUSd.Manifest Tracking Number T.Generator!D Number 2.Page f of 3.Emergency Response Phone WASTE MANIFEST C A L 0 0 Q 1 9 1 1800424-9W0C0FeiEMAmrffi 015104766 J 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) STERN TRUCK CENTER WESTERN TRUCK CENTER PO BOX 32020 3333 S.HIGHWAY 99 STOCKTON CA 95213 � STOCKTON CA 95215 Generaior's Phone: 6,Transporter T Company'Name U.S.EPA ID Number FREMOUW ENVIRONMENTAL SERVICES INC C A R 0 0 0 1 7 1 0 1 7 7.Transporter 2 Company Name U.S.EPA ID Number 8,Dee gnnated Facility Name and Site Address U:S;EPA ID Number YUMA YES LLC 2730 F 13TH ST YUMA AZ BMWA901 Facility's Phone: q->$% 8U— ga 9b.U,S,DOT Description(including Proper Shipping Name,Hazard Class,l0 dumber, 10.Containers 11.Total 12,Unit 13,Waste Codes HM and Packing Group(if any)) da. Type Quantity MAID, 1.NON-RCRA HAZARDOUS WASTE,LIQUIDS(OILY SLUDGE) � .343 I DI 2, 3. ( 4, { i 14.Special Handling Instructions and Additional Information 1 YES —C(J SItdge ER 171 k 7553 D HAMLM TO BE 40HR 1Tt.ArAW AND USE PPF..ER Contmt#205907 15. GENERATOR'SIOFFEROR'S CER nFICATION:t 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 labelediplacarded,and are in all respects in proper condition for transport according to applicable intemationatand national governmental regulations.If export shipment and 1 am the Primary Exporter,l certify that the contents of this ccnsagnment conform to the terms of the attached EPAAcknowledgmentof Consent. I certify that the waste mAimization 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, Qenerator'siOfFerofs Printedrtyped „ Si tore Month iDay Year --r 16.lntemalional Shipments. ❑Import to U.S. ❑Export from U.S. Port of entrylexit; Transporter signature(for exports only); Date leaving U'S.: UM 17,Transporter Acknowledgmsm of Receipt of Materials Transporter 1 PrintediTyped Name Signature Month Day Year a i Cr f' Transpa er 2 PrintedtTyped lame Sfgna Month Day Y ar Dw rv 4 4'k 16.Discrepancy 1 Be,Discrepancy Indication Space ❑ quantity ❑Type ❑ Rejection ❑Full Rejection Residue Partial R'action Manifest Reference Number: f8b,Alternate Facility(or Generator) U.S.EPA ID Number a ti. Facititys Phone: testi 18c.Signature of Alternate Facil'.ty(or Generator) Month Day Year Z 19.hazardous Wasta Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 20 Designated Pacility Owner or Operator:Cartification of receipt of hazardous materials covered by the manifest except as noted in Itom 18a Printed+Typed Name Signature Month 2Day71 Y r EPA Form 6700-22,(Rev;3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IE REQUIRED)