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Form Approved.OhAU No.2(15fl-0339 <br /> ease print Or Vol of 3 Emergen Response <br /> 1 fens of 10 Number <br /> Pow e <br /> UNIFORM us 77) 577--2669 ml address) <br /> I Gemrators Sale Address ff different than WASZ HM=EST different th <br /> 5,Geni Nam and Maii MOMS Marsha lls#MO122 <br /> Marshalls #M0122 2203 Grand Canal <br /> (209) 952-7870 2203 Grand Canal <br /> Generators Phone: ......... ....... ------- umber <br /> ID Number <br /> ricyc <br /> 7.Transporter 2 Comi Nam <br /> U-S.EPA 8D"Wt <br /> 8 Designated Facility Name and Site Address Yuma Yes,' LLC <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 AZROW515924 <br /> Fadl'iy-s ph,n,92864289,3810.Con iners 11,Total 12,Unit ;3Wl Codes <br /> 98, 9b,U.S.DOT Deschriton(Including Proper Shipoing Nam,Hazard Class,ID Number, No. Tyf e Qual NO'Nol. <br /> HM aro Pacidrig Group(d WO DF 00046 P 331 <br /> cl: Non RCRA hazardous waste, solid (Consumer <br /> ;0 Products), <br /> 2- <br /> w <br /> 4, <br /> 1. 102,339(CA State Regulated Solids) <br /> 3 V,Lilt dose dad above by the proper shipping rame,ard are olassil padi <br /> Mftn of this consignment are fully and a=gto'Y I am the Pnmary <br /> EMERATOR'SIOFFEROR'S— ERTIFICAMM:I hereby declare that the contents according to Vpkable jr�*oalj and national governmental regullaitons.if export shipment and <br /> mal and labeleritplacari and am 1134 respects M proper cord"ton forDf the attached EPAA4mililltedgment of COI`lsert <br /> x4nment conform to the leffirm <br /> Exporter,I cwtl�that the comarria of this M in40CFR262,2T�a)(liamabWquanRygerffator)or(�)(gla,nas=pquanUtyg:erwaW()istrw. <br /> I ceritty that ft waste mintinization statement identified 1. hiref TJxrl monoth y Year <br /> PrnilediTyped Name 23 201 <br /> Export from U.S. Pod of entryltnt <br /> IR 11 G,wal.1 Shi;)Ments U import to u s. Date leaving U.S.: <br /> Transporter Signal(rnr"OOds only): <br /> IT Trani AduvAdgment Of Rel of Maliartals ay Year <br /> r I P 08 23 201 <br /> Train 41— 1 month Day year <br /> Demarco S-gnar/ <br /> u,, <br /> rryped Non* <br /> Vt Qkk <br /> 18 Discrepancy Partial Rein EJ Full ll <br /> jes.Mcnapancy Indication Space El C."tity Type Ll Residue <br /> Marl Reference Number &EPA 10 Number <br /> 181n.Allemate Facility(or Generator) <br /> sae Mmorodh D Year <br /> FactlrYs Phone: <br /> UO Jac,Signature of AMmate Facility <br /> !R <br /> Z I,and tecycling Sill <br /> )d codes(i.e,,codes V hazardous waste IrOatirent,d <br /> 19,Hazardous Waste Report Management Methli 1 3. 4 <br /> 2. <br /> C11 1 exempt as rded Item 1 88 In <br /> 20 Designated Facility owl or operator Cartfulion of receipt of hazardous materials materials b'fft manifest ex Day 'Year <br /> Sgnatre Printed7iliped Name1 /0 <br /> E I Form 6 00-22{R .12-17) previous eddions,are obsolete. DESKFACILITY TO EPNs e-MANIFEST SYSTE <br />