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Form Approved.OMB No.2050-0039 <br /> Please print or type. <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000122264 209-831-0261 006108429 GBF <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CITY OF TRACY AIRPORT <br /> 333 CIVIC:CENTER DR 5749 S TRACY BLVD <br /> TRACY,Cf: 95376 "TRACY,CA X35377 <br /> Generator's Phone 09-83'x'-OZG1 U.S.EPA ID Number <br /> 6,Transporter 1 Company Name <br /> AMERICAN VALLEY WASTE OIL, INC. CAR000272302 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEMS INC CAR000176422 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YUMA YES LLC AZROOD515924 <br /> 2730 E. 13TH ST <br /> `(11MA,A? 135365 <br /> Facility's Phone <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 /> 3 <br /> O NON-RCRA HAZARDOUS WASTE SOLID,ABSORBENTS,OIL& 1 Cinli 1E35 N ., <br /> DEBRIS <br /> Z 2. <br /> LU <br /> c� <br /> 3. <br /> 4. f <br /> 14.Special Handling Instructions and Additional Information <br /> PROMLE#19 1 2- nI'l tJ R,S ABSORBENT,01 ERG#17 i <br /> EMERGENCY CONTACT. RALPH <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 /> Month Day Year <br /> Generator's/Offeror's PrintedlTyped Name Sign re <br /> J 16.International Shipments Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Date leaving U.S.: <br /> z <br /> Transporter signature(for exports only): <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> LL162 Transport P' a ITyp me ure Month Day Year <br /> O <br /> CL <br /> z Tra a ig&46�� <br /> Sig lure 'Day ear <br /> 18,-Discrepancy <br /> ,18a.Discrepancy,) tion SpaceQuantity ❑Type ❑Residue ❑Partial Rejection ElFull Rejection <br /> i <br /> Manifest Reference Number: <br /> 'I8b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> rar Facility's Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1' 2. <br /> 3. 4. <br /> 20.Designs d Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest pxNpt as noted in Item 18a <br /> Printedrfy d ame Signa re Mot7�D <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. buidWED FACUTY TO EPA's B-{r jf"��)�' I'OYST`ENVY <br />