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.�...., . I���NIN��I����II��IIIIYNI►�������� ���1�11i •,.,...,.,r n 1 � rf:':l'7: <br /> 'Please print or type.(Form designed for use on eine(12-pitch)typewriter.) For.n ),,, .rci.„M6 i Je 2q.„I,,3,) <br /> UNIFORM HAZARDOUS 1,Generator ID Number7111 <br /> ge 1 of 3.Emergency Response Phone 4.Manifest Tracking NumberWASTE MANIFEST CAL000376262 8775772669 012121142 F L E <br /> g.Generalo's Name and Mailino Address Generator's Site Address(if different than ma ling adcress) <br /> Dollar General #14130 Dollar General#14130 <br /> 2097749073 4115 N EL DORADO ST 4115 N EL DORADO ST <br /> Generator'sPhofle: STOCKTON, CA 95204-2104 � STOCKTON, CA 5204-2104 <br /> r„�nsocratlcmparny Name J'S EPP+ip <br /> Steric cle Specialty Waste Solutions Inc flva Utr',a4 <br /> ? T<rrrsaedar 2 Company Name U.S.EPA ID Nember <br /> Worldwide Recovery Systems ( CAR0001175422 <br /> u.Designated Facility Name and SiteAddress Yuma Yes, LLC US.EPA IDNumber <br /> 2730 E. 13th Street <br /> Yuma, Az 95365 ( <br /> z`aC'il sPhone; 928642893f1 I AZRiTlfl,051yt'c124 <br /> gy. 9t U DOT groper Shipp'ng Name,Hazard CI-?:.10 Nd Mm :.r 10 Comamers i 1 T:Al 12 unli <br /> S1hA and Packirte3 Gran p rif any}) h, ripe v1 rmatp L't`cl <br /> lNon RCRA haaardous waste, liquid (Consumer 2 DF 0019; P 33 ^ <br /> OProducts), <br /> i I <br /> Z 2. t <br /> U <br /> I <br /> 4. <br /> 14.saec'alHandlinylns!r.;ctionsa^dAddit:onallnto;matron 1, 110524(Non-RCRA Liquid Waste (CA,-Only) t_Dosepack) <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:i hereby declare?hat the c;llntentsof this ocif(sigrMent are fully ano accwately described above by the pro,:er;:at g name,and are classified,pa:�aged <br /> marked and 4nbelee--nlecardeci,and.are in all respects in proper condition for transport according to applicable intematlo111 ane r%a6onel governmental requ'a9<xts If expor sh pmnt and I an,the Primir) <br /> expo ter,I certify that the conterts of this consignment confomt;o the terms of the attached EPAAcknowledgmem cf Consent <br /> I oerfify that the waste minimization statement identified in 40 CFR 26227(al i,if I am a large quantity generator)or(b)(if I am a;mall quantity generator)is true. <br /> a n Ntdrre r n u / I,1Month My ear <br /> � 16lnternatinnal5hipments I <br /> El <br /> ff' ''tI ) <br /> i— !__I Impart to U.S. ;. D Export from U.S. PJ: _- <br /> Transpoder signature ifcr exoods unlal: Dane cow n4 U S <br /> W 17 Transporter Ackno'rlcdcm.nt of Receipt of Materials f` T <br /> t— ransporter 1 Printedr yped Narnr> Signature Ion!; ,i;,•; <br /> a Isidro Martine f • I I 091 261 2011 <br /> Z rarelperter d awe ontn ay ar <br /> I/dIrl�il // <br /> 18a,Discrepancyindicat Space El Quantity ❑Type Pallial Rejcc'i;n Full RejAc;;,n <br /> tAanitest'�rjererca rVwr ger: <br /> 7877ernale Facility(or Generatorj U-S EPA 10 Nu.vier <br /> '<a <br /> a <br /> 'LL FaatitYs Phare: <br /> w 18C.Signature ofTSmate Facility(or Generator) Month Day Year <br /> at I I I <br /> z <br /> yt9.Hazardous WasteReport Management Method Codes(!&.codes for hazardous waste treatment,disposal,and recycling systems) <br /> o Uj f -H-'l <br /> t G1jlI I2. <br /> I3 14 <br /> 20.Designated Facility Owner or Operator:Certification o(receipt of hazardous materials covered by the martifesl ex94Ft 4 noted a Item 18a r,, <br /> PrintedlTyped1 8 Signalu Month Day Year <br /> EPA Form 8700.22(Rev 3.05) Previous editions are obsolete. 'I DESIGIIATED MILI TY 1"0 DESTINATION STATE(IF REQUIRED) <br />