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doo <br /> Please print or. e. Fprm .designed.for use on ellte 12-pitch) typewdter.) PForm AppmvK OMB No: 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3:Emergency Response Phoria 4. Manifest Trab ing umber <br /> WASTEMANIFEST GAL00b394625 1 ($Q0) 4249300 p 7468547, JJK <br /> 5, Ge for tdemaatnr(ly@�Ir��dVF#4$ Generator's Site Address Of different than mailing address) <br /> 2 NESTLEWAY <br /> U <br /> LAT HROP CA 95330 <br /> Generators Phone: 209 513.9941 <br /> B. Transpo ter l ComName U.S. EPAID Number <br /> WORLD OT NVIR0NMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7. TraN R!?D�PI� RE OVERY SYSTEM INC. U.S. EPAID0 Number <br /> g� �y CAR000175422 <br /> 8. D t hA' YES LLC and Silo Address U.S. EPA ID Number <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 AZR000515924 <br /> Fadii s Phone: (928)344-9828 rr 1 , - • •. <br /> get 9b. U.S. DOT Description (including Proper Shipping Name, Huard Class, ID Number, 10. Containers 11, Total l2. Unit. ^4ON <br /> 13,Waste Codas <br /> HM and Paddng Group Of any)) No. Type Quantity Wt,N.ol. . <br /> 140N.RCRA HAZARDOUS WASTE, SOLID ( OILY SOLID, PAPER FILTERS) J2 <br /> r ' DM nab P <br /> z 2. ' <br /> tW.7 • <br /> 3, <br /> 4. <br /> 14, Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT : CHEMTREG 1-800424-9300 WOES TERMINAL: r, PROFILE # 960. : 162623NRSDEL642 OILY SOLID, <br /> PAPER FILTERS * * APPROPRIATE PPE EQUIPMENT ! !, �C �_ 1 f 0. <br /> 15. GENERALO�$1OFFEROR'SCERTIFICATtON: Iherebydeclarethatthecontentsofthisconsigamentarefuilyandacuratelydescribedaboovebybythepro``peerrshipping( V'nam• ee,,aandareclassified, padceged; <br /> marked w4liibelediplacarded, and are in all respects in proper condition for transport according to applicable intemation rand national ovemmenial regulagoris. If export shipment and I am the Primary <br /> Exporter, Ice thatthecontentsofthisconsignmentconformtothetemsoftheattachedEPAAcknowfedgmentof sent <br /> I certify that a waste mWmhation statement identified in 40 CFR 282.27(o) (if i am a large quantity generator) or @ m a surae quantity ge lot) Is°W e. <br /> Gagspigr'sf ff or' Piirit ypad N me O� Sig re ' • ' 'Month Day Year <br /> 0 . . : r r <br /> 18. InternallorkI Shipments r—� <br /> ❑ Import to U.S. Q Export from U,S. Port of entry/exit: <br /> MINES Transporter signature (for exports only): Da leaving U.S <br /> PON <br /> 17. TransporterAcknowledgment of Recelpt of Matedels <br /> Transpo driledlryp Name Signature Month Day ear <br /> aQ. LdQ <br /> 4 Transpdrter2 ype Na Signature Month Day Year <br /> A. V6 laaaal <br /> 18. Discrepancy <br /> lest Discrepancy Indication Space El Quantity F'] Type Residue El Partial Rejection El Fug Re)erdion <br /> Manifest Reference Number. <br /> leb. Alternate Faality (or Generator) U.S. EPA ID Number <br /> a <br /> v <br /> I Faalitl/s Phone: Month Da Year <br /> W 18c. Signature ofAitemate Facility (orGerierator) Somalia <br /> y <br /> 4 <br /> z <br /> N19, Hazardous Waste Report Management Method Codes (i.e,, codes for hazardous waste treatment, (fisposal, and recycling systems) <br /> 124 3. 4 . . .. . . <br /> 20. Designated Facility Owneror Operator. Certification of receipt of hazardous materials covered by the manitesl except es noted in Item 18a <br /> Pdntemyw ame Signa Month y Year <br /> EPA Form 8700.22 (Rev 3.05) Previdus editions are obsolete: DESIGN ) ED F CILITV TO DESTINATION STATE (IF REQUIRED) <br />