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'ase print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Appn <br />UNIFORM HAZARDOUS Generator ID Number 2. Page 1 of 1 3. Emergency Response Phone 4, Manifeal Tracking Number <br />I i AL000383 768 '`1157 ~ 011385, <br />WASTE MANIFEST 1 8'r , ,;, 7�E� a <br />�, Gererato. s Name and Mailing Address Generator's SiteAddress (if different than mailing address) <br />Drtliat^ Gener�il #14313 <br />@9:7513"i;y�7Dollar Gr.�tter�tl#14:��s <br />5 E YOSEMITE AVE 915 E YOSEMITE HVL <br />Genaratdr's Picone: MANTECA, CA 95336--5928 <br />o. Mnspwer 1 Cornpary Name <br />Stel-icvcie Specialty Ws;te Suiution= lric <br />7 TranspWer 2 Company Name <br />Worldwide Recovery Systems <br />8. Designated Facility Name and Site Address Yuma Y 8 c, LLL <br />�73�t E. 13th atoeet <br />Yuluat AZ 85136:=, <br />Fac;ii: %Phmre 928642893a <br />ga, 9b. U.S DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 1D, <br />HNt and Packing Group (if any)) No. <br />1.NOri RCRA halal -dotty Waite. Solid c 'anaumet <br />Product5)Y <br />2.Non RCRA h za-irdou5 w;Aste, 1 igttid (Consumer 1 <br />Product E ) , <br />MN500011 0924 <br />S. EPA 10 Number <br />CAR000175422 <br />OMB No. <br />A Z IR00051'5924 <br />11, Total 12, Unit 13, Waste Codas <br />Quantity wuvol <br />ill- J�) -.1VI ani <br />ttSpecialHanding lnstuctionsandAdd:f'omalnformation <br />L. 1105c9(Non-RCRA Solid W3�te (CA Only) .- Looseoack) 7 <br />1101':':4(Nnn--RCRA Liquid Wa_te iCA Unit.') - LOG.ePaCI-,) <br />r,J. VCR CMT vn-WVPI'1 RVR•S CERTIFICATION: i hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeiedfplacardea, and are in an respeds in proper condition for transport according to applicable international and national governmental regulations, if export shipment and 1 am the Primary <br />Exporter, I cartily that the contents of this consignment conform to the terns of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.71(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is we. <br />amara a rn am Ignaure omn a ear <br />` 8 1201 <br />s. International Smipmencs f� <br />❑ Import to U.S E Expcn fro U S Port of enf laxit <br />Trani oder sprature iter exports onfv! Date Icavin4 U. <br />17 Transporter Acknowledgment of Receipt of Materials / V-- /f <br />ranseortEr ; mtetlrryped Name azure ) J�� / Win ay ser <br />Anthony Mack I / .lY/ AI( / li I �� <br />T-- 'J Onnn,ITa,nnw .,...�.. <br />18 Discrepancy - — <br />18a..Discrepancy lndicaOonSpace ❑ QuanAt �--7 <br />Y �J Type ❑ Residue 77 <br />Manifest Reference Nun <br />18b. Alternate Fadlity (or Generator) <br />J <br />U <br />LL Fede Ptnone; <br />18c Sgnature W Alternate Fadi (or Generator) <br />Q <br />Z <br />19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyc" systems) <br />C 1 2.'r I I3. <br />20 Daeiynaled Facility gamer or Operator: Certification of receipt of hazardous materials covered by the manifest OYC" noted in nem 18a <br />r. <br />f I[ 1 () 1A &1 t'71 1 lei <br />3-05) Previous editions are <br />❑ Partial Relacticn <br />U.S. EPA ID Numbe <br />4 <br />i _( Full %eclion <br />1 1012.1i�j <br />TO DESTINATION STATE (IF RFni immi <br />