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Please print or ly.pe. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManNsetTracidng Humber <br /> WASTE MANIFEST CAL 0 0 0 3 8 5 7 0 3 1 (800)424-9300 020383339 JJ K <br /> S.Generators Name and Ma'A nitches Generetots StteAddress(d dtffomnl than malEnhg addmss) <br /> ANTONINI ENTERPRISES LLC-LATHROP <br /> P.O. BOX 8468 <br /> STOCKTON CA 95208 701 IYARCY PKWY <br /> GsnersWsF hrxw. 209 9938695 LATHROP CA 95330 <br /> 6.Transporter t Company Name U.S.EPAID Numbor <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 0 g:-OV- V=F=Cg4gfM SU11VAS O q0t—tS y22 <br /> 8.Dosignalnd Feeft Name and Stte Addms9 ! U.S.EPA ID Number <br /> YUMA YES,LLC <br /> 2730 E 13TH ST <br /> YUM <br /> AAZ 85365 <br /> F es Phone: AZR000515924 <br /> 9a 9b.U.S.DOT Dew"' @hdhrdbhg Proper Shlpphhg Name,Hazard Class,ID Number, 10.Contalnera 11.Total 12.Unit 13.Waste Codes <br /> HM and Pa Nng Group(ffarry)) No. Type Quentty WUVd. <br /> 0 "NON-RCRA HAZARDOUS WASTE SOLID(PAPER FILTERS) 352 <br /> Z DM P <br /> 2. <br /> 0 <br /> 3. <br /> 4- <br /> 14.Special Handang Instructions and Additonal tnfonrtratcrh (�o 641 Co r2EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#981:171*PROFILE#961: <br /> 162823ANTWS PAPER FILTERS* *APPROPRIATE PPE EQUIPMENT <br /> Z '1�SS <br /> 16. OENERATOIpWFEROR'S CERTIFICATION:I hereby dedme that the contents of thio consigement are fatly and accurately described above by the proper ethippbh9 name,aid are rlw*W,patkagad, <br /> marked and Iahaladlplacarded,and sre In ail respects In proper com7don for transport ao rftg to app!wb!o hbmallonal and national governmental rog&&ons.If export shipment and I am the Primary <br /> Exporter I oertlly that 11►0 oontsnts o<tMs oonslgnnteltl oonfarnrm to the terms of the attached EPAAdmoWedg:mnt of Consent <br /> I cedgy that the waste noun statementIdentified In 40 CFR 26227(a)(ffI am a large quantity generator)or(b)ml am a sm4 quantity generator)Is . <br /> 7107s PrInta f 0ed N2: <br /> Month Day Year <br /> �]b <br /> 16.International <br /> Import to U.S. ❑Export from U.S. Port of !e <br /> Transporter signature(for exports only): Datejpaving U.S.: <br /> 17,TmrtspontonAdnn4adgmmi of Reosipt of Materials <br /> Trans n ams Slgnabrre Month Day Year <br /> N Transporter 2 P4nWFW kA SlgnaYura worith flay You <br /> 11011, � - log It 'q <br /> 18.Discrepancy <br /> 18a Discrepancy Indication Space ❑ Qrrentfly ❑Type ❑Residue ❑Portal R*dlan ❑Ful Rejection <br /> Manliest R&mrrce Number. <br /> 166,AReawta Fud ty(or Generator) U.S.EPA ID Number <br /> V <br /> U. Fadlityo Phone: <br /> a 18c.Signature of Altemate FooQlty(or Generate) in Day Year <br /> X <br /> 19.Hazardous Waste Report Management Method Codes p.e„codes fe Ihozartbn waste treatment,disposal,MW necycerQ systems) <br /> C 1. 2. 3. 4. <br /> 20.Dasfgnotad Fadtlty Owner Or Opastor Cefflca0on of roaelpt ofhamrdous materiels covered by the montestOxcepl as nded In Item 18a <br /> ft Homo Ignaft w Day Year <br /> L yitjfj ( -A )Onk I — i 1i <br /> EPA Form 8700.2.2(Rev. 2-M Previous edleons v otete. ifIDNESIG�Y- EDFACILITY TO EPRS B-MA IFES SY5 it <br />