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Pleaserint or e. I1[�11VI VIII VII 111P yP VIII II I[1111[IIII III 11I <br /> [(JelAlo,ID Number m Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUSCLtZ 00 37 95 j 2 Pap 1 of 3. g� R��Sonse Phone�ffi­ <br /> e9mart <br /> 4.Manifest tracking Number <br /> WASTE MANIFEST 6G i 012 4 9 7 6 5 6 F L E <br /> 5.Generator's Name and Mailing Addr �r_�y Generator's Site Address(if di Arent ama'ing df ress)& F=inal #393 �mar � h tress) 3 <br /> 2099521030 744 West Nlammer� Lane '744 West dammer Lane <br /> Stockton CA Stockton, CA 9521VI <br /> Generator's Phone: 9 .9�ti+�•52 1� •— <br /> 6,Transporter l"Company Name <br /> U.S.EPA ID Number <br /> Stericycle Specialty Waste Salutions Inc MNSOOOII0924 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> Worldwide Recover v Systems CAR� �1'7�`+� <br /> 8.Designated Facility Name and Site Address <br /> Yuma Yes, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Facility's Phone: •:, Yuma, AZ 853G5 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit <br /> 1 No. Type Quantity Wt.Nol. 13.Waste Codes <br /> o Non RCRA hazardous waste, solid (Consume DF 00147 P 33 <br /> 0 Products), <br /> w <br /> W2. Non RCRA hazardous waste, liquid (Consumer 1 DF' 117 P 33 <br /> Products), <br /> 3. <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> Liquids —GA) 10 1013`1 (State Regulated Solids — CA) 2. 101320(State Regulated <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, are cla sified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x)if I am a large quantity generator)or(b)(if l nm a small quantity generator)is true <br /> Generator's/Offeror's Printed/Typed Name Signature <br /> 01 ehalf_. 0. ,S—ear-t.....&---Fi.na1 Month Day Year <br /> _J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entryiexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17 Transporter Acknowledgment of Receipt of Materials <br /> F— Transporter 1 Printed/Typed Name <br /> O <br /> Signature. <br /> ,� Month Day Year <br /> -L711 8 <br /> U) <br /> Transporter 2 Printed/Typed Name „_--„ <br /> SignatuLL <br /> re 2 Month Day Year <br /> F— /�s 'Lo <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space <br /> 111ection Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 9 <br /> 18b,Alternate Facility(or Generator) Manifest Reference Number: <br /> J U.S.EPA ID Number <br /> U <br /> u< Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> 4 <br /> Month Day Year <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU gDesignated <br /> raE0,,n.er <br /> 2 4. <br /> erator:Certification of receipt of hazardous materials covered by the manifest exce s noted in Item 18a <br /> 4E4ak;;;;A's <br /> �� Month Day Year <br /> (Rev.12-17) Previous editions are obsolete. o-MINI ES SYSTEM <br />