Laserfiche WebLink
i <br /> + Please print or po.(f=arm dWslgnsd for use-on elite(12• it*typoarriter-) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 Generator iO Number Manitasf T1imaing Number <br /> WASTE MANIFEST C A L 0 CIO 6 5 017696564 JJ K <br /> 5 Generator's Name and MAIIii 9Arldross Generax}?s 5!a Address VI(Illferenl than rnaatng addressl <br /> ANTONHAI ENTERPRISES LLC-LATHROP <br /> P.O, BUX 5:468 rrI <br /> S I i;.C"k t ON CA 95208 <br /> a.=.narawrsphnne: 2099131-8695 LATHROP 095330 <br /> Transporter i Cumpany Name U.S.EPA Nu nbar. <br /> WORLD OIL ENVIRONMENTAL SEPVlire C,A 0 r0 12 8 2 i ; G 3 6 <br /> 7.Trar>Sa iQ?Y Cw oauy Name U.S,EPA M.Nuntber <br /> WORLDWIDE NLCOVI RY:�1'S's``rivl lf,f . G ik P. ;z')17 4- <br /> d.De rc�natc�d Facr1 ty Ni+n+e aruf Srta Address U.S.CPA ID Number <br /> WIVIA'YES LLC <br /> 273`0 L 13TH ST <br /> YUMA AZRi?O05:1.5924 <br /> FadIli y's Phone: 1"44.9r 2% <br /> 9a, 91b.U S.DDT Description(including Proper Shipping Name,Hazard Class;ID Number, 1u,Containers 11.Tatal 12.Unit ,. <br /> and Packing Group if any)) No. Typo. Quantity 04-r4'ol. 3,Waste Codes <br /> HM n9 p( Y!, <br /> "NON-RCRA F1t.ZARDOUS WASI'E,SOLID OILYPAPFR FIL Tc=i6 <br /> W <br /> W <br /> 1 <br /> 3 <br /> fI <br /> 4 _ k <br /> 14 S(uerlal Hand'r;rg InstrucG:int aMlAddaipral InrumWGar <br /> ElViERGENCY CON kCT :CHEMTREG s-600 424-9.300 1AiOES'TERN1I4JAL:C'E=:'r`3 t f� C3FILI 961 .1C42623f.IRSNIV I6[?8 <br /> OILY SOLID, PAPER FILTERS x *APF'ROPPIATF PERSCDI�iL PROT CI IVE EQ'U ;'i,.1Li.i <br /> t5- GENERATOR'SIOFFEROR'S CERTIFICATION: I mmby declare that the contents of this consignment are f Ay and arolvaie`:y gbaGritrerl above by trm proper xhlpping mune.Drd are clasad+ed,packaged, <br /> marked and labeledfplacarded,and are in all respects In proper condition for transport according to appliCable intemaWraiarra natfcnal govemmentol iegu!alions.If export shipment and I am the Primary <br /> Exporter,I certify lhait the contents of this consigoment conform to the Terms of rhe attached EPAAcKr:?r-riocigs2nitri Corrsen( <br /> rarlrfy that the waste minimization statement identified in 40 GFR 262:2T(a){.f t am a largo q.:r.=3 gr„r.sta o.ib (if am a sma.1 r slily• vak')'s true. <br /> C,erwrawesr3aaroesirrintextrlypt Name Sgna!ur,, Mom Day Year <br /> 1 <br /> 16.Intemallonal ShipIrWnls r Expo t':.rom U<S, Pori en /exii: <br /> F ❑Import to 0.S: L—J vY — — <br /> Transporter signature(for exports only}: Datalepving U.S.: <br /> W 17.TranspwierAcknowledgment a1 Receipt t+f ft ovals <br /> der 1 Pf,RIe fypnd Name S' n-' ih Day Year <br /> 0 _ <br /> u� <br /> moft i7ny yEh� C6M_�� si:�' 71 . <br /> Q rrrn5pu .r:'Phnludr i yprr Naarrr _ - <br /> SB 1]lstropnncy + � <br /> Ma.Oi y Indication Space ❑ O�a,t!ry type Partial Re ❑Full Rejection <br /> I !225.due joction <br /> h:3^lfes'R�fur4r:c:e Nunlut: <br /> 18b.Alterrmte Fadlity jorGenerator) U,S.EPA ID Number <br /> U <br /> FacAtVs Phone: Muntn Uay Your <br /> W 1t3t Slgnaturo olAkernaw Facliq(Ill Generator) <br /> Q <br /> 19,Hazardous Waste Report Idriaagement Method Codes(!.W.,codes for hazardous�iaste treatment,disposal,and rOogc'hng syslems) <br /> 1 2 3- 4. <br /> 20,O led Facility(Avner or Operator:Cedikrmiiori of receipt of hazardous materials covered by tha nwhsl e>e. tt9 f in 'um f <br /> Pant fIr ,d a e S ry ` Slgnahrre 4 �oD <br /> r 1 1 <br /> EPA Farm 00 22( ev.3 05 Previous cdillorts are ohsnlcge := "i�t is ;'s=;:I`'' ' is I ;9� I tf13 s <br />