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�❑ a se print or type. <br />FormAooroved. OMR No. 2050-0039 <br />UNIFORM HAZARDOUS7Generatorff) <br />Number <br />2. Page 1 of <br />3. Emergency Response Phone7020383172 <br />anifest Tracking NumberWASTE <br />MANIFESTL <br />0 0 0 2 6 8 7 4 4 <br />1 <br />(800) 424-9300 <br />J.J K <br />5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) <br />LAWSON ROCK & OIL INC LAWO18 <br />10848 S HARLAN RD <br />FRENCH CAMP CA 95231 <br />Generators Phone: 559 9$3-1024 <br />6, Transporter 1 Company Name U.S. EPA ID Number <br />WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />WORLDWIDE RECOVERY SYSTEM INC. <br />CAR 0 0 01 7 5 4 2 2 <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />YES MANAGEMENT, INC. <br />6500 US HIGHWAY 95 <br />YUMA AZ 85365 <br />AZRO00521146 <br />Facility's Phone: 928)344-9828 <br />9a, <br />9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />13, Waste Codes <br />No. <br />Type <br />1•NON-RCRA HAZARDOUS WASTE, SOLID (OILY DEBRIS) <br />0 <br />352 <br />2 <br />D M <br />p© <br />P <br />Z <br />W <br />2. - <br />A 313 <br />24 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 WOES TERMINAL: CERES CS NAERG# 9131: 171 PROFILE # 9131: <br />162623NRS-LAW018 OILY DEBRIS x Y APPROPRIATE PPE EQUIPMENT ,,--- <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, and are classified, 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 EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a I quantity generator) is true. <br />ene tors/Offerors Printed/Typed Name Signa re Month Day Year <br />r4-MJI AA14 44J <br />16. International Shipments <br />❑ import to U.S. ❑ <br />j... <br />Export from U.S. Port of entry/exit: <br />? <br />Transporter signature (for exports only): Date lea#g U.S.: <br />W <br />17. TransporterAcknowledgment of Receipt of Materials <br />LU <br />Transpl PnntedlT ed N e Signature Month Day Year <br />O <br />( ' In `C <br />ZTransporter <br />2 Printed/Typed Nime Signature Month Day Year <br />H <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ quantity ❑ Type Residue El Partial Rejection El Full Rejection <br />❑ <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />v <br />L <br />Facility's Phone: <br />H18c. <br />Signature of Alternate Facility (or Generator) Month Day Year <br />Q <br />z <br />CD <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />1. <br />2. <br />3. <br />4. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Name Signature Month Day Year <br />