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'lease print or type. Form Approved.OMB No.2050-0039 "C .Generator ID Number [2.Pae 1 of 3.Emer enc Res onse Phone 4.Manifest Trackln Number UNIFORM HAZARDOUS9 y 0 2 0 0 919 7 JJ K WASTE MANIFEST CAL 0 0 0 3 5 9 1 0 2 1 800 4124-930 0-811ifF€� 5. U 19l l UC�K l •fi g gddiess Generators Site Address(it different than mailing address) 2526 W WASHINGTON STREET STOCKTON CA 95203 Generators Phone: 2 0 9 3 2 0 - 3 7 1 9 '- KW a.e IRONMENTAL SERVICES INC U.S.EPA ID Nu CAR 0 0.0 0 1 7 1 0 1 7 7.Transporter 2 Company Name U.S.EPA ID Number WORLDWIDE RECOVERY SYSTEM INC C A R 0 0 0 1 7 5 4 2 2 8.Desia Ad ft9Enand Site Address U.S.EPA ID Number 2730 E 13TH ST YUMA AZ 85365-1901 Facilltys Phone: 928 344-9828 A,Z..R 0 0 0 5 1 5 9 2 4 9a• 9b.U.S.DOT Description Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity WINot. 1SOUD(OILY DEBRIS, ABSORBENT) �n � � 223 L Z 2. L , :7 3. 4. 14.Special Handling Instructions and Addltional Information I t,%5 1 bZ326_Ully Debris 20 HANDLERS To BE 40HR TRAINED4NAL PPF-.ER Ca t>raci#205907 15. GENERATOR'SlOFFEROR'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, marked and labeledlplacarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. - I certify that the waste minimization statement identified in 40 CFR 262.21(a)(if I am a large quantity gene lor)or(b)(if I am a small quantity ge erator)is Genu torsfOfferors Printedfrypedr Name lure Month Day Year Q IC-- 14 j 16.International ShipTnents ❑Impart to U.S. ❑Export from . . entrylexit: S Transporter signature(for exports only): to leaving U.S.: j 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Nam Signature , Month Day Year D e.\)kv� cam- 5 a l� Transporter 2 Printed/Typed Name Signature Month Day Year 5 /lJJ; —L I'© K—Z— L 18.Discrepancy — OS I 18a.Discrepancy Indication Space Quantity El Type ❑Residue ❑Partial Rejection ED Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number i i Facility's Phone: 18c.Signature of Allemate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 2. 3. • 4 20.Designated Facility Owner or Operator:Certlffcatlon of receipt of hazardous materials covered by the manifest except as noled in Item 18a Prinled/Typed Ne Signature Month Day Year In A Form 8700-22(Rev.12-17) Previous editions are obsolete ESI SN ED FACILITY TO EPA's e-MANIFEST SYSTEM