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Please print or pe.(Form designed for use an elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> Ai FORM HAZARDOUS 1.Generator ID Number" 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST l%4 g 1 a-m-255-111m B03454489 G B F <br /> e�era=Name and Mailini Ad Ire m Generator's Site Address(if different than mailing address) <br /> Generator's Pho o6i—t4la <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 9 <br /> 7.Transporter 2 Company Name U.S.EPAl um er <br /> • 4 <br /> WOLDWIDE RECOVERY SYSTMO CAR000175422 <br /> 8.Designated Facility Name and Site Address �y�� U.S.EPA ID Number <br /> YUKA YES LLC , <br /> (925) 2,730 E 13"" ST <br /> Facility's Phone: 64229939 , YUWUL, AZ 95365 AM000515924 <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(if any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> o NON RCRA HAZARWUS WASTE <br /> DM ZU U P l <br /> W <br />} 3. <br />` 1�• '• .I::. i .fit <br /> 4 . <br /> 14.Special.Handling Instructions and Addifional Information ► { <br /> r <br /> c'zc 0). (3 <br /> 8 RL <br /> 15. GENE TUTS1 T1Pf0 0 :`Tfiereby ec"fare of t ie con en o tis wnsignmen`t are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and 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 EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a Prge quantity generator)or(b)(if I am a small qua 'ty generator)is true. a <br /> Gen tor'sl0fferor s P'ntedfTyped Name C ignature Month Day Year, r , <br /> 1 � Y ` L } <br /> 1 <br /> j 16.lntemationa ipments <br /> W ❑Importto U.S. 1:1 Export 4U.S. TDte <br /> entry/ r' <br /> Z Transporter signature(for exports only): aving .S.:,, <br /> LU 17.Transporter Acknowledgment of Receipt of Materials ' <br /> DZG&TraWrIterPrintedrryped Name Signature Month Day YearQ P'ntedlTyp Name Signature _M0A Day. Year <br />)' 18.Discrepancy <br /> .000 <br /> I <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partici!Rejection El Full Rejection <br /> f •• 1 <br /> Manifest'Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Z <br /> V <br /> Facility's Phone: <br /> Ll 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedrryped Name Signature Month Day Year <br /> l <br />- EPA Form 8700-22(Rev.3-05) Previous edi#ions are obsolete. t <br /> . 130,12,9RO <br /> NATED FACILITYTO GENERATOR STATE (IF RE"RED) <br />