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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone Manifest Trac""Number WASTE <br /> WASTE MANIFEST A(��t�)� 0V ?"!l> 1 (300)424-9300 4. 018531260 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 1 i ALAT a 9'LA v�►� Y�� X530 <br /> Generator's Phohe: �. t �1 clil a' ►C fl <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES JCAD028277036 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> YES MANAGEMENT, INC. <br /> 6500 US HIGHWAY 95 <br /> YUMA CA 85365 <br /> Facility's Phone: (928)344-9828 A Z R 0 0 0 5 2114 6 <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 Wtivol. <br /> CC 1NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID, PAPER FILTERS) DM , P 352 <br /> z 2. <br /> w <br /> 3. <br /> 4. L. . ..... <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT :CHEMTREC 1-800-424-9300 WOES TERMINAL *PROFILE#961:OS-PF CERES *ADDITIONAL EPA <br /> CODES:9B1: , NONE *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 9- a 0i), <br /> i,, ! <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are�andcurately described above b the proper shipping name,and are classed,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicabconal government. ulations.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 EPAAcknowlednsent.I certify that the waste minimiz tion statement identified In 40 CFR 262.27(a)(if I am a large quantity aI am a small quantity gen or)is true. <br /> Nam Signature <br /> Generators/Offer a yp Month Day Year <br /> f <br /> C i 7 o1 t <br /> 16.International Shipments <br /> F- El import to U.S. Export from U.S Pori of entrylexit: <br /> M Transporter signature(for exports only): Date leaving U.S.: <br /> = 17.TransporterAcknowledgment of Receiptof M.!P616 <br /> a Transporter 1 Printed/Typed Name Signature Month Day Year <br /> N t c c> ate t 11/ %`1 0 r 1 <br /> Z orter 2 entedrryped Name Sig ure Month Day Year' <br /> F <br /> 18.Discrepancy <br /> 18a.Discrep cy Indication Space ❑ Quantity <br /> ❑Type Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number. <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> ti19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 20.Designated FacilE Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Namil Signature Month Day Year <br /> c <br /> EPA Form 8700-22(Rev.345 Pre-,A edi Ions are obsolete. DB,;it MKfk )FAQ°il_ i'Y-0 li)FS 9 INATiO i S'f T is (€s- <br />