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Please print or type, Form Approved,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2,Page 1 0l 3.Emafgency Response Phone 14,Manifest Tracking umber <br /> WASTE MANIFEST CAL000039= 1 '208-91 r4-3881 021823791 JJ K <br /> 5,Generator s Name and Pdalling Address Generator's Site Address(if different ih3n mailing address) <br /> MADRUGA IRON WORKS <br /> 305 GANDY DANCER DR, <br /> Generator's Ph -83 . d �TRACY,CA 95376 <br /> 6.Transporter—1company Name U.S,EPA ID Number <br /> AMERICAN VALLEY VVAS7t OIL,INC. CAR000272302 <br /> 7,Transporter 2 Company Name U&EPA ID Number <br /> WORLDWIDE RECOVERY SYSTEMS INC CAR000175422 <br /> 8,Designhted Facility Name and Site Address U.S.EPA ID Number <br /> YUMA YES 7 WASTE TRANSFER FACILITY <br /> 6500 US HIGHWAY 95 AZR000521146 <br /> YUMA,AZ. 85365 <br /> Facility's PhoneD28.34!jtW2g <br /> 9a. sb.U.S,DOT Description(Jncluding Proper ShOping Name,Hazard Class,ID Number, 10.ContaNiers fi.Total 12,Unit HM and Padung Group OI any)) 13.Waste Codes <br /> 1, <br /> No. Type Quantity wtNol. <br /> o NON-RCRA HAZARDOUS WASTE SOLID,ABSORBENT PADS&OIL 1 DM 216 p 352 <br /> - <br /> w <br /> w 2. <br /> w , <br /> C7 <br /> a <br /> 4. <br /> 14.Special Handing Insbuetions and Additional Information <br /> PROFILE#740 OIL ERG#171 <br /> EMERGENCY CONTACT:JOSEPH <br /> 15, OENed and labeled/placarded, <br /> a'Sk)fFEROR'S CERTIpICAT10Nt 1 hereby declare 8uat the contents of th(s cgnsignment are fu8y and aavralely descnbed above by the proper shipping name,end are da ]W,packaged, <br /> marked and labete at the cont,and are in ell respects In proper condition for transport according to appl cable Inlematbraaland rta6anal governmental regulations.It export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conlorm to Ihs farms o(Uae atfadred EPAAcknowiedgment oI Consen(."" <br /> I certify that the waste minimization alatemenl identified in 40 CFR 262,27(a)(il I am a largo quangty generator)or i a smoU quantity generator)le true, <br /> Generator ores Ptintedrrypol Name Sin <br /> Month Day year <br /> J 16.IntomationaiShipments <br /> ❑Import to U,S. �—E-I <br /> I Export from U,S, P nlry/exh: -� <br /> Transporter signature(for exports only)., --- <br /> Data leaving U.S.; <br /> fe 17.TranepoderAckrwtMedgmontofRo-oolptofMatedwe <br /> Transporter.l rinledrrypedName Signaturoa <br /> a0 C Month Day A <br /> Iransporler 4 ypedNina S alar U Moth Day ea <br /> 18.Discrepancy (� <br /> i$a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Raeidue ❑Partial Re)edw, ❑Full Re)ecHon <br /> 18b,Alternate Facifity(or Generator) Manifest Reference Number; <br /> U.S.FPA ID Number <br /> U <br /> W Faclflly's Phone: <br /> 1 0.4nalufe of Allernate Facility(ef Generator <br /> Q <br /> Monthy Year <br /> a <br /> 19,Hazardous Wasla Report Management Malhod Codes(Le.,codes for hazardous waste trealment,disposal,and recycling systoms) <br /> 0 1• q 2. r- <br /> . 4, <br /> 2a.Danignotod F04 ner or Oporator eerencaaon or receipt of hazardous materials covored by the manifest except as nded)KIto)183 <br /> Prinlaw yped.Na Signature <br /> onlh Day Year <br /> EPA Form 8700-22(Re.12.17) revfous editions are obsolete. <br /> C,�i NAI '- CILI Y TO EPA's ta��9AN1FF5')'qSrs r E141 <br />