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'lease print or type.(Form deslgned for use on elite(12•pllch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11.Generator iD Number 2.Page 1 of d.Emergency Response Phone 4.Man oat Trocking Na mbar <br /> WASTE MANIFEST CAL 0 0 O'3 8 5 7 0 3 1 (800)424-9300 017468585 JJ K <br /> 5.GBoarato68 N:ir1m MftPM%?' LLC-LAT H RO P Generators Site Address(If diHarent than malling addteas) <br /> HPI.VOi. BOX <br /> 18468 f' <br /> 5 T OCKT ON CA 95208 i 01 D'ARCY PKWY <br /> GeneralersPhone: 209993-8695 ZROP CA 95330 <br /> 5.Tran odor 1 Compaq Name <br /> WORLD OIL ENVIRONMENTAL SERVICES U.S.F�A1D Number <br /> CAD028277036 <br /> 7.Transportar 2 Co n Name U.S.EPA D Number <br /> WORLDWEZ RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 <br /> 11 posianalad Fazifity l fume and Slie Address U.S.EPA ID Number <br /> YUMA YES LLC <br /> 2730 E'.3 f l-I ST <br /> YUMA AZ 85365 AZR000515924 <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.Tolal 12.Unit <br /> HM and Pacidng Group Of any)) 13.Waste Codes <br /> W. Type Quantity WWoI. <br /> ANON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) 352 <br /> ci D M ZSR P <br /> L 2. <br /> ul <br /> [7 <br /> 3. <br /> 4• <br /> 14.Special Handling instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL: *PROFILE#961:162623NRSANT608 OILY SOLID, <br /> PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT CSO 2,9 <br /> :t <br /> 15. GENERATOR'SIDFFEROR'S CERTIFICATIDNI I hemby dodaro that the contents of tics consignment are fully and aecuralefy des64ad above by the proper shipping name,and era dasslfiod,paaegod. <br /> marked and labeloolacarded,and ere in 94 raspW&In proper condition far Iransport a000rding ID app[Iceblo Internal'sonalam nauonai gevernmenlal regulations.If export shipment and I am the Primary <br /> Exporter,I certify that lha conlonts of INs consignment can form to the terms of lha attached EPAAckrwwladgmoradConsent, <br /> I co*that the waste minimization statement idanllr[od in 40 CFR 262.27(a)[if I am a large quadly SonarsIor)or(b)Rf I am a wall quanliVAq norator)is true. <br /> ralorsf aroesprintod/Typad arga Ig are Month Day Year <br /> l - <br /> 18-iniemabnnel s pmanls Import to U.S. ❑Even from U.S. Port of enlryla .- <br /> Transporter slgnalure(for exports only): Date leaving U.S.; <br /> 17-TransporleTAcknowledgment of Recelpl of Materials <br /> 1'ransporl led/Typed me Signalura Monlh" Day Year <br /> V� <br /> Trans War 2 Prinled(fypa a Signaler Month Day Year <br /> .� <br /> 18.Dimpancy If <br /> 18s.Discrepancy Indication Space ❑ quantity, ❑Type <br /> ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Fadii!y(or Generator) U.S.EPA ID Number <br /> U <br /> uud Facility's Phone: <br /> LCUI 18c.&gnaturo of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 19.Hazardous Waste Repnri Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20.Designated Fadltly Owner or Operator Cerilllcation of recefpl of hazardous materials covered by the manifest oxcepl d In Item 18a <br /> ponle ed Name Signature -- Month Day Yynar <br /> LV�1 UC. � 1nLJ I� !� <br /> PA Form 700.22(Rev.3.05) Previous editions are obsolete. DESIG ED FACIL TO DESTINATION STATE(IF REQUIRED) <br />