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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.M nlfe 1 Tac Ing Number WASTE MANIFEST 1 (800)424-9300 T 531274 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) -a ANi1 M TRACH t_1iEVR,UGET °' pu Aw t7 p fl Generatcr's Phone: Oct,) 5— J 0 0 6.Transporter 1 Company Name U.S.EPA ID Number bVORLD OIL ENVIRONMENTAL SERVICES ICAD028277036 7.Transporter 2 Company Name U.S.EPA ID Number G410EL- Gv IDC--- vat tS 8.Designated Facility Name and Site Address U.S.EPA ID Number YES MANAGEMENT, INC. 6600 US HIGHWAY 95 YUMA CA 85365 Facility's Phone: (928)344-9828 JAZR000521146 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group Of any)) No. Type Quantity WiVol. 0 1NON RCRA HAZARDOUS WASTE.SOLIQ(OILY SOLID, PAPER FILTERS) DM P 52 V z 2. L c� 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT :CHEMTREC 1-800-424-9300 WOES TERMINAL *PROFILE#9B1 : OS-PF CERES *ADDITIONAL EPA CODES:9B1: , NONE *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 15. GENERATOR'S/OFFEROR'S CERTIFICATION; I hereby declare that the contents Is consignment are fully and accurately describedaboveby the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for tran:ama ac ing to ap Iicable International and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of thached E ckn ant of Consent. certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I large quantity for b)(if I am a small quantity generator)Is true. Generator's/Offeror's Printedfryped Name Signa Month Day Year ,J16.International Shipments t= ❑Import to U.S. ❑Export from U.S. Po f entry it: Z Transporter signature(for exports only): Data tea" U.S.. IX 17.Transporter Acknowledgment of Receipt of Materials ~2 Transporter 1 Pdntedfryped Name Signature Month Day Year N tM�'c�a _I b to —t / US -S ) I1 za Trans er 2 Printe ad Name Signa Month Day Year , � 7 Vfve '�G�4�Jd �2 -- C1_1p 71 18.Discrepancy 18a, iscrepancy Indicatyn Sppce � QJr dA..Auant' AAa T e Residue I� � Partial Rejection Full Re'ecti n V x'1 Its �- 0-- V )AN6-e r C; 0 1 I Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V W Facilitys Phone: W 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 2• 3. 4. 20.Designated Facility Owner or Operatoc.Certifcation of receipt of hazardous materials covered by the manifest except as noted In Item Printe3 yped Name Signature Month Day Year EPA Farm 87 0-22(Rev.3-OS) Previous editions are obsolete. O� DESIG ATED FACILITY TO DESTINATION STATE (IF RE UIRE )