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Form Approved.OMB No.2050-0039 <br /> Tease print or type. <br /> 1.Generator Number 2,Paye 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> ID <br /> UNIFORM HAZARD <br /> WASTE MANIFEST OUS CAL000022111 1 209-639-0999 006108153 G B F <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> STOCKTON EAST WATER DISTRICT <br /> 6767 E. MAIN <br /> STOCKTON,CA 95215 <br /> Generator's Phon;.09-639-0999 <br /> U.S.EPA ID Number <br /> 6.Transporter t Company Name NC;. CAR000272302 <br /> AMERICAN VALLEY VVAS-fE OIL, I <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name CAR000175422 <br /> WORLDWIDE RECOVERY SYSTEMS INC <br /> U.S.EPA ID Number <br /> 8.Designated Facility Name and Site AddressYUMAYES LLC AZR000515924 <br /> 2730 E. 13TH ST <br /> YUMA,AZ 98306 <br /> Facility's Phone928-642-8938 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> HM <br /> and Packing Group(if any)) No, Type Quantity Wt.Nol. <br /> 352 <br /> 0 1 NON-RCR,A HA7ARDOU5 WASTE SOLID,ABSORBENTS R OIL 1 DAA 140 P _ <br /> Z 2, <br /> UJ <br /> 3 <br /> 4. ., <br /> 14.Special Handling Instructions and Additional Information <br /> PROFILE# 1710501NRS ABSORBENT,OIL ERG#171 <br /> EMERGENCY CONTACT:ANGELO <br /> 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: hereby declare that the contents of this consignment are fully I <br /> y described above by the proper shipping name,and are classif ed,packaged, <br /> marked and beledlplacarded,and are in all respects in proper condition for transport according to applicable intnational governmental regulations.If export shipment and I am the Primary <br /> Exporter,I c rti that the contents of this consignment conform to the terms of the attached EPA Acknowledymecerlify that e aste minimization statement identified in 40 CFR 262.27(a)(if I ama large quantity generator)oSignature Month Day Year <br /> Generator'slOffer 's 'nt Typed me 16.International Shi ments ❑Import to U.S. ❑Export from U.S. of entry/exit: <br /> z <br /> Date leaving U.S.: <br /> Transporter signature(for exports only): <br /> W 17.Transporter Acknowledgment of Receipt of Materials M nth D y Ye r <br /> Transpo ter 1 P Typed e <br /> a th Day Ye <br /> N gna re �� <br /> Z Tr yp ame <br /> 18,Discrepancy:% <br /> 18s.Discrepa Indication Space ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> ❑ Quantity <br /> 1 s' r <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> Fr— 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> LL Facility's Phone: Month Day Year <br /> LO 18c.Signature of Alternate Facility(or Generator) <br /> a <br /> Z <br /> CD19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1' 2. <br /> 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year <br /> PrintedfType�(Rev.. <br /> Signature <br /> EPA Form 8700 �17) Pre�vioused nsare bso:ete. �I��aB��l�f?�I��@�.'f ��-hf ��®hI�A`0 °�`IANII' a T�'YS 11109 <br />