Laserfiche WebLink
Form Approved.OMB No.20W-0039 <br /> Please print or type, 2.Pie 1 of 3.Emerganey Response Pune 4 as((tN)eet T Nu <br /> type- <br /> UNIFORM Garrwator Io Number V.LL�X v+W14 07757 <br /> 5.Gera yaws Name and Mating rens s rase d tStterent than rrtatlut�edtir�s)' <br /> [office Max #6298 Office IMax#6298 <br /> 099579771 4733 Quail makes Drive 4733 Quail Lakes Drive <br /> ra <br /> Gena,'a PhOne' Nrmber <br /> 6..Transp AW t Camp ty Ptame <br /> t <br /> 7.Transpoderarty <br /> 420 <br /> 81 Dask nated FadAy Name and SW%P dress U.3.EPA tD Number <br /> Yuma Yes, LLC <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facpttn2 L119266 4 LW938 <br /> 9a, <br /> 9b,U.S,DOT Description(irdxtirr9 Primer Sit Name,Hazard{bass,10 Number. to.Contamecs ti.Tubed 12. l t3.YVaste Codes HM and Pads Grasp('dam)} No- Tr€e Ouantltr mm, <br /> o ton RCRA hazardous waste, liquid (CA STATE CF 00003 P " <br /> EGULA`fiED LIQUIDS), <br /> aZ <br /> s, <br /> 4. <br /> 14.Special Hand]v thstwctons and AddW"Infoh%110n <br /> I.102342(CA State Regulated Organic Containing Liquids) <br /> 15. GfN€iLATt t S1flFFERRR 8 GFRTIFICATtOlt t Tleratry tieolare trod Ste owdsnts of Sus txlrsslgrm+ettt are my and acwratety described abo"by the �n and are slfiad,Pa , <br /> marW and iabe ,and are to ad respects In i t coreStlon for transport aaor*V to a 1 vein tal S export sh8srrwnt�l the Prunary <br /> Exporter,I ceratr M the MnW is of this axss hrhent Ohle m to the roans of the WWdW EPA Adnawledlpnent of C=Wt <br /> t. <br /> I fy that Stewaste minoftawn statement itfenMed in 40 CFR 262.27(x)(S I am s ftp Quantity )or(b)f 9eheraixl <br /> Year <br /> $ 111 11 019 <br /> -j 16,11WWWW is ©Inspart to U.S. El Export from U.S. Port of entryle' <br /> I— Transportersv' (tor0*01%fly} Date 5.: <br /> ad 17.Transporter ust mOf R OfMaterials <br /> t2 anta Transporter 1 Pra+tedtTyped N <br /> Spnattxe . Year' <br /> 111 11 <br /> Do-Jared Marci e l Month Day Year <br /> p�a ArintedJTypad a <br /> - <br /> 18a.DssXepancy W4katton Spew t2uanSky ❑Tye_ ❑Raw- 0 Parte Rejection ❑Ful Rejection <br /> Manifest Referents Number. <br /> 18b Atterrote Fadkty(or Generator) U.S.EPA 0 Whim <br /> u`b <br /> FaalkysPtone: <br /> Lu t8e.Stgnatura of AWnate Fac (Ge Getwa8u} Ma Eh Day Year <br /> 19.Hazardous Waste Report Managenat MOW Codes(Le:,mles for hazardous waste treaunent,disposal,sm mcYcrt9 systems) <br /> W y. 2, 3. 4, <br /> AM <br /> 20,Designated Fao�q Orate+ tar:Certiftcattan ofemptothaardous materials omred byth0marviestex0eptas noted in!tent 188 <br /> PrintedrTyped Name * Signature Mordlt Day Year <br /> All <br /> lq <br /> fill <br /> -MANIFEST SYSTEM <br /> EPA Form 8700-22(Rev.1 -17) Prevaus aditlons are obsolete 6ATED FACILITY TO EPA's L <br />