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Please print or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator iD•Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST I CAL000378684 1 209-993-1022 0061484.20G BF <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than malling address) <br /> IDEALESE OF MODES O-TURLOCK <br /> 5837 N. GOLDENSTATIE 2400 E.LOUISE AVE <br /> TURI OCK, CA 95380 LATHROP,CA 85330 <br /> Generator's Phone09-993-1022-105 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AMERICAN VALLEY VVASTE OIL, INC. CAR000272302 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> WORLDWIDE RE=COVERY SYS-I Efv1S INC CAR000175422 <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YUMA YES 2*WASTE'l RANSFER FACILITY AZR000521146 <br /> 6500 US I-fIGHVVAY 95 <br /> Yl1MA,AZ 85365 - . <br /> Facility's Phone:928-344-9828 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wtivel. 13.Waste Codes <br /> 1. 352 <br /> 0 <br /> NON-RCRA HAZARDc7US WA+1-F SOLID,HBSORBENT:S&Oil. I UM 'I 80 p <br /> Z 2. <br /> LU <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional information <br /> PROFILE#1811573NRS FIA NE'R F=ILTERS F RG#i7.1 <br /> EMERGENCY CONTACT:ALEX <br /> 15. GENERATOR'SIOFFEROR'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)(if I am a small quantity generator)is true. <br /> Generatoes/Offerces Printed7Typed Name t _ Sig atur Month Day Year, <br /> A • V� <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAcknowledgment of Receipt of terials <br /> LU <br /> �i Transporte Prin d Name SIV i M0 a Ye r <br /> O <br /> CL <br /> Tra o er 2 firinTecIfTypea Name Signature Ironth Elay Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type EJ Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W I. 2. <br /> dAl I <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest excfpt as noted in Item 18a <br /> Printed/Typed Name Signalur Month Day Year <br /> il�Wiw A <br /> EPA Form 8700 22(Rev. Previous editions are obsolete. I ATED FACILITY M EPA's 9-MANIFEST SYST <br />