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� F '• r, <br /> Please print or type.(Form 0511 ad for use on ellte(12-"1tch)yNewntef.) 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 CAL 0 0 0 3 8 5 7 0 3 1 (800)424-9300 018531037 JJ K <br /> 5.Generator's Name and Melling Address Generator's SiteAddross(It dllrero nl than mating address) <br /> ANTONINI ENTERPRISES LLC-LATHROP <br /> P.O. BOX 8468 <br /> STOCKTON CA 95208 701 D'ARCY PKWY <br /> Generators Phone: 209 993-8695 LATHROP CA 95330 <br /> S.Transporter t Company Name U,S,EPA 10 Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Tmnsportar 2 Company Name U.S.EPAID Number <br /> Qt�.L FSE Uri �. S STEMS' 0 G l9Is LfZ2- <br /> 8.Do signaled raciiiry Name and SILO Ad'ultls3 U.S.EPA ID Number <br /> YUMA YES, LLC <br /> 2730 E 13TH ST <br /> YUMAAZ 85365 <br /> AZR000515924 <br /> Facility's Phone: (928)344-9828 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group Of any)) No. Type Quantity Wl,Nol. <br /> NON-RCRA HAZARDOUS WASTE SOLID(PAPER FILTERS) you 352 <br /> DM P <br /> z 2. <br /> w <br /> (D <br /> a. <br /> ,4. <br /> 14.Special Handling Inftclions and Additional Information c <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS *PROFILE#961:1 2623ANT608 PAPER <br /> FILTERS * *APPROPRIATE PPE EQUIPMENT j�_ �.n/� `-- <br /> 15. GENERATORWOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully yaand daaccurately described above by the proper shipping name,and are classified,pa ad, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable Inlemallonatand 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 EPA Acknowledgment of Consent, <br /> I cerfdy that the waste minMze6on statement Identified In 40 CFR 262.27(a)(if I am a large quanli4 generator)or(h)(if l am a Wait qua,pp generetoo Is coo. <br /> G neralaesMffaroj Printedlfyped Name Sfgntit Day Year <br /> • r a '-f -I <br /> -j 16.Inlemallonal Shipmen <br /> ❑Import to U.S. El Export from U.S. Port of entrylexil: <br /> Transporter signature(for exports only): Date leaving U,S,: <br /> W 17.TransponerAcknowledgmenl of Receipt of Materials <br /> OTraMsllntodayp d Name r f � Signature Month Day r <br /> IL <br /> z Transporter 2 Printadr Name 1 Signature Month Day Year <br /> D61P5;1r--L 03 1 z9 r OY <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Resldue ❑Partial Rejection ❑Fug Rejedon <br /> Manifest Reference Number: <br /> 16b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U s <br /> tea Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU1, LA2. 3. 4. <br /> 20.Designated Facility 0 er or Operator:Certification of receipt of hazardous materials covered by the manifest except a oted in Item 188 <br /> PdnledlTypedName Signature Month Day eel, <br /> r-aa F.,r n7nn.97 rRav,nr,1 R avlrnrs wfli nna era nhgnlAte. n�crr_n TFn Gerl rn nFSTIKIATInN STATE(IF REDUIREDW <br />