Laserfiche WebLink
` I - <br /> Please ptitlhor type.(Form designed for use on elite.(12-pilch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFRM HAZARDOUS 1 Ganerawr 10 Number 2.Page 1 of 3.Emergency Respeasa Phone 4,Manifest Tracking Number <br /> W,ISTEMANIFEST G A L 0 0'0 2_2 7 :l 1 1 €is i)) + SOU 018529401 JJ K <br /> 6.Generalcr's Name and Maiimg Address Genera!o;s Site Address fu different than mail ng address) <br /> NIXON-EDLI EQU)PirilENT <br /> k44 S.VI^IEYARL'AVE LjD,v i;:r•+.i`i fLl vE l�C <br /> tviARIO CA 9:1 t31 f <br /> Generllor's Phone: 209$30.8600 'i FfryCY CA 95304 <br /> 6.Tra sporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL EIVVifdC7rNMENTAL SERVICES CAD 0 2 8 : 1 7 O 3 u <br /> 7.T:atisporter 2 Company Name U.S.EPA iD Number <br /> iWORLDWIDE RECOVERY SYSTEM INC. r,A R 0 0 01. 7;i 4 2 2 <br /> 8.08gnated Facility Name and Silo Address U.S.EPA 0 Number <br /> }U MA YE:,'LLT; <br /> 73U E 13TH ST <br /> PUMA AZ 85305 AZR000515924 <br /> Facility's Phone: e;[l.�T �A <br /> oa, 9b.U.S.DOT Description(including Proper Slipping Name,Hazard Class,ID Number, 10.ContainersI 11.Total 12.Uril <br /> and Packmo Grou If an Quantity Wt.,ryol. 13.Vias a Codes <br /> Hilo Pl Y)i No. Type ty <br /> cc 1NON-RCRA HA-?ARDOLIS kMAZTlE.SCUD(i)ILY 00'4_ID. I'.,PE3 F!;J ?'�;i 52 <br /> DPI <br /> W <br /> W <br /> U' <br /> J. <br /> 4. <br /> 14.$pedalHandJngInstructions and Additional Information Q -a��i1r7 <br /> E111ERGE:NCY CONTACT:CHEiv1TREC 1-800-1424-9300 WOE$T ERMINAL: Y PROF-ILE-0 J)81:1.$252:•3IMNIX0021 OILY SOLID. <br /> PAPER FILTERS * "APPROPRIATE PPE EQUIPMENT — �v <br /> 1s. �ENERATOR'SIGFFERORB CERTIFICATION:I hereby declare that the conten s of this cogsignmeni are fully and accurately dE5c6bad.above by the proper shipping name,and are classified,packaged, <br /> rharked and labeledrplacarded,and are in all respects in proper condition for transpon according to appFLable limerrational end nallcnel govemmenta!regulations.Ifszport Vnipmenl and I am the Primary' <br /> Exporter,I certify that the cGllents of this consignment.conform to the Terms of tna attached EPAAceno-Medgmeni61 Cousen!. <br /> ljcertlfythel the waste mitam¢ation statement Identified In 40 CFR 26227(a)(if I am a large quanlit,generetor)or(b)lif i am a small quantity goneralor)is,vue. <br /> !�eneI tar sfOffemr's rirttedfTyped Name jrlaipre Month Da year <br /> —+ 16.Intematlonal5 pmenls <br /> i ❑Imp®rt U.S. �Expert from U.S. Pari of enlrilexil: <br /> Transposer signature(for expons only): Date leavng U_-S.: <br /> L 17.TrinspoderAdmDw!edgment of Receipt of Malshits <br /> Transporter 1 P-l yped N to Signature month Day 'Year <br /> CL V 0 1 <br /> Q Trans!"PA <br /> rtar2 nntaaypod ame Signature Month Day Year <br /> F_ 1-CJ� C:2--,EL LOP k <br /> 18.Discrepancy <br /> 18a.discrepancy Indication Space El Quantity ❑Type ��----!! 1 <br /> ❑Residue Partial Ae)ecticn J Full Reaction <br /> Manifest Reference Number: <br /> 181b.Allernale Facility(or GenteraMr) U.S,EPA:D Number <br /> J <br /> U <br /> uQ. FacilitysPhone: <br /> �. 18G.Signature ofAllemale Faalily(or Gonerator) Month Day Year <br /> d � <br /> z <br /> .9.Hazardous Waste Report Management Method Codes(Le.,codes for-hazardous waste bestmenr disposal,and rdcyd,y syowns) <br /> WW <br /> 20.Designated Facillty Owner or Operator:Certification of receipt of hazardous imtter"als.wvered by the manfest exce -nued in ha 18a <br /> Pnn1*gypad am � .5:9natum nth Day Year <br /> EPA Forrti8700.22(Rev.3-05) Previousedidons are obsolete, 17E8(C R7r5'FAf:ur7C tc571iUKi6G3Niifiif=(9FR IQUEElCD) <br />