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W Ile a tint orlp Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZAPDOUS 1.Generator ID Number 2.Page i Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFESTO CAD 9 8 0 7 3 7 2 2 5 • 1 (800)424-9300 0 236 3 8 2 4 6•JJ K• <br /> 5.Generator's Name and Mailin Address Generator's Site Address(it different than mailing address) <br /> STOCKTON SCAVENGERS ASSOCIATION <br /> 1240 NAVY DR <br /> STOCKTON Ah CA 95206 <br /> Generator's Phone:* •209 460'3912 <br /> 6.Transporter 1 Com any Name U.S.EPA ID Number <br /> • WORLD�IL ENVIRONMENTAL SERVICES •CAD 0 2 8 2 7 7 0 3 60 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> • WORLDWIDE RECOVERY SYSTEM IN • •CAR 0 0 01 7 5 4 2 2• <br /> 8.Desi nated Facility Name and Site Address U.S.EPA I� <br /> IYUMAMANAGEMENT.ING. <br /> 5US HIGHWAY 95 <br /> Facility's Phone: (928)39828M40ff&M= 0 1,A Z R 0 0 0 5 2 114 <br /> 44- <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total12.Unit <br /> and Packing Group(if any)) • s, ' <br /> HM No. Type Quantity Wt.Nol. 013.Waste Code <br /> 1.NON-RCRA HAZARDOUS WASTE,SOLID(OILY ABSORBENTS) _ • • 352 • 1=11`• <br /> 0 <br /> aa, DM P <br /> z 2. <br /> UJI <br /> •3 <br /> rw <br /> e --- <br /> r 1 10 Ilimi, im <br /> 4 • r nr"' r <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 14800-424.9300 WOES TERMINAL:CERE" <br /> 1: * ROFILE�9B1- <br /> 162623NRSST0621 OILY ABSORBENTS * *APPROPRIATE PPE EQUIPMENT _ r • <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: Thereby declare that the contents of this consignment are fully and accurately described above 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 international and national govemrn§ntal 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 EPA Acknowledgment of Consent. • • <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signature • Month Day Year <br /> 16tematio hi n <br /> t.J. El rt to U.S* • Export from U.S.• Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Tra r 1 PrintedlT ped Name • Signat� • • Month Day Year <br /> Ce <br /> a b o7 2 <br /> Z orter 2 Pn d/Typed Name /Signa e y• Month Day Year <br /> 18a.Discrep ndication Space ❑ quantity _ El Type �Mi ❑Residu� ❑Partial Re1ectio�❑Full Rejection <br /> Manifest Reference Number. <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: • • — <br /> Ll 18c.Signature of Alternate Facility(or Generator) Month :y Yr <br /> Q - <br /> Z <br /> w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdntedlTyped Name Signature Mon Day Year <br /> U <br /> IILPA Form 8700-22(Re�) rr vious,editions are obsolete. D SIG T FFAACrLITY TO EPA's e•MANIFEST SYSTEM <br />