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Please prini or type. Form proved.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 i (800)4249300 0 2 0 3 8 0 8 5 8 JJ K <br /> 5.Generatoes Name and Maging Address Generstoes Site Address(if different than mailing address) <br /> ANTONINI ENTERPRISES LLC-LATHROP <br /> P.O. BOX 8468 <br /> STOCKTON CA 95208 701 D'ARCY PKWY <br /> Generator's Phone: 209 993-8695 LATHROP CA 95^^0 <br /> 6.Transponor 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA1D Number <br /> �1lle )wtD -ctrl+ v �7>VN.� r c GkIZC-00175 ��- <br /> 8.Designated Fedlfty Name and SRO Address U.S.EPAID Number <br /> YUMA YES. LLC <br /> 2730 E 13TH ST <br /> YUMA AZ 85365 AZR000515924� <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(brdu ft Proper Slopfng Name,Hazard CLW%ID Number, 10.Contalners 11.Total 12.Unit <br /> HM and PackIng Grmp(K any)) 13.Waste Codes <br /> No. Type Quantity yh fyd, <br /> 11VON-RCRA HAZARDOUS WASTE SOLID(PAPER FILTERS) 352 <br /> D M I Zb P <br /> z 2. <br /> w <br /> 0 <br /> 3. <br /> 4. 1 -T F <br /> 114.Special Handling insbudions and Addidonai information e-Te-0 J d <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#961:171 *PROFILE#9131: <br /> 162623ANT608 PAPER FILTERS * *APPROPRIATE PPE EQUIPMENT 11t,lbZg /X 5-,1- <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:t hereby declare Wfhe contents of this consignment are fufiy and accurately descr bbd above by the proper shlpp?ng narno,and aro dussiflod,packaged, <br /> marked and labeled1p carded,and are Ind respects in pmpercondkton for transport according to apptleable Irdemationaiand national govemmental regulatma.if oxpwt sh!pmeat and I am Iho Primary <br /> Exporter,I certify that the contents of this consignment conform to the berms of the attached EPAAcMuMedgmont of Consent. <br /> I te"that 0te mHmirntlon statement Identified In 40 CFR 2&2.27(x)Of em a largo quantlly generator}or{b)(ifl am a am afi gumnfl m>Pra!or)Is tine. <br /> n IcrslOHe P dfTypadName �+ 5fgn4lum Month Day Year <br /> Y <br /> G <br /> J 1 ❑Import to U.S. ❑Export from U.S. Port of entrylexih <br /> Transporter signature(for exports 0*): Date leaving U.S.: <br /> cc w 17.Transporter AckrPNIedgmerd of Receipt of Materials <br /> Tramsr ntedlTypod arra StInaftim moaUr Day Year <br /> Q <br /> 0 <br /> Transporlaf 2 FWedlTyi� 5!gnature WnN Day Year <br /> 0Z 7z-Ze� <br /> nG � <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quentky [:]Type ❑ResWue ❑Partial R*edm ❑FW Re)eclbn <br /> Maaltest Reference Number. <br /> 10.htamato Facility(or Generator) 11S,EPA ID Numbor <br /> J_ <br /> 0 <br /> I Facir.ys Phone: <br /> W 18c.Signature of AlWmate FK0aty(o Geaorolor) Menih Day Yem <br /> a <br /> z <br /> 29 19.Hazardous Waste Report Management Method Codes p.o.,codes for hazardous waste treatment,disposal,and recycling sys as) <br /> G 1. 2. 3. 4. <br /> 20.Designated Fadgty Owner or Operator.Certification of receipt of hemrdmrs materials covered by the manifest except as nded in Item 18a <br /> PrfntedlTypedNemo Signature Month Day Year <br /> urs 0 <br /> EPA Form 8700.22(Rev.1:117) Previous edlilons area soiete. D SE E AC1LlTY TO EPA's e-MANIFEST SYSTEM <br />