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Please print or type. Farm Approvec.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.GeneMop lC Number 2.Pa9e1m 3.Emxgenay ReNanse PN one 4.MenMeat ioGinp Number <br /> WASTE MANIFEST CALLOf 420BW 1 20RL43n2UM OT ? ^ 0030 GBF <br /> 5,Generators Name aro Mailing Address Genei Site Adtlress ofdi0erent Nan mailing atlareas) <br /> SARALE FARMS <br /> 18500 CLIFTON CT <br /> t3�OCKTON,CA till <br /> Generemra PboneN <br /> B.irdnaand 1Cernpany Name U.S.EPA ID Number <br /> AMERWNI VALLEY WASTE OIL,M. CiAR0002723132 <br /> 7,Tmnsporl Company Name U.S.EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEMS RIC CAIROUCH175422 <br /> 0.Designmal Facility NameaM SdeAoaress U.S.EPAIDNurber <br /> YUMA YES 2 WAS7E'I HAN VER FACILI TY AZR000521145 <br /> 0000 U5 HIGHWAY EO <br /> YUA1,A2 a5ws <br /> FauliVa PlmwV2iy.34 r <br /> ga. 9b.U.S.00TDeeenpwn(imwirg Pnopersnippin9 Name,tem class.IO Number fo.comar 11.Tmal 12.Um fa Waage codes <br /> HM aodomedn9Gm40fany)) No. Type Quantity WLNu. <br /> 1. <br /> p NnµRCRA FA7ARrIA M WA,9TF SOI IO,ARSORRFNTg,FAPFR OIL �'z DM 400 P 352 <br /> Fit TIFFS 6 OFRRIS <br /> a 2. <br /> w <br /> 3. <br /> a. <br /> 14.Specal Handing lostiuulons andMailimal Infernal <br /> PROFILEEIS11hutOWS IAPERFILIERS Eflol 1 <br /> EMERGENCYCONTACT: OEROLD <br /> 15. GENERATOR'SIOFFE110R5CERTIFICATNM: Iherebydemare Nat the contents cattle consignment are finlyandapamlery command above terms pmparshippin9 name,ardare Naasil packages, <br /> marked and labeladrplacarded,and are in all respects in preperommi forbanspodawooirg to applicable intemampaland national gmemmenbl populations.If expert afternoon and I am Ne Primary <br /> Exposer,I cooly Nat Me contents of Nlswnsignment wnfm to Me lenms of Me atiadad EPAAdmowleagmentof CaneenL <br /> IoOf Oat Oawasteminimir onstatemotident din4OCFR26227(a)(BIamaHrge Wantdygenembr)or(b)(91amasnagquanbtyg rator)is We. <br /> GenenrYwORemrs ParImPTyped Name Signserq al Day Year <br /> U V <br /> 16.InMmational Siege - - -- <br /> F ❑lmwdWU.S. ❑Expodfmm U.S. Palofereded: <br /> ? <br /> Treatments rsignatumearosixes sty): Calek'e,U.S.: <br /> M 1T Tranaewrm Coweed9ment m Rae¢t of Materials <br /> KTrenspoderl Pnn ypM Name SignaNre MwN Oey Year <br /> is. =A N 14 <br /> QTrenefmMr2PmteNtypaa Name SI9n MwN COy Year <br /> F <br /> 1 del Di aep <br /> I ma Mannerisms,Indicative Space 1:10uanmy E]Type Residue ❑PA.1 gal ❑Full Rdimfian <br /> Manifest Referenco Numbe, <br /> 10b.Alienate Faulity(ar Gecarelor) U.S.EPA IO Number <br /> J <br /> U <br /> pQi Fai Planes: <br /> Maj Us.Signature offterste Fautity(or GmereluN Morn Day Y r <br /> Q 1 2 <br /> y19.Hazaelous Waste Report Management Method Cotles(Ie,wiles for baasmous waste baeleasl,disposed,aro pec ding sysbmed <br /> 3. Notice:State of California requires <br /> generator to photocopy and mail to <br /> 20.Dedgnatea Fmill amerw Ocemter:camNalionofmmiptoflaanrdousmWalsw.ereaby Nemanifestexcepta aMinit iSo DTSC With 30 DEVs: <br /> 1 PimeNryped Name Samara. P.O Box 400 <br /> Sacramento,CA 95812-0400 _f <br /> EPAFarm 8700-22(Rev.12-17) Previous editions are amolete. GENERATOR'S INMAL COPY <br />